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Monday, November 10, 2014

Plan Your Pregnancy Tips

When are you going to have a baby is the first step in planning your pregnancy. In Mexico the average age of first pregnancy is just over 21, in the UK it's closer to 29 on average, in the US we are something between those two, so think over your reproductive life plan, how are you going to fit baby into your school, job, or marriage plans if any. Then get physical and get ready to do what it takes to get ready for the conception, prenatal days, the birth and the life with baby. Planning your pregnancy by some simple tests to insure your health, and relatively simple steps is more likely to result in getting pregnant more quickly and having a healthier baby and pregnancy. A new study says that preconception care has potential for return on investment. Women with chronic illnesses have the most to gain from planning their pregnancies, and yet they the least likely to plan their pregnancy according to this new study, and thus enter pregnancy less likely to maximize their chance for a healthy outcome.
  • See your gyno to discuss any medical concerns, especially missed or menstrual periods, what your gyno likes is data! So get a calendar, and app, or a tracker
  • Normalize your weight (as much as possible) and boost your nutrition, this is a time for basic vitamin use, pregnancy vitamin guidelines can be found on line
  • When you track your cycles figure out if you are ovulating, simple tests are available in the drug store or with free apps, fertility problems respond best to early treatment
  • Treat anemia, get iron in your diet to improve your iron stores, begin folic acid and begin Vitamin D if you have blood level deficiency, and this is a time of your life you may have to consider eating meat  if you are vegetarian, read ACOG nutrition recommendations
  • Take omega-3s, or eat more fish (check locally regarding fish mercury recommendations)
  • Track your blood pressure, blood sugar, and your BMI, get any hypertension, diabetes, obesity (ideally) get these treated before conceiving, it will lower your miscarriage and birth defect rate
  • Treat any vaginal or bladder infections, discharge and odor, see your gyno if you have questions
  • Decrease toxin exposure, minimizing red meet can also reduce hormone exposure, toxins can be found in unregulated supplements, always check with your health care provider for questions
  • Get a visit and perhaps blood testing to confirm vaccinations still are current, and catch up on vaccines prior to pregnancy as some cannot be given when you are pregnant
  • Get tested for Herpes if symptoms are suspicious, and get on suppressive medication if your gyno thinks it is indicated
  • Ask your family and his family about any known genetic problems, and get blood genetic testing for you and the baby's dad; there are so many options, consultation can lead you to many sources of information, it is not legal to be discriminated against on the basis of genetic information, so that is not a reason to not test
  • Exercise regularly, and take up swimming and yoga which can be carried as your exercise all through pregnancy
  • Drag the baby daddy in and get any problems with him sorted, his health will impact fertility, miscarriage rate, birth defects, and stress levels 
  • Make time for sex! 
  • Get a good home pregnancy test, there are some that turn positive before the missed period and estimate how far pregnant you are

And most commonly, is weight and nutrition management first. Anemia, vitamin D deficiency and obesity are all associated with subfertility, as well as miscarriages, growth disorders for the fetus, birthing problems, diabetes and hypertension, just to name a few of the issues. It is not known exactly why obese patients have trouble conceiving. Women who are obese and have polycystic ovarian disease (PCOS) are less likely to ovulate and conceive. But women who are obese without PCOS are also less likely to ovulate than the average person due to increased insulin resistance (your body not responding to insulin as normal women do), and that treating this will increase fertility.  Miscarriages also called Spontaneous abortions (SAB) and recurrent SAB are also associated with obesity. We don't know if this is more related to insulin and sugar levels, how you process carbohydrates, or if in fact it could be related to the level of inflammation in your blood. And those women who also have diabetes secondary to obesity are particularly prone to risk. In some states the diabetes rate is already over 10%. New criteria for the diagnosis of diabetes in pregnancy likely is going to push the rate of diabetes to over 20% of all pregnancies. Those states right now that have diabetes rates of over 10% are Texas, Alabama, Tennessee, Georgia and West Virginia. And if you do not lose weight we therefore will see that getting pregnant when you are obese puts both mom and baby at risk. 
Obesity has risks other than miscarriages and diabetes, they also have more risk for hypertension, preeclampsia, gestational diabetes, thrombophlebitis, preterm or post term delivery, abnormal labor, c-sections, and complications of c-sections. 
When you are obese and pregnant your body doesn't pass nutrients to the baby as effectively. Moms who are obese will preferentially put on midline fat in the last trimester, and that this is not necessarily beneficial for the developing fetus. Hypertension and diabetes as well as labor abnormalities are associated with obesity during pregnancy. Moms who are obese or diabetic also at more risk to have pre-eclampsia and to have the most severe forms of PEC.  Stillbirth rates are increased 2.6 fold in women with obesity.  If an obese woman receives surgery, such as a C-section, it is more likely she will have a complication of that surgery, including increased risks with anesthesia and/or bleeding and infection. So see your gyno first. We want to know about your sugar processing, your nutrition, your overall fitness as well as whether you are overweight. There maybe ways we can, through blood testing, find out if you are fit for your weight as well as ready for a pregnancy. If you can effectively post pone pregnancy until you have normalized your weight, or at least gotten closer to a normal weight, you will likely have a much healthier and happier pregnancy. If you develop hypertension in pregnancy, there are new guidelines as to how to minimize the effects on the pregnancy, but it is still important to try to become healthy, before you become pregnant.

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