Baby Makes Three. Are you Ready?

One of the most important steps in helping you prepare for a healthy pregnancy is a pre-pregnancy examination (often called preconception care) performed by your health care provider before you become pregnant. This examination may include any or all of the following:

• Family medical history--An assessment of the maternal and paternal medical history to determine if any family member has had any medical conditions such as high blood pressure, diabetes, and/or birth defects.
• Genetic testing--An assessment of any possible genetic disorders as several genetic disorders may be inherited, such as sickle cell anemia or Tay-Sachs disease. Some genetic disorders can be detected by blood tests before pregnancy.
• Personal medical history--An assessment of the your medical history to determine if there are any of the following:
• Medical conditions that may require special care during pregnancy, such as epilepsy, diabetes, high blood pressure, anemia, and/or allergies
• Previous surgeries
• Past pregnancies
• Vaccination status--An assessment of current vaccinations to assess your immunity to rubella (German measles) since contracting this disease during pregnancy can cause miscarriage or birth defects. If you are not immune, a vaccine may be given at least three months before conception to provide immunity.

Additional steps that can help reduce the risk of complications and help prepare for a healthy pregnancy and delivery include the following:

• Proper weight and exercise
  It is important to exercise regularly and maintain a proper weight before and during pregnancy. Women who are overweight may experience medical problems such as high blood pressure and diabetes. Women who are underweight may have babies with low birth weight.
• Smoking cessation
  If you are a smoker, stop smoking now. Studies have shown babies born to mothers who smoke tend to be born prematurely, be lower in birth weight and are more likely to die of sudden infant death syndrome (SIDS). In addition, women with exposure to secondhand smoke are more likely to have low birth weight babies. There may also be dangers from third-hand smoke--the chemicals, particles and gasses of tobacco that are left on hair, clothing and furnishings.
• Proper diet
  Eating a balanced diet before and during pregnancy is not only good for your overall health, but essential for nourishing your baby. It’s also best to limit the amount of fish that you eat. The U.S. Food and Drug Administration recommends women who are pregnant or planning to become pregnant consume no more than 12 ounces of fish a week and avoid large ocean fish such as shark and tilefish. Tuna has higher levels of mercury. You should limit your tuna intake to one can of white tuna or one tuna steak per week or two cans of light tuna per week.
• Get your chronic conditions in check
  If you have a chronic medical condition — such as diabetes, asthma or high blood pressure — make sure it's under control before you conceive. In some cases, your health care provider may recommend adjusting your medication or other treatments before pregnancy. Your health care provider also will explain any special care you may need during pregnancy.
• Preventing birth defects
  Take 800-1,000 micrograms (0.8-1.0 mg) of folic acid each day, a nutrient found in some green leafy vegetables, nuts, beans, citrus fruits, fortified breakfast cereals, and some vitamin supplements. Folic acid can help reduce the risk of birth defects of the brain and spinal cord (also called neural tube defects).
  Avoid exposure to alcohol and drugs during pregnancy. In addition, be sure to inform your health care provider of any medications (prescription and over-the-counter) you are currently taking–all may have adverse effects on a developing baby.
• Exposure to harmful substances
  Pregnant women should avoid exposure to toxic and chemical substances (i.e., lead and pesticides), and radiation (i.e., X-rays). Exposure to high levels of some types of radiation and some chemical and toxic substances may be harmful to the developing baby.
• Infection control
  Avoid the ingestion of undercooked meat and raw eggs. In addition, pregnant women should avoid all contact and exposure to cat feces and cat litter, which may contain a parasite called toxoplasma gondii that causes toxoplasmosis.
• Daily vitamins
  Begin taking a prenatal vitamin daily to make certain that your body gets all the necessary nutrients and vitamins needed to nourish a healthy baby.
• Identifying domestic violence
  Women who are abused before pregnancy may be at risk for increased abuse during pregnancy. Your health care provider can help you find community, social, and legal resources to help you deal with domestic violence.

Older moms

It’s more difficult to get pregnant when you are older. The chance of getting pregnant in a given month decreases as you get older, and your risk of miscarriage rises after age 35. If you are older than 35 and have been trying to get pregnant for more than six months, you should talk to your health care provider about fertility treatments.

The biggest risk for women who are 35 or older is genetic abnormalities in the baby, such as Down syndrome. According to the American College of Obstetricians and Gynecologists, the risks of Down syndrome increases with mother’s age (see chart below)

• At age 25, the risk of having a baby with Down syndrome is 1 in 1,250.
• At age 30, the risk is 1 in 1,000.
• At age 35, the risk is 1 in 400.
• At age 40, the risk is 1 in 100.
• At age 45, the risk is 1 in 30.

This increased risk is found in all women of advanced maternal age regardless of race, ethnicity and socioeconomic status. If you will be older than 35 when your baby is born, you should be offered genetic counseling and, if desired, prenatal screenings such as the first trimester screening and additional screenings such as chorionic villus sampling and amniocentesis. Perinatal Center of Iowa provides these prenatal screenings. Today, many women younger than 35 years will also choose to have genetic testing in pregnancy.

Prepared and provided by Perinatal Center of Iowa