Ask the Doctor about Preconception care




By Fletcher Wilson, M.D.
August 4, 2005

Q: "I’m thinking about becoming pregnant. Is there anything I should do to prepare my body first?"

A: "All of a baby’s internal organs develop in the first trimester and continue to grow for the remainder of the pregnancy," says Dr. Fletcher Wilson, M.D., Obstetrician/Gynecologist at Monadnock OB/GYN Associates. " By starting certain healthy practices several months before pregnancy, such as taking folic acid, limiting exposure to toxins, avoiding some legal and all illegal drugs, controlling chronic medical conditions and learning about genetic diseases, women can significantly decrease the potential for birth defects and other complications.

Take Folic Acid

Folic acid is a B vitamin that is found in green leafy vegetables, meats, grains, nuts and cereals. Studies show that it helps prevent neural tube defects like spina bifida. The Centers for Disease Control recommends that all women of childbearing age take at least 400 mcg of folic acid daily, as nearly 50 percent of all pregnancies are unplanned. Dr. Wilson adds that women who are planning to become pregnant should increase that amount to 600-800 mcg at least three months prior to becoming pregnant and throughout pregnancy. Women with a family history of neural tube defects or who are taking seizure medications should talk to their health care provider about increasing the amount to 4,000 mcg (4 milligrams) per day. Folic acid can be found in women’s daily multivitamins, prenatal vitamins and over-the-counter at the pharmacy.

Limit exposure to environmental toxins

Environmental toxins at home and work such as lead paint, pesticides, paint thinners, paint strippers and other chemicals should be avoided. To find out if a chemical, medication, radiation or infection could harm an unborn child, Dr. Wilson recommends calling the Pregnancy Exposure Infoline for confidential and non-judgmental counseling at (781) 487-2386 or 1-800-322-5014 or visiting www.thegenesisfund.org.

Quit smoking

Cigarettes, alcohol and illegal drugs are all dangerous to unborn children, says Dr. Wilson. Smoking increases the chances of miscarriage, premature birth, low birth weight, and fetal death. In addition, babies born to women who smoked during pregnancy are more susceptible to respiratory infections, ear infections, and Sudden Infant Death Syndrome (SIDS).

Avoid Alcohol

Alcohol should be completely avoided. "There are no studies showing a safe level of alcohol during pregnancy," says Dr. Wilson. Even limited amounts can have irreversible effects. According to the American Pregnancy Association, women who drink "moderate" amounts of alcohol could give birth to a baby with Fetal Alcohol Effects (FAE). A syndrome related to Fetal Alcohol Syndrome (FAS), FAE causes mental and physical problems in children. Those include behavioral impairments such as learning disabilities, poor school performance, and poor impulse control; problems with memory and attention span; and malformations of the skeletal system, heart, kidneys, bones, and/or hearing system.

In addition to the problems noted above, children born with FAS may also experience problems with motor skills, social interaction, problem solving, and speech. FAS is caused by high alcohol consumption, either through binge or regular drinking.

Know Which Medications are Safe

Many over-the-counter drugs and prescriptions are dangerous during pregnancy. Women who are taking medications should consult with their health care provider prior to becoming pregnant. "In some cases, we can help women choose safe alternatives to the medications they are taking," says Dr. Wilson. "And when an alternative is not available, we provide counseling on coping strategies and other safe ways to alleviate symptoms."

Avoid Illegal Drug Use

Illegal drugs are a different matter, says Dr. Wilson. They all significantly increase the risk of stillbirths, SIDS, miscarriage, birth defects and low birth weight. Babies may be born drug-dependent and suffer serious withdrawal symptoms.

"Today, society has many good supports for quitting addictive drugs," says Dr. Wilson. "Before becoming pregnant, seek the help of professional counseling and support groups."

Research genetic diseases

Many genetic diseases, like cystic fibrosis and hemophilia, tend to run in families, while others are associated with particular ethnic groups and nationalities. For example, Tay-Sachs is most prevalent among descendants of Ashkenazi Jews and Franco-Americans. If a genetic disease is a concern, women can work with a genetic counselor and their health care provider to determine the chances of passing that disease to their babies and their options.

Control medical conditions

Women should consult with a health care provider to safely control major medical conditions such as asthma, high blood pressure and diabetes. "In some cases, prescription medications, such as insulin, have been proven safe during pregnancy. In others, alternative medications and coping strategies can be offered."

Other medical conditions such as high blood pressure and gestational diabetes are sometimes linked to obesity and significantly overweight mothers. "Being at an optimal body weight prior to pregnancy is recommended. However, once pregnant, an overweight woman should not diet because it can rob the fetus of necessary nutrients," says Dr. Wilson. Instead of dieting during pregnancy, Dr. Wilson suggests ensuring that nutritious meals and snacks are eaten at regular intervals during the day. Women who are obese are generally counseled to gain less weight during pregnancy. "Excess weight can always be lost after the baby is born. The most important thing is to have a healthy baby first," he says.

Other considerations

Immunizations against diseases such as hepatitis B and German measles should be up to date before becoming pregnant. In addition to health care considerations, women should make arrangements to avoid heavy lifting at home and work.

"By becoming healthy prior to conception and continuing those practices throughout pregnancy, women can maximize their chances of having a healthy baby and a good pregnancy experience," says Dr. Wilson.

For more information on care before and during pregnancy, visit these web sites: www.americanpregnancy.org, www.pregnancy.org and www.marchofdimes.com.

If you have a question you would like answered in this column, write to "Ask the Doctor," c/o Laura Gingras, Director of Philanthropy and Community Relations, Monadnock Community Hospital, 452 Old Street Road, Peterborough, NH 03458.

The "Ask the Doctor" column is written by MCH’s Community Relations Department. Fletcher Wilson, M.D., is an Obstetrician/ Gynecologist at Monadnock OB/GYN Associates in the Medical Arts Building at Monadnock Community Hospital. This article originally appeared August 4, 2005 in the Focus on Health Section of The Monadnock Ledger.