(courtesy of www.DrWeil.com)

Question:
Do you have any advice on how to prepare for pregnancy, both physically and emotionally? My husband and I are talking about when to have our first child, and I need to know more about what’s involved for prospective mothers.

Answer:
You’re wise to think about these at this time - before you become pregnant. There are a number of concerns to consider - everything from your fertility to your diet, lifestyle and the state of your health. You also have to focus on the inevitable practical considerations. Can you and your husband afford to have a baby? Will you have to work after the baby is born, and if so, what kind of child care is available to you? You have to consider other less tangible factors, too – whether or not you’re secure in your relationship with your husband and whether you both have a realistic appreciation for what it will be like to have a baby and how profoundly it will change your lives.

All of these issues are very personal and vary from couple to couple. I can only suggest that you have frank discussions about your desire for a baby and that you try to make sure that the most important of your concerns are addressed and discussed at great length before you get pregnant.

As far as medical issues go, one of the things you have to bear in mind is the effect of age on fertility, a good reason not to wait too long before starting your family, particularly if you want to have more than one child. In women, fertility begins to decline in the late 20s, in men after age 35. In women, fertility can be affected by irregular ovulation and scarring in the reproductive organs (from conditions such as pelvic inflammatory disease). Although men can father children well into their 90's they have fertility issues as well. The number, shape and movement of sperm all influence male fertility. For both genders, environmental factors can impair fertility so it is best to avoid exposure to pesticides, paints, solvents, cigarette smoke, and other products with potentially harmful chemicals.

Before you decide to get pregnant, you’ll want to be in the best shape possible so that your baby will get a good start in life. Here are the most important changes a woman should make in preparation for pregnancy:

• Folic Acid: This water-soluble vitamin is essential for human growth and development. Pregnant women have an increased need: folic acid supports the growth of the placenta and fetus, and helps to prevent several types of birth defects, especially those of the brain and spine. Folic acid deficiency has been linked to birth defects, particularly neural tube defects such as anencephaly (the lack of part or all of the brain's tissue) or spina bifida (incomplete development of the spinal cord or the tissue that covers it), low birth weight, pregnancy loss, depression, memory loss, and cervical dysplasia. Pregnant women are at a higher risk of folic acid deficiency. I recommend that all adults take a daily vitamin supplement that includes 400 micrograms of folic acid. Once you get pregnant, you’ll need more - 600 mcg daily - and you’ll need 500 mcg daily if your breastfeed your baby. Foods that provide folate (the natural form of folic acid) include spinach, green vegetables and beans. In the U.S. some foods are fortified with folic acid. They include orange juice, baked goods, and cereals. Other natural sources of folate include asparagus, bananas, melons, lemons, legumes, yeast, and mushrooms. Don’t wait until you’re pregnant to begin taking folic acid - by the time you know you’re pregnant, your baby’s brain already begun to develop.
• Iron: When you’re pregnant, you’ll need more iron than you do now. I don’t advised taking iron supplements unless tests have shown that you’re deficient, but before you get pregnant make an effort to boost your iron stores through your diet. Good sources include lean red meat, beans, lentils, millet, chickpeas, dark, leafy greens, molasses, dried apricots, dried peaches, pumpkin and sunflower seeds, pistachios, walnuts, almonds, scallops, clams, oysters, soybeans, and many other foods.
• Smoking: In a word, don’t. No matter what your age or gender you shouldn’t smoke. If you do smoke, quit now, before you get pregnant. Smoking can affect fertility and has been linked to altered fallopian tube function and damaged eggs. If your husband smokes, he should quit, too - it can affect sperm mobility and sperm production. Smoking during pregnancy puts your baby at risk for low birth weight at delivery and sudden infant death syndrome as a newborn.
• Alcohol: It’s important to stop drinking alcohol as soon as you begin trying to become pregnant. According to data from a Danish study completed in 1998, even moderate drinking during pregnancy may increase the risk of stillbirth. There is also considerable evidence of physical, mental and behavioral problems among the children of mothers who consume alcohol during pregnancy.
• Caffeine: You also have to consider the amount of caffeine you ingest daily. Fertility studies have not linked caffeine with delayed conception except among smokers who drank eight or more cups of coffee per day. However, researchers have found that consuming the amount of caffeine found in five or more cups of coffee per day doubles the risk of miscarriage. Roughly 200 mg of caffeine are found in one and a half to two cups of brewed coffee and half that amount in two cups of brewed tea. There's no evidence that moderate caffeine consumption (about 200 mg daily) from green tea or other beverages increases the risk of miscarriage. Although the caffeine contained in a cup of green tea typically is about half the amount found in coffee, some kinds of green tea can contain as much as 110 mg of caffeine, almost as much as you would get in some brewed coffee. When estimating your caffeine intake, remember to add in other sources of caffeine in your diet, such as soft drinks and chocolate, as well as the amount found in some over the counter medications.

Fortunately, no studies have found any connection between caffeine and birth defects, low birth weight, a baby's motor development or intelligence. But because caffeine can enter breast milk, you'll need to watch your beverage consumption if you plan to breastfeed your baby and limit your caffeine intake to no more than 300 mg daily.

• Medications: If you’re taking any drugs - prescription or over the counter - you should discuss the need to continue taking them with your doctor before you try to get pregnant. The prescription drug Accutane, for example, used to treat acne, has been shown to cause severe birth defects, and any woman trying to conceive should stop using it.
• Your Weight: You know you’re going to gain some weight during your pregnancy, and its healthy to do so. But if you are already overweight, this is the time to do something about it. Overweight women are at risk of developing gestational diabetes - this is diabetes that develops during pregnancy. The symptoms usually disappear after the baby is born, but according to the U.S. Centers for Disease Control, about half of all women affected will develop type 2 diabetes later in life. Diabetes occurs when the body does not produce or properly use insulin, a hormone necessary to convert sugar, starches and other food into the energy needed for daily life. With gestational diabetes, a woman is at increased risk of high blood pressure throughout her pregnancy as well as at increased risk of having a large baby and needing a cesarean section at delivery. Being overweight when you’re pregnant also puts you at risk for pre-eclampsia, high blood pressure induced by pregnancy. If not recognized and treated, this condition can progress to eclampsia, the occurrence of convulsions that can lead to coma and can be life-threatening for both mother and baby. Since obesity is a contributing factor in some cases of preeclampsia, it is important to maintain a healthy weight before and during pregnancy. I recommend a balanced diet that consists of 50-60 percent of calories from carbohydrates, 30% from fat, 10-20 percent from protein (preferably whole soy or fish). Remember to buy organic foods whenever possible.

Deciding to have a baby is a big step in any woman’s life. I hope I’ve outlined for you some of the things you should be thinking about in advance of becoming pregnant. If you’re confident that you are in good health and are taking steps to avoid those things that could negatively affect your baby’s health, you - and your baby - will have an excellent chance of starting your life together in health and happiness.


Andrew Weil, M.D.