University of Virginia Health System

Plan Good Health and Fitness before Pregnancy

Would-be moms often want to know the best way to slim down after having a child. But how actively do they seek tips for getting their bodies in great shape before getting pregnant?

Until recently, that part of the baby-making equation had been largely absent from the discussion.

Increasingly, though, maternal health and prenatal-care experts are urging women to improve their health before conceiving.

The hope is that measures taken to bolster a woman's health prior to conception - whether it is reaching an optimal weight, controlling a chronic disease, or boosting overall nutritional health - will improve the odds of having an uncomplicated pregnancy and a healthy baby.

Make a Checklist, Seek Prevention

Dr. Lorey H. Pollack at Mercy Medical Center in Rockville Cenre, New York, has some patients who are very informed and motivated to take better care of themselves before contemplating pregnancy.

Others, though, come in pregnant and say, "By the way, I have diabetes; by the way, I have Lupus; by the way, I have high blood pressure, and they're kind of shocked to find out that's an issue when they're pregnant," says Dr. Pollack.

He blames the medical profession and the media for failing to get the word out.

But recommendations compiled by experts at the Centers for Disease Control and Prevention (CDC) as well as more than 35 government, public, and private partners may help to draw attention to the importance of preconception care.

Dr. Hani K. Atrash at the CDC National Center on Birth Defects and Developmental Disabilities and co-author of the government report, says, "If a woman or couple has decided to conceive, then at least one pre-pregnancy visit is recommended."

Five key recommendations from the experts include:

• Take 400 micrograms of folic acid a day for at least three months before pregnancy to reduce the risk of birth defects.
• Stop smoking and drinking alcohol.
• Consult with a health-care provider to manage any and all medical conditions, including, but not limited to, asthma, diabetes, oral health, obesity, or epilepsy, and maintain up-to-date vaccinations.
• Talk to your physician and pharmacist about any over-the-counter and prescription medicines you are taking, including vitamins and dietary or herbal supplements.
• Avoid exposure to toxic substances or potentially infectious materials at work or at home, such as chemicals, or cat and rodent feces.

Dr. Atrash was also co-editor of a special supplement of the Maternal and Child Health Journal, published last September, devoted entirely to the topic of preconception care.

Research Supports Best Outcome

The movement to intervene prior to conception is based on evidence linking certain factors, such as lack of folic acid, smoking, alcohol misuse, and obesity to unwanted pregnancy outcomes.

"Some of these risk factors have stronger associations with particular adverse outcomes than others," says Dr. Atrash.

"For instance, daily consumption of 400 micrograms of folic acid before or early in pregnancy can reduce the occurrence of neural tube defects [such as spina bifida]," notes Dr. Atrash.

And while single interventions, such as taking folic acid or quitting smoking, are effective in modifying behaviors in pregnancy, "we do not yet know the effectiveness of multiple interventions packaged together in the form of a preconception care model," explains Dr. Atrash.

He says this is mostly because this is a new approach that has not been widely practiced, and we have very little or no data to analyze.

"It's a hard thing to measure," agrees Dr. Pollack. Still, he always tells patients contemplating pregnancy to make an appointment to talk about some of these issues and begin taking steps to address health issues.

"It's always easier to try to prevent a problem than to catch up with it later on," he reasons.

Always consult your physician for more information.