Preconception: Thinking of getting pregnant?

If you’re thinking of having a child, here are some things to think about in order to improve your health and that of your future baby. While much research is still needed to better understand the complex impact that a mother’s health and her environment have on the fetus, we do already know some basic principles.

Folic acid and other vitamins Certain surveys show that many women of childbearing age are not getting enough vitamin A, C, B6 and E, nor enough folic acid, calcium, iron, zinc and magnesium. Folic acid in particular has been getting a lot of attention ever since it was established that a folic acid deficiency, especially early in the pregnancy, is associated with a risk of birth defects, including malformations in the neural tube (which later becomes the brain and spine).

Folic acid, which is also called folate or vitamin B9, is necessary when cells are developing and multiplying rapidly. It can be found in certain foods, especially leafy green vegetables, citrus fruits and whole grains, as well as in vitamin supplements. Since 1998, enriched white flour, pasta and cornmeal have been enriched with folic acid in Canada, coinciding with a drop in the incidence of neural tube defects in the country.

It can be challenging to consume the recommended amount of folic acid each day, which is why it is recommended that a folic acid supplement be taken (alone or in a multivitamin formulated for pregnant women). Since folic acid is crucial to the early development of the fetus, women should start taking a supplement before conception and keep taking it until they begin breastfeeding. It is best to speak to a healthcare professional when choosing the most appropriate product, because the ideal dose of folic acid can vary based on the way the woman eats and the different risks associated with her potential pregnancy.

Excess weight and diabetes The risk of birth defects is higher when the mother is obese or diabetic, and the risk is even greater when both factors are present. The risk of birth defects is estimated to be around 2 to 3 percent in the general population, but can be as high as 12 percent among diabetic women. The risk is associated with glycemic control during the first trimester, as is the risk of miscarriage. Overweight women are also more likely to suffer from infertility. Weight loss, regular physical activity and adjusting the diabetic drug therapy before conception can have a positive impact on the pregnancy.

In addition, certain pregnant women are at risk for gestational diabetes. These women have a greater risk of giving birth to a baby that is larger than average, which can cause obstetrical complications. After giving birth, they are also more likely to develop type 2 diabetes. Maintaining a healthy weight through exercise and a balanced diet helps reduce the risk of gestational diabetes.

Keeping vaccinations up-to-date All women of childbearing age should make sure to update their vaccinations, since some require a booster during adolescence in order to reduce the risk of infection during pregnancy. Some infections, such as chickenpox, are known to lead to complications when contracted during pregnancy.

Smoking cessation Other than the increased risk of developing and dying from cardiovascular disease and certain types of cancer, smoking mothers’ babies are at greater risk for miscarriage, fetal death and failure to thrive. So when it comes to smoking, quitting as early as possible before conception is best for both the mother and her future baby. There are many smoking cessation aids on the market, but they aren’t all appropriate for pregnant women.

Alcohol and drugs Prenatal exposure to alcohol is associated with an increased risk of miscarriage, failure to thrive and fetal alcohol syndrome. And yet, many women continue to drink early in their pregnancy, before they realize they’re pregnant, and this is when the harmful effects of alcohol are most likely to occur. There is no so-called “safe” level of exposure to alcohol. A woman who is trying to get pregnant should therefore avoid drinking any alcohol until a pregnancy test confirms whether she is pregnant or not.

Physical activity Regular physical activity is known to reduce the risk of hypertension and also of dying from heart disease, breast cancer, colon cancer and diabetes. Exercise also helps you maintain a healthy weight and keep your bones, muscles and joints in good condition, while also having a positive impact on symptoms of anxiety and depression. You can reap these benefits by moving moderately from 30 to 60 minutes every day.

For all these reasons, women should be physically active and maintain this activity throughout their pregnancy, unless otherwise indicated by their physician.

What about chronic diseases? In many cases, an uncontrolled disease is more harmful to a pregnancy than the medication used to treat it. Nowadays, more and more women who wish to have a child suffer from a chronic illness (e.g. asthma or hypertension). These women should speak to their physician about their plans to become pregnant, to make sure their condition is properly controlled and that their treatment does not have any adverse effects on their baby.

Psychiatric disorders and pregnancy Many women’s pregnancy is complicated by the onset or recurrence of a psychiatric disorder. If left uncontrolled, depression and anxiety disorders can have a negative impact on the mother, the baby and family relations. Depression has been associated with an increased risk of premature birth, underweight babies and post-partum depression.

It is therefore best to speak to your physician and pharmacist as early as possible, and to surround yourself with people you can trust (family, friends) to support you if the need arises.

For a healthy pregnancy Any woman who wants to have a child should pay attention to her lifestyle and, where applicable, make sure that her health problems are under control. It is also important for her to take a folic acid supplement every day, ideally even before she becomes pregnant.