You Asked: What do I need to know before getting pregnant?

When couples are planning to have children, they often think about where they will live, what their work arrangements will be or what pet names the grandparents will go by, but planning for a successful pregnancy should involve a health check as well—and it should start well before conception occurs. “The pregnancy journey is not the nine months of pregnancy alone,” said Robin Page, PhD, RN, CNM, midwife and assistant professor at the Texas A&M College of Nursing. “It often starts a year prior.”

One year before conception

Each year, women should visit their health care provider—often a gynecologist—for a wellness exam. During this exam, let your health care provider know if you believe you and your partner may or will want to begin trying to conceive within the next year. “This will allow for time to address health issues or make medication adjustments so that there is minimal interference to your health when it comes time to become pregnant,” Page said.

The conversation at this stage should not be limited to the health of the eventual mother but also the eventual father, and there are numerous matters to begin addressing at this stage of child planning.

Sexually transmitted infections (STIs)

Both men and women need to be tested for STIs prior to any intercourse and especially when planning to have children. There needs to be ample amount of time for medications to rid the body of any infection prior to conceiving, as prescription medications can be teratogenic, or toxic to a fetus during development. Also, some STIs such as chlamydia and genital herpes can infect the baby during delivery, which could impact the delivery plan.

Birth control

Your health care provider will also be able to discuss the best timeline for getting you off of contraceptives, which drastically varies based upon your preferred method of birth control, whether it be an implant, intrauterine device, injection or pill. “Hormonal contraceptives suppress the menstruation differently, ranging from no cycle to regular cycles, and that cycle pattern is what determines how long it will take a woman to become fertile after discontinuing birth control,” Page said.

Oral health

Oral health affects the health of much of the body, and when women become pregnant they are often prone to gingivitis—initially, a mild form of gum disease—and enamel erosion from morning sickness. “Taking care of any cavities or other dental issues ahead of conception is a good idea,” Page said. “Starting off a pregnancy with good oral health can make it easier to manage any oral health concerns that could potentially occur during pregnancy.” Some dentists do not want to take on the liability of treating a pregnant woman, so find a dentist who is willing to make an oral health care plan for the duration of your pregnancy.

Vaccines

It is important to discuss with your health care provider how up to date you are on your adult vaccinations. Vaccines do not cause autism—in you or in your baby—and some vaccines women received as children could require a booster for full protection. Prior to conceiving, women need to be tested to see if a measles-mumps-rubella (MMR) vaccine or hepatitis B vaccine is necessary.

Women should get and maintain their influenza, or flu, vaccines before and throughout their pregnancy. The injected form of the vaccine is made from a “dead virus,” meaning the virus cannot replicate or give you the disease, but your body still learns how to react so that it may respond accordingly if exposed to the live virus in the future.

Diabetes

It is important to know whether you have diabetes and, if you do, to get it under control. “If a woman is diabetic before pregnancy, she should work with her health care provider to adequately control her blood sugar before conceiving,” Page said. Uncontrollable spikes and dips in blood sugar could be very harmful to a fetus.

Weight

Weight loss and maintaining a sustainable weight is not something achieved overnight and could take several months. Having a normal body mass index – not too high, not too low – can help regulate the menstrual cycle, which is key to getting pregnant.

Smoking

Smoking is a notoriously tough habit to break, and both partners are better off breaking that habit before becoming parents. “Mothers should not smoke while pregnant nor around their child,” Page said, “and fathers should not expose the mother or child to second-hand smoke during or after pregnancy either.” Smoke exposure is associated with higher risk of sudden infant death syndrome.

Genetic testing

More couples are opting to do genetic testing before trying to conceive. Often couples may not be aware that they are carriers of particular genes that can cause disease, and these tests can help them evaluate the odds that their child could be born with certain conditions. “For example, a child can develop cystic fibrosis if both parents are carriers of the gene, which is recessive,” Page said, “Because it is a recessive gene, prior to a genetic test, neither parent may have been aware that they were carriers.”

Six months before conception

Prenatal vitamins

Six months prior to conceiving, begin taking prenatal vitamins, which can be found at local drug stores and provide at least 400 micrograms of folic acid. “The main reason for this is that folic acid levels need to be sufficient early in the pregnancy when the neutral tube of the fetus is being formed,” Page said. Folic acid has been shown to decrease the baby’s risk for neural tube defects by 70 percent.

Two Texas A&M College of Medicine researchers also believe that a carnitine supplement may help reduce the risk of autism. Carnitine deficiencies have been found to affect fetal brain development.

Medication use

During this time, it is also important to make your health care provider aware of all medications, whether prescription or over-the-counter, that you are taking in order to evaluate their potential effects on a pregnancy.

Three months before conception

Birth control

The most common form of female birth control is the pill. “Generally, it takes three months of being without contraceptive pills for the body to recalibrate its menstrual cycle,” Page said. “However, for some women, it could only take one month for partners to conceive.”

Caffeine and alcohol

Because you could become pregnant very soon after stopping your birth control, it is important to completely avoid alcohol and significantly limit caffeine intake as it can impair fertility or may increase the risk of a spontaneous miscarriage. Furthermore, when a fetus is exposed to these drugs—and yes, alcohol and caffeine are drugs—life-long harm can result.

Tracking ovulation

At this point, begin tracking your menstrual cycle. There are numerous phone applications and calendars to help you determine when you will be ovulating. This information will be helpful when you and your partner start trying to have a baby.

Time to conceive

Healthy, informed soon-to-be parents are now ready to get pregnant. With the help of ovulation predictor kits, which are similar in concept to pregnancy tests, and natural body indicators, such as increased body temperature or discharge of cervical mucus to help facilitate the transport of sperm in the reproductive tract, a couple can determine the ovulation window. “During this 4– to 5–day window, the couple should have intercourse every other day to account for a refractory period to achieve an ample sperm count,” Page said. 

It is difficult to predict how easy it will be for a woman and her partner to conceive. Age is often the biggest factor, especially for women over the age of 35. However, if there is still no luck after six months of unprotected sex, you and your partner should visit with your health care provider to discuss the next steps.

“Building a family is an exciting time in a couple’s life, but it can also be overwhelming,” Page said. “Working with your and your partner’s health care providers to better understand your health and address your questions can offer some peace of mind and potentially make the process run a little smoother.”