How to Plan a Healthy Pregnancy

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): And welcome to the show. I am Deborah Howell and today our guest is Danielle Dawes, a women's health nurse practitioner for the Magella Medical Group, which is affiliated with Miller Children's and Women's Hospital in Long Beach. Danielle specializes in preconception counseling, prenatal care, and postpartum care. Welcome, Danielle.

Danielle Dawes, NP: Hi, thanks for having me.

Deborah Howell (Host): Our pleasure. So nearly four million babies are born in the US every year, while pregnancies are common, most families do have a lot of questions about pre-pregnancy planning, so let's get into some of those questions, alright?

Danielle Dawes, NP: Alright.

Deborah Howell (Host): How early does pre-pregnancy planning start?

Danielle Dawes, NP: Well, the timeline for pre-pregnancy planning is really different for every couple. Being pregnant can be physically, emotionally, and financially challenging even under the best circumstances. So it's important to have an open dialogue with your partner on all these topics prior to pregnancy. Especially if you suffer from a chronic illness, it's also important that you discuss getting pregnant with your healthcare provider so that he or she can help guide you in determining the ideal time for your own health and the best chances of having a successful pregnancy.

Deborah Howell (Host): Okay. And do you know what kind of vitamins you should be taking if you're pregnant?

Danielle Dawes, NP: Most prenatal vitamins actually contain the necessary combinations of vitamins for a pregnancy. They include folic acid, vitamin D, calcium, vitamin C, riboflavin, niacin, vitamin B12, vitamin E, zinc, iron, and iodine. The additional 400 to 800 micrograms of folic acid is really what universally separates a prenatal vitamin from a regular woman's vitamin. It's equally important to talk about when to begin taking them, not just what to take. Prenatal vitamins should actually be initiated a few months before attempting to conceive so that you have adequate vitamin stores and should be continued through the pregnancy up to the conclusion of breastfeeding. Folic acid is most important in the formation of the fetal neural tube, which is the embryologic precursor to the spinal cord, and actually begins to occur immediately following conception and is completed by 28 days after conception. Many people don't even know that they're pregnant by that point. So it really is important to take these vitamins prior to conception. Additional folic acid above that 400 to 800 micrograms is only recommended for women who have had a previous child with a neural tube defect or a birth defect of the brain or spinal cord and should be initiated after talking to your healthcare provider. It's important not to take additional vitamin supplements without talking to your healthcare provider as some can actually carry additional risks. There are risks of fetal toxicity, for example, with vitamin A supplementation above what is found in your standard prenatal vitamin.

Deborah Howell (Host): That is some great information. Alright. Now, when should you stop taking birth control?

Danielle Dawes, NP: You should really only stop taking your birth control when you're ready to become pregnant since many women will actually get pregnant during their first cycle off of birth control.

Deborah Howell (Host): Really?

Danielle Dawes, NP: Yeah.

Deborah Howell (Host): That surprises me. Okay. So, well that answers my next question, how quickly after you stop can you get pregnant? In your first cycle.

Danielle Dawes, NP: Yeah, absolutely. So, as I said, many birth controls will actually have a very rapid return to fertility and can be actually even as fast as two missed oral birth control pills, believe it or not. Some specific hormonal birth control methods can be associated with a longer or slower return to fertility. One that specifically comes to mind is Depo-Provera. Several studies actually show that it can take four or more weeks beyond the typical three-month redosing interval before patients using Depo-Provera actually begin to ovulate again. But, as I mentioned previously, because you can become pregnant almost immediately after stopping most birth control pills, not only is it important to keep this in mind, but it's actually ideal to have at least one normal menstrual cycle off of birth control before attempting to conceive in order to really establish a healthy endometrial lining for implantation of the embryo.

Deborah Howell (Host): And this is just excellent information. Are there certain medications you shouldn't be on if you're trying to get pregnant, and if so, can you tell us what they are?

Danielle Dawes, NP: Yeah, that's actually a really good question that comes up quite a lot. Many medications can pose a risk to fetal development at different points throughout pregnancy. Although there certainly are some high-risk medications, the decision to take or not take a particular medication typically depends on the reason a patient is taking the medication, the severity of the underlying medical illness, and the specific fetal risks at different points throughout the pregnancy. Each patient should really plan to discuss the medications she's taking with her healthcare provider and discuss their specific profile of safety during pregnancy before trying to conceive in order to determine which ones should actually be stopped. On the other hand, there are a number of medications that actually should be continued during a pregnancy that many patients automatically discontinue as soon as they find out they're pregnant. A great example of this is medications for diabetes, including insulin and oral hypoglycemic agents. Diabetes itself is actually a really risky disease in pregnancy, and when poorly controlled, it carries a high risk of miscarriage and birth defects. In pregnancy, we actually aim to keep patients' blood sugars, when fasting or first thing in the morning, less than 90, and after meals, one hour after meals, to about 130. And for this exact reason, because some medications should be continued and others discontinued, especially in the very early time period of pregnancy, it's really best to talk about all your medications that you're taking with your healthcare provider before attempting pregnancy.

Deborah Howell (Host): And don't hold back and that includes supplements.

Danielle Dawes, NP: Yes, that certainly includes supplements.

Deborah Howell (Host): Okay. What should the partner be doing if the couple is planning a pregnancy?

Danielle Dawes, NP: Well, there's really a heightened level of concern for partners and partner travel during pregnancy and even prior to pregnancy right now because of the effects of the Zika virus on the growing fetus. The Zika virus is a mosquito-borne illness transmitted by the Aedes aegypti mosquito. Symptoms of the Zika virus can include fever, rash, joint pain, or red eyes during or immediately following travel to an endemic area after being bitten by an infected mosquito. It has been associated with abnormal brain development including microcephaly, intracranial calcifications, and developmental delay. More recently, the Zika virus has also been discovered in the semen of men who have traveled to an endemic area and been bitten by an infected mosquito. Therefore, travel by the male partner can potentially pose a risk to the pregnancy even if the woman has not traveled. So, based on our current understanding of the disease, couples should wait two months before trying to conceive if the male partner has traveled but had no symptoms of the Zika virus, and six months if the partner has had symptoms. If the woman is the partner that's traveled actually to this affected area, a two-month waiting period is recommended regardless of her symptoms. This is because the Zika virus appears to affect the male reproductive system longer than the female reproductive system in symptomatic patients. To date, there have been no reported cases of locally acquired Zika virus in the mainland US, and all US cases have actually occurred following travel to an endemic or affected area. But, because the areas where Zika virus is found are constantly changing, you should always plan to check with the CDC and check their most up-to-date list of affected areas when planning your travel.

Deborah Howell (Host): Right. The information is out there, you just have to seek it out.

Danielle Dawes, NP: Absolutely.

Deborah Howell (Host): Alright. Is there a benefit to doing fertility testing prior to getting pregnant?

Danielle Dawes, NP: Fertility testing is really only recommended in women under 35 who have been unable to conceive after one year of regular unprotected intercourse. After age 35, that timeline does change some and becomes more abbreviated and fertility testing is recommended after six months of regular unprotected intercourse. This is because a woman's fertility rate does begin to decrease as she gets older. Fertility can also be decreased in overweight or obese women, especially for those women who get irregular periods. Weight loss can really help increase fertility for women who experience this.

Deborah Howell (Host): Okay. And what are the five most important things a woman can do to prepare herself for pregnancy?

Danielle Dawes, NP: Yeah, there's quite a number. I think the first thing really to consider is it's important to check that you're up to date on all of your vaccinations. There are some vaccinations that cannot be given during pregnancy because they do contain small amounts of active virus, and therefore present a risk to the developing fetus. However, these same viruses present a risk to the baby if the mother is exposed during pregnancy for the first time and has not previously developed immunity either through vaccination or prior exposure to the disease itself. The second thing I would really recommend is to maintain a healthy diet and keep up with your normal exercise routine. In the US, 26% of women of reproductive age are overweight and nearly 30% are obese. Achieving or approaching your ideal body weight prior to pregnancy really helps to reduce your risks during pregnancy, specifically risks that it would reduce would be risks of diabetes, gestational diabetes, hypertension, and preeclampsia, which can be associated with adverse pregnancy outcomes including growth restriction of the baby, preterm delivery, and in some cases, stillbirth. The third important thing to consider is both partners should plan to stop smoking. You know, this can be very difficult. This includes stopping cigarettes, e-cigarettes, and nicotine substitutes including patches. Smoking cessation can be quite difficult, so it is important to start that process as soon as possible when you're thinking about planning a pregnancy. In addition to increasing the risk of cancer, heart disease, stroke for the average adult, smoking carries additional specific risks during a pregnancy, including fetal growth restriction, placental abruption, and preterm delivery. And studies after delivery show that actually if you resume or continue smoking during that period, that there's increased risk of asthma, bronchitis, and sudden infant death syndrome or SIDS for the child. The fourth thing to consider would be to stop drinking alcohol, including wine, beer, and liquor. There really is no safe amount of alcohol to drink during pregnancy because we don't know the threshold at which fetal alcohol syndrome occurs. Alcohol consumption even in small amounts has been associated with birth defects, miscarriage, stillbirth, preterm birth, and developmental delay. Alcohol consumption can affect the fetus as early as four to six weeks after conception. Again, a time period when some people don't know they're pregnant. There are also studies that show limiting caffeine consumption, especially in the first trimester, can reduce risk of miscarriage, and caffeine should really be limited to 200 milligrams a day. The final, but probably most important thing that I would recommend, is to plan a preconception visit with your healthcare provider to discuss any of your medical or genetic risks and how they might affect your pregnancy. It's important to develop really a very patient-specific, individualized prenatal care plan for your specific health history with your healthcare provider.

Deborah Howell (Host): Beautiful. And where can listeners go to get more information about pre-pregnancy planning?

Danielle Dawes, NP: So there's a lot of great information out there. One place that I would certainly recommend is March of Dimes. They have a great general website that talks about a lot of different information and different topics for pre-pregnancy or pregnancy planning and early pregnancy care. Mother to Baby is also another good source of information that covers a little bit different information than what can be found at the March of Dimes. And actually the MemorialCare maternity website actually has a lot of helpful information including information on different classes that you can take to learn even more about birthing classes, breastfeeding, things that are really important when planning a pregnancy.

Deborah Howell (Host): Sounds good. And thank you so much, Danielle, for coming on the show today. To learn more or to listen to a podcast of the show, please visit memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness. Have yourself a fantastic day.