What tests you need before trying to get pregnant

There are quite a few tests and procedures you need before trying to get pregnant. Here's a rundown of what to expect at your pre-conception doctor's appointment.

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For something so simple—a sperm meets an egg and, nine months later, a baby is born—there can be an awful lot of tests and procedures, even before trying to get pregnant. While the checkups and screenings for immunity can be overwhelming, it’s important to remember that they’re all there to make sure you and your baby will be as healthy as possible.

Pre-pregnancy checkup
Before you ditch the birth control, it’s important to book a checkup with your doctor. You should be prepared to talk about your family medical history and that of your partner, as well as your medical history, medications you’re currently taking and your lifestyle. This can help your doctor assess which tests may be needed.

A healthy lifestyle, including diet and exercise, is especially important during pregnancy, says Christina Sun, an OB/GYN at Lakeridge Health, a community hospital in Oshawa, Ont. If you’re overweight, your doctor may recommend making changes to your diet and getting more exercise, as even losing a small amount of weight can have a positive effect on your fertility and help you stay healthy throughout your pregnancy. Ultimately, having healthy eating habits and being physically active matters more than the actual number on the scale. Sun also encourages her patients to stop drinking alcohol, taking recreational drugs, and smoking before trying to get pregnant.

Your doctor might also do basic blood and urine tests for various sexually transmitted infections and review your immunization record and test for certain immunities.

Prenatal vaccinations
Your immune function is somewhat lower during pregnancy, making expectant moms more susceptible to infections and complications. Vaccinations can go a long way to preventing or reducing the severity of illnesses that can make you sick or harm your baby during pregnancy.

The flu shot is always recommended for women who are pregnant during flu season, so it’s a good idea to get it if you’re trying to conceive to protect you in those early weeks when you may not know that you’re pregnant yet. (The flu shot is also safe for pregnant women.)

Live vaccines like varicella (chicken pox) and rubella (German measles) are out of the question during pregnancy, so it’s recommended that you get tested for immunity and, if necessary, get vaccinated before trying to get pregnant. It’s important to keep in mind that you’ll need to wait at least a month after a live vaccination before trying to get pregnant, notes Sun.

Chicken pox may not seem like a big deal, but pregnant women have an increased risk of developing pneumonia as a complication. If a pregnant woman gets chicken pox between eight and 20 weeks gestation, the baby will have a slight risk of developing congenital varicella syndrome, which can cause skin scarring, underdeveloped arms and legs, eye inflammation and problems with brain development.

Rubella can have more serious consequences: There’s an increased risk of miscarriage, stillbirth and premature birth and, if rubella is passed on to the fetus, there is a small risk that the baby could be born with a range of problems, including vision and hearing issues, heart damage, microcephaly and liver and spleen damage.

So what do you do if you find out that you’re not immune to rubella or varicella during your pregnancy? “We advise that women avoid children or patients with rubella until they give birth,” says Sun, adding that Mom can be vaccinated after delivery.

Sexually transmitted infections
There are a number of sexually transmitted infections (STIs) that can lead to infertility or affect your health or your baby’s health during pregnancy, notes Sun, so if you are at high risk, you might be tested for STIs before trying to get pregnant and again early on in pregnancy.

Both chlamydia and gonorrhea often go undiagnosed because many people who have these STIs don’t have any symptoms. Both infections can damage the Fallopian tubes and lead to pelvic inflammatory disease, which can cause infertility. These STIs can also affect your pregnancy and your baby. Chlamydia can cause premature delivery and, if the infection passes to your baby during birth, your newborn could develop an eye infection or pneumonia. Gonorrhea can lead to miscarriage, premature rupture of membranes and premature birth and, if it passes to your newborn during delivery, can lead to eye, joint or life-threatening blood infections in your baby. While chlamydia and gonorrhea can be cured with antibiotics, treatment can’t undo any damage that’s already been done.

Syphilis can also have serious health effects during your pregnancy. If diagnosed after 20 weeks, there’s an increased risk of preterm labour and fetal distress, and babies born with syphilis may develop serious health problems, such as brain damage and hearing and vision loss. But if you receive treatment before 20 weeks, there’s a good chance that the infection won’t be passed on to your baby. As with chlamydia and gonorrhea, syphilis can be treated with antibiotics.

Similarly, HIV can be passed along to your baby, though the transmission can occur during any stage of pregnancy, labour and delivery, as well as during breastfeeding. Early diagnosis and treatment can help reduce the risk of mother-to-baby transmission. Combined with treatment of the baby during the first four to six weeks of life, the risk is as low as one percent.

Lastly, you may be tested for hepatitis B before trying to get pregnant, as it can also be passed on to your baby during delivery. Babies who are infected at birth can develop chronic hepatitis B infection, which can cause lifelong health problems, but this can be prevented if the baby is treated with a series of vaccinations and a hepatitis B immune globulin shot at birth. If you haven’t been vaccinated for hepatitis B, talk to your doctor about getting the shot—you can safely get it at any point before or during your pregnancy.

Genetic screening
Your age, family history and ethnic background can factor into the risk of your child being born with genetic conditions, some of which can severely reduce the quality and length of a child’s life.

Some genetic conditions are more common in certain populations. For example, blood disorders like thalassemia and hemoglobinopathy are more prevalent among people of African, Mediterranean and Asian decent. Cystic fibrosis is most common among Caucasian people. People of Ashkenazi Jewish descent are more likely to be carriers of Tay-Sachs disease, Canavan disease and a number of other conditions that are fatal or severely reduce a child’s quality of life.

While genetic screening for certain conditions may be recommended by your doctor after you get pregnant, there are now tests available that determine if you’re a carrier of—but not affected by—some autosomal recessive conditions. If both parents are carriers of an autosomal recessive gene mutation, there’s a 25 percent chance that their child will be born with the condition (it’s important to note this means that there’s a 75 percent chance that a child won’t be affected). For example, the Counsyl Family Prep Screen 2.0 tests for 105 genetic conditions, including 80 that can affect life expectancy or quality of life (such as cystic fibrosis and Tay-Sachs disease), many for which there are no cures or standard treatments (like Canavan disease) and many of which can be treated with early intervention (like Biotinidase deficiency or MCADD).

The test is costly. (For instance, Counsyl runs $995 for the full sequencing of one parent, plus $795 to test the other parent if necessary. Look into your insurance plan to see if it covers this type of testing.) It does, however, give couples options when they think about family planning, says David Chitayat, a genetics physician at The Hospital for Sick Children in Toronto. “We’re talking about primary prevention, and that means trying to avoid a condition from happening in the first place,” he explains. A couple could choose to use a sperm or egg donor (from someone who isn’t a carrier) to eliminate the risk. Or they might turn to pre-implantation genetic diagnosis, where they go through in vitro fertilization for pregnancy, check each fertilized egg for the condition and only implant unaffected embryos. Or they could get pregnant and determine if the fetus is affected through amniocentesis (if you’re interested in the test, talk to your doctor).

When you’re planning to have a baby, the questions and what-ifs can feel overwhelming at times, but your doctor can help you find answers and address concerns.

Read more:
25 things to talk about before getting pregnant
Everything you need to know about ovulation
What is the best sex position for getting pregnant?

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