Q: My husband and I are ready to have a baby. Can you tell me what we should do to be sure we have our “ducks in a row” before we start trying?
Answer from Dr. Larry L. Veltman, medical director of obstetrics and gynecology at Providence St. Vincent Medical Center: There are a number of factors that you and your partner should consider before trying to conceive. A visit with a physician or midwife that provides prenatal care and delivery before you become pregnant makes excellent sense and is probably the best way to address all of these issues.
You should review any known medical conditions that you have with your physician. It’s important to be sure that those conditions are well managed and to discuss any risks or problems these conditions may cause during your pregnancy. It’s also essential to make sure that any medications you are taking are safe for pregnant women. In some cases, the type or dose of your medications may need to be adjusted.
It’s also important to look at factors that may influence the risk of genetic conditions in your baby, including your age and your family’s ethnic background. Some inherited diseases have a higher incidence among certain ethnic groups; for example, sickle cell disease is more common among African Americans, cystic fibrosis is more common amongst Caucasians, and Tay-Sachs disease is more common in Askenazi Jews. You should work with your physician to evaluate those potential risks and, in some cases, consider genetic counseling and screening before trying to conceive.
It’s also important to make sure that both you and your partner have reviewed exposure and screening for a number of infectious diseases, such as rubella, chicken pox, hepatitis B, and HIV.
In terms of lifestyle, you (and probably your partner) should without question, discontinue smoking. We do not know the threshold for safety when it comes to alcohol use for any given individual. It is better to abstain from alcohol during pregnancy.
Folic acid decreases the risk of certain birth defects, so you should begin taking al least 400 mg. of folic acid daily before you start trying to conceive. Most full-spectrum women’s multivitamins offer 400 mg of folic acid.
You should also follow FDA guidelines with regard to eating certain fish during pregnancy that may be contaminated with mercury. These fish are shark, tilefish, swordfish and king mackerel. The mercury is a result of industrial pollution falling from the air into surface water, and then making its way in high levels into large, long-living fish that feed on other fish.
It’s also best to limit your use of caffeine. Some studies suggest that using caffeine may increase the risk of miscarriage. It doesn’t necessarily need to be eliminated, but its use should be kept to a minimum.
Finally, once you become pregnant, you should plan to discontinue ultra-vigorous exercise and activities that present a high risk of falling, such as horseback riding, downhill skiing and water-skiing. Scuba diving also presents special risks during pregnancy, and must be avoided.
You and your husband should be able to address all of these issues in one pre-conception visit with your physician.
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January 2003
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