The A to Z of Preconception Health

Creating and growing your own little mini-me puts both your mind and body under all sorts of stress and strain. Before sperm meets egg, taking the time to get your own health in tiptop shape will give you the best chance of growing a beautiful healthy baby, and of staying well throughout pregnancy and as a new mum.

Attend your GP
The first stop on your road to pregnancy should be a chat to your GP, who can give you personalised advice, arrange necessary tests and also give you info about local maternity services. If you don’t already have a regular GP, then now is the time to find one you like. Finding a GP who you’d feel comfortable eventually taking your kids to is also a bonus. Most general practices list the special interests of their GPs on their websites, so keep an eye out for any who list women’s health, antenatal care or paediatrics as their areas of expertise.

Booze
If you are planning pregnancy, the safest choice is not to consume any alcohol. Alcohol intake can negatively affect fertility in both males and females, so now is the time to cut down and stop drinking altogether. It is difficult to know whether having one or two drinks occasionally whilst trying to conceive will have any impact on an embryo (such drinking in the early weeks before you know you are pregnant), but it is better to avoid the what-ifs by not drinking at all. Once pregnancy is confirmed, avoiding all alcohol is even more important.

Caffeine
Coffee addicts be warned - during pregnancy it is recommended to limit caffeine to no more than 300mg/day. This is around 2-3 shots espresso coffee, so you can hit that allowance in a single large coffee. Having more than this is associated with impaired foetal growth, and with miscarriage - although a direct causation has not been proven. So if you are consuming significantly more than 300mg per day then the time to start cutting down is prior to falling pregnant, because the only thing worse than first trimester morning sickness and fatigue is suffering through caffeine withdrawals at the same time. 

Drugs
It goes without saying that illicit drugs should be avoided anywhere near pregnancy, but it is just as important to discuss with your GP any regular medications you are taking to ensure these are safe to take prior to and during pregnancy. Some medications used for epilepsy and other conditions can cause damage to a developing foetus and cannot be used while pregnant. It may take some time to switch over to other treatments so don’t wait until you are ready to start trying to check on this.

Exposure to infectious disease
Zika virus affects many tropical and subtropical countries, and is spread by mosquitos and sexual contact. Zika can cause birth defects if a mother-to-be is infected. If you are planning to become pregnant, the Department of Health recommends either delaying travel to areas affected by zika virus, or delaying pregnancy if travel goes ahead. If you have traveled to an area with zika in the last 6 months, chat to your GP to find out if you need to delay pregnancy - different countries have different risk levels so it depends where you’ve been.

Folic acid
One of the most important things you can do now to prepare your body for building a baby is to start taking a folic acid supplement of at least 400mcg/day. Folic acid reduces the risk of a baby having a neural tube defect such as spina bifida, and most people cannot consume enough in their diet alone, so supplementation is needed. However - to prevent neural tube defects, you need to be taking folic acid for at least 12 weeks before falling pregnant and continue to take it until at least the end of the first trimester. If you have a family history of spina bifida, or if you have epilepsy or diabetes, you will need a higher dose of folic acid - ask your GP. Most pregnancy multivitamins contain the recommended amount of folic acid, but check the label as there are lots of different brands (and huge variations in price). It’s also worth noting that many ingredients in those pregnancy multivitamins have not been shown to have any benefit in either getting pregnant or growing a healthy baby. Folic acid is one of the very few supplements shown to improve any outcome and can be bought on its own for a fraction of the price of the multivitamin tablets marketed towards women trying to conceive.

Get lots of sleep
May as well stock up on sleep now while you are able to! From as early as 8 weeks pregnant, hormones and a growing uterus cause mums-to-be to wake up several times a night to pee, along with the first trimester fatigue that hits you like a truck. As the pregnancy goes on there is a baby using your bladder as a trampoline all night, and all the back pain/squished lungs/kicks in the ribs and other fun to interrupt your sleep - and that’s all before your bundle of joy even arrives earthside to keep you up all night. So stop what you are doing and go have a nap. Really, you will thank me later. 

Hospital clinic vs private obstetrician vs group midwifery
Fairly early in pregnancy you’ll need to decide on the mode of your antenatal (i.e. during pregnancy) and birth care, so it’s worth researching your options before falling pregnant. In Australia there are two broad options for maternity care - public and private. In the private system, you pay out of pocket for an obstetrician of your choice, and are charged for costs incurred during a stay in a private hospital for the birth (though these are mostly covered if you have top level private health insurance). In addition to the cost of health insurance, out of pocket costs are likely to be several thousand dollars, however you’ll get your choice of doctor, a private room, likely better food and a longer hospital stay after birth. In the public hospital system, the cost of antenatal care and of being in hospital for the birth is all completely covered by Medicare with no out of pocket cost to you. In most areas, you will have a choice of GP shared care (where your antenatal care is partly done by your GP and partly by public hospital obstetric doctors) and midwife-led care. If your pregnancy is complicated by medical conditions, twins or other issues you will see obstetrics doctors at the hospital antenatal clinic, however you may see a different doctor at each appointment and are not able to choose your obstetrician. Talk to friends who have delivered in both systems, call your local hospital and ask your GP, as services vary in different areas. I personally had a fabulous experience through my local public hospital and GP shared care - the only thing I paid out of pocket for were ultrasounds (total of $300-400 over the pregnancy), and even this cost could have been avoided by choosing a bulk-billing radiology practice. 

Iodine and iron
Iron and iodine are both important nutrients for conception and pregnancy, and requirements often increase more than women can consume in their diet. It is recommended that women take an iodine supplement during pregnancy unless they have a thyroid condition, in this case discuss with your GP. Many women have low iron to start with so it’s worth increasing your dietary intake (red meat, leafy greens, iron-fortified grain products) and taking a supplement if you can’t get enough from your diet. Your iron levels can be easily checked by a blood test if needed.

Journal your cycle
Before you start trying to conceive you’ll need to know which days of your cycle you are fertile - in a nutshell you can become pregnant from around five days before and one day after ovulating, and in a 28 day cycle most women ovulate somewhere around 2 weeks after the first day of their period. There are lots of apps that allow you to track your cycles and then predict your fertile days. The more data you add, the more accurate your predictions will be. You can also buy ovulation test kits which measure hormones in your urine, similar to a pregnancy test, that can help you figure out your fertile days. Knowing all of this before you start trying can make it a bit less stressful.

Know your genetic risks
About 1 in 100 babies will be born with a genetic disorder, ranging from minor to life-limiting. If any genetic conditions (such as cystic fibrosis) run in yours or your partner’s family, ask your GP whether you need genetic testing before trying to fall pregnant. Screening is not yet covered by Medicare for the general population, but this is a hot topic at the moment so may change in the near future. Potential parents can be tested to see if they carry genes for several hundred conditions, at a cost of several hundred dollars. If you are found to be a carrier for a condition, your partner can then be tested to determine if there is any risk of passing the condition to a baby. 

Leave - what are you entitled to?
Find out from your work’s HR department how much maternity leave you are entitled to, as well as your options for potentially returning to work part time or in a different role down the track. Also check if you are eligible for paid parental leave from Centrelink. Paternity leave entitlements vary wildly amongst employers and are worth checking out in advance as well. 

Male partner
Dads-to-be also need to prep for baby making - poor diet, sedentary lifestyle, smoking, alcohol and being overweight can all negatively impact a man’s fertility.

No more sushi
You’ve probably heard at least one pregnant woman recite a list of foods she will be devouring as soon as her baby is born - sushi, brie, a McFlurry, prosciutto… These foods all have a risk of being contaminated by bacteria called listeria. If a pregnant woman is infected, listeria can cause miscarriage, stillbirth or a bloodstream infection in a newborn baby. While you don’t need to avoid all the at-risk foods prior to pregnancy, you’ll need to know what is a no-go once those two little lines appear. There is a great brochure here by the NSW Food Authority with more info.

Occupational risks
Are you exposed to chemicals, infectious diseases or radiation at work? Or does your job involve strenuous physical labour? Now is the time to find out if any of those exposures need to be avoided in pregnancy and how your employer would be able to accommodate any need for a change in duties. 

Pap smear
Make sure you are up to date with cervical cancer screening, which now is done as a test for the HPV virus instead of the traditional Pap smear. Testing prior to pregnancy means that any abnormalities can be further investigated or treated without being complicated by also being pregnant. Read more on the recent changes to cervical screening here.

Quit smoking
This one is a biggie… if you smoke and have ever needed a reason to quit, growing a baby is a great one. Your GP and the Quitline website and phone line are all good places to get help to quit for good.

Review control of chronic health issues 
Pregnancy can mess with all sorts of health conditions like type 1 diabetes, asthma, and autoimmune diseases. The pregnancy hormones make some of these easier to manage and others more difficult. See your GP or specialist to ensure any specific health issues are under tight control before adding pregnancy into the mix. 

Social support and mental health
The transition to motherhood is a wild ride - exhilarating one moment, exhausting the next. Hormonal changes, sleep deprivation, changes in your relationship and spending every moment caring for a new baby will test even the happiest and most adaptable woman. Anxiety and depression are very common during pregnancy and in the year following childbirth, as are feelings of isolation and loneliness. Think about who will form your support system and who you can call on for help. Practical info from Beyond Blue here.

Teeth
See your dentist and get those pearly whites checked and cleaned. Gum disease has been linked to lower birth weight of babies and early births. Get flossing!

Understand the likely timeframe
A healthy couple in their early-mid 20s only has a 25-30% chance of pregnancy in any one month and this chance declines with age, but knowing which days you are actually able to conceive will give you the best start (see above!). It is likely to take a few months if not longer, although plenty of people get pregnant when not trying so don’t rely on luck for contraception! If you are under 35 years old and have been trying for 12 months, or are over 35 and have been trying for 6 months without falling pregnant then see your GP about looking into any reasons that pregnancy may not have occurred yet.

Vaccinations
Check that your vaccinations are up to date, especially for measles/mumps/rubella as rubella infection can be very harmful to unborn babies. This vaccine can’t be given to a pregnant woman so needs to be done before falling pregnant if a dose was missed in childhood. 

Weight 
Being a healthy weight maximises fertility and minimises the risk of some pregnancy complications such as gestational diabetes and high blood pressure. If you are overweight, losing 5-10% of weight can significantly improve your chances of falling pregnant. Taking steps (literally - get your 10000/day!) to get to a healthy weight will set you up for a healthy pregnancy. 

eXercise 
Doesn’t quite start with X but it’s Xtra necessary to be active in the lead up to trying to fall pregnant. Doing moderate intensity exercise like swimming, power walking or aerobics classes improves fertility. Getting into the habit of exercising regularly now will make it easier to continue right up to delivery and beyond. Being active during pregnancy may reduce the risk of gestational diabetes and may make your labour, birth and post-postpartum recovery smoother.

You are what you eat
Growing a baby from two cells up to 3-4kg of squishy cute human requires a huge amount of energy and nutrients, and your ever-expanding bundle of joy will sap all of your stores before going without. Eat a varied and balanced diet high in iron and calcium with lots of fruit and veggies and lean protein. There is no need to cut out any food groups, just minimise the usual nasties (sugar, saturated fat, salt) and enjoy eating all your favourite foods before any morning sickness kicks in! Seeing a dietitian can be helpful especially for vegetarians or vegans, or people with food intolerances to help plan out a diet which includes enough of the essential nutrients for baby-building.

Zzzzz
Sleep gets two mentions because it is so important. Now go and have a nap on my behalf!


Resources used to guide this post:
Department of Health Pregnancy Care Guidelines https://beta.health.gov.au/resources/publications/pregnancy-care-guidelines
Dorney & Black - Preconception Care; AJGP July 2018 https://www1.racgp.org.au/ajgp/2018/july/preconception-care
Pregnancy Birth Baby - Listeria https://www.pregnancybirthbaby.org.au/listeria-food-poisoning
QLD Health Pre-Conception - Health Lifestyle for Mothers https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/clinical-staff/maternity/nutrition/lifestyle/pre-conception
RANZCOG Planning For Pregnancy https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Patient%20information/Planning-for-pregnancy-pamphlet.pdf?ext=.pdf
RANZCOG Pre-Pregnancy Counselling https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Pre-pregnancy-Counselling-(C-Obs-3a)-review-July-2017.pdf?ext=.pdf
​SA Health Preconeption Advice Clinical Guideline https://www.sahealth.sa.gov.au/wps/wcm/connect/1f11de804eed8cb5afbeaf6a7ac0d6e4/Preconception+Advice_Sept2015.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-1f11de804eed8cb5afbeaf6a7ac0d6e4-moBLd0A
WHO Zika Virus Classification Table https://apps.who.int/iris/bitstream/handle/10665/260419/zika-classification-15Feb18-eng.pdf;jsessionid=0D67718AA2CA0A85F84F36B851AB9E9F?sequence=1

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