Are you planning pregnancy? In the UK many women in heterosexual relationships spend a great deal of time avoiding becoming pregnant. Contraceptive services are widely and freely available. However, becoming pregnant should not simply be a question of no longer using contraception, even for fertile heterosexual couples. For many people there are specific issues relating to fertility and conception, but for anyone planning pregnancy there are some things you should consider. This post addresses some of the issues for intending biological parents. There may be specific issues for those in less traditional situations and/or for people using assisted conception or donors and I am always glad to offer information and advice about your specific situation.

Growing a baby is one of the most physically challenging things that the body ever does, so it makes sense to think about whether you are fit enough to be pregnant. Living with a baby who them becomes a demanding and busy toddler is easier if you are fit and well too! It is known that fertility tends to be reduced in people who have a raised BMI, and being pregnant with a raised BMI can be very challenging for the heart and cardiovascular system. A healthy eating programme combined with gradually increasing exercise is ideal. Rapid weight loss can lead to temporarily reduced fertility, as can having an unusually low BMI, because nature wants to avoid babies being born in a time of famine. Psychological and emotional health are also important and many clients come to me with issues they need to discuss and address.

If you currently take any regular medicines you should contact the prescriber of the medication or a pharmacist to let them know that you are planning pregnancy and to check if any changes or special precautions are needed. Longterm medical issues such as epilepsy, diabetes or heart problems may require special attention. There is little clear evidence about the effect of recreational drugs and “over the counter” medications, but there are many questions about their safety and so my advice is to avoid them. If you are thinking of taking any medicine, always read the information leaflet first.

Folic acid is involved in the formation of the neural tube in the first few weeks of pregnancy. Taking folic acid supplements for 3 months before conception and for the first 12 weeks of pregnancy can reduce the risk of conditions such as spina bifida and anencephaly. For most people the recommended dose is 400mcg daily and these can be bought without prescription in pharmacies and supermarkets. In some situations, such as if your BMI is raised or you take certain medications, an increased dose of 5mg is recommended and this needs to be prescribed by your GP. If you eat a varied and balanced diet you probably get a wide range of vitamins and minerals in your diet but you may wish to take preconception vitamins. These are widely available in pharmacies and supermarkets. Different nutrients are needed to optimise eggs or sperm, so look for the relevant product for you. If you are using a donor egg, the intended carrying parent should take the preparation sold for women.

Smoking and alcohol can both impair fertility. Smoking while pregnant (including passive smoking) is known to reduce blood flow through the placenta. Newborn babies exposed to cigarette smoke and the chemical resides have an increased risk of cot death. Now is the time to stop, to improve your health and that of your baby. The effects of alcohol in small amounts is less clear, but prolonged heavy drinking or binge drinking can impair fertility and can affect a baby’s brain development.

Have you had your blood pressure checked recently? If you are due to have a cervical smear (particularly if you have had changes on a smear previously) it is sensible to have this done during your planning time.

If there are health issues affecting your family there can be issues to consider. Haemoglobin variants, such as those that cause thalassaemia and sickle cell disease are only an issue if both parents have a variant. Many people who are carriers of these variants do not know, but your ancestry and/or family history can indicate that this may be a factor to consider. Testing is offered to people who are already pregnant, with testing of the other parent suggested if a variant is identified but it makes more sense to me to do this before pregnancy. If you are using a donor this could be an important factor affecting your choice.

In some cases, if there is a relevant family history genetic testing can be appropriate. I was fortunate to undertake a genetic counselling course at Cambridge University some years ago and so am able to discuss and advise this if appropriate.

There are a number of infections which can cause harm to a baby during pregnancy. Chicken pox is a very common childhood illness and the majority of us will recall having had it, and may have some scars to prove it. A first infection with chicken pox during pregnancy can cause very significant harm to your baby. However, if you do not know if you have had it you can have a simple blood test to check if you have immunity. If you do not, you may wish to have the chicken pox vaccine. This needs to be given at least three months before pregnancy. There is more information here.

It is useful to consider your hobbies and lifestyle too. Infections such as toxoplasmosis may be important to consider if you spend time with animals or gardening. If you are planning to travel in the coming months, bear in mind that some travel vaccines are not safe in early pregnancy. Also make sure that your travel insurance covers pregnancy related issues. You should avoid saunas and hot tubs in pregnancy, even in the very first weeks.

I offer a two hour pre-conception appointment, in your home, to discuss these issues and to provide personalised information. The cost is £165. Check my visiting area here. My aim when you are planning pregnancy is to help you to maximise your chance of achieving a healthy and successful pregnancy. I work with a wide range of people in different situations, some will be able to conceive naturally whilst others will use some form of assisted conception.

Contact me to find out how I can help you when you are planning pregnancy.

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