Preconception Health Part 1
My name is Badenan Ibrahim Fathulla and I am delighted to be writing my second article for Nina. I am currently working as a specialist obstetrician and gynaecologist at the Royal Free Teaching Hospital in London. You may remember in my introductory piece I shared that my vision is to help women in poorly resourced places to have a better quality of life. I feel passionately that creating practical guidance ‘sheets’, with information on what we women need to know and do to maintain better health is critical. The ultimate aim is to deliver an up to date information and advice section in a way that is accessible and relevant, as well as being beneficial to the wider family and community also.
I would like to kick off the first in my series from the very beginning – creating optimal physical health, in the stages of preconception. In this first part I will deal relationships, lifestyle choices and physical environment. In part 2, out next week time, I will be discussing medical issues, including necessary immunizations, medication and chronic health problems and how to deal with these when planning a healthy pregnancy.
Please note: All information contained in this article is based on best practice in the UK, with some modifications for women in Iraq, particularly taking in consideration the culture and available resources. Anything you read in my column is up to date and evidence based. However, please be aware that health practices and research are subject to change. I welcome questions, and you can find my Email contact to ask these below.
What is preconception health and why is it important?
Preconception health is a woman’s health before she becomes pregnant. It means knowing how health conditions and risk factors could affect you and your unborn child. These can include foods, lifestyle ‘habits’ and medicines. Certain existing health problems can also significantly affect pregnancy and you need to know how to deal with these.
Essentially, by the time you realize you are pregnant, much of the early development of the embryo (child in the womb) will already have happened; any intervention past these early weeks is therefore likely to be too late. By taking action on health issues and risks before pregnancy, you can prevent problems that might affect you or your baby later.
Half of pregnancies are unplanned and are therefore at greater risk of complications. By taking preconception health seriously and planning ahead, you promote your health as well as giving your child a good start. I, of course, believe that every woman should be thinking about her health whether or not she is planning a pregnancy. However, women are more motivated prior to pregnancy than any other time to achieve changes. I have put together some things you might like to consider in order to help you build a positive parenting future.
- Your husband/ partner
The closer the two of you are the more you’ll be able to share the experience of pregnancy and birth. If you can learn to support each other now, your relationship will be stronger when the baby arrives. You need to understand his feelings and wishes. Just because you are the one who will be carrying the baby doesn’t mean that the pregnancy has no impact on him. Working together and supporting each other will support your well-being and mental health also. A couple of things for discussion might include:
- Do you both want to ‘ be pregnant’?
Pregnancy should be a joint decision. Your partner’s support and encouragement is important. You will feel you are not alone. Also, you will be more likely to get pregnant and have better outcome by making decisions together.
If you are having a regular (2-3 times per week) intercourse without contraception your chance to get pregnant in the first year is 84% and 92% within the second years. Some couple might take longer and need help to conceive. Other than progesterone only injections, contraception methods use previously should not affect your fertility. Discuss your worries and fears; if it takes longer than expected you can deal with it together.
- Life style changes like smoking, alcohol, diet and exercise:
It is easier to change some risky behaviours, like drinking and smoking and not eating healthily, if you do it together. Studies show that men who drink a lot, smoke, or use drugs can have problems with their sperm.
Explore with him any health problems that might need to be addressed; this includes any medication he might be taking. Some medicines have been known to have impact on fertility e.g. steroids.
- His work:
If he works with chemicals or other toxins, he has to be careful not to expose you to them, e.g. fertilizers or pesticides. He should change out of dirty clothes before coming near you. You should handle and wash soiled clothes separately.
- Sexually transmitted diseases:
Your partner might need to be screened for sexually transmitted disease, so as to not so harm you or your baby. You need to discuss this issue with him within cultural sensitivies, without casting blame.
It is good to discuss your family history together. Some inherited conditions are more common in some families. This is particularly important if you are related in any way.
- Make healthy lifestyle choices
It is strongly advised to stop smoking. Women who smoke are more prone to have adverse pregnancy outcome e.g. growth restricted baby, intrauterine death, premature deliver and early placental separation. Passive smokers also risk of sudden infant death. Alternative such as Nicotine replacement therapy (NRT) should only be used if absolutely necessary.
There is uncertainty about safe levels of alcohol consumption. However, drinking alcohol is associated with physical, intellectual and behavioral problems in the baby. If you choose to drink you should not drink more than one to two units of alcohol once or twice a week (8g pure alcohol).
You need to stop using recreational drugs if you want to get pregnant. None have been deemed as safe. If you decide to continue to use drugs you should use a reliable contraceptive method. If you inject drugs you need to check your hepatitis B, C and HIV status before getting pregnant. If you feel you can’t stop alone please seek medical help.
- Check your caffeine intake:
Caffeine is present in chocolate, cola, energy drinks and in coffee and tea. Consumption of large amounts might decrease fertility and increase miscarriages. Stick to one cup of coffee or the equivalent per day. Please also be aware that when substituting with herbal preparations and teas, there may be risks – as not all have been studied.
- Why is your age important?
The best biological age of pregnancy is 20-35 years. Pregnancy before and after is associated with higher risks and problems. The risks of chromosomal abnormalities, such as Downs Syndrome, increase with maternal age and if a pregnancy has been previously affected. Antenatal screening tests can determine risk. Older women are also more likely to have health problems, which might negatively impact the pregnancy.
Inversely, numbers of pregnancies of very young women is growing in the Middle East due to the increase of early marriages. This can impact overall reproductive and mental health of these girls who are unlikely to be physically or mentally prepared to give birth.
You need to exercise regularly. Start with gentle exercise if you have been inactive previously, maintaining a regular exercise is the important thing. Any exercise could be safe prior to pregnancy but you should avoid the vigorous ones when pregnant. You should also avoid the saunas and hot tubs once pregnant (also see healthy eating and BMI below).
If you are living in areas with this service make sure you have it before you get pregnant. In pregnancy, it is difficult to interpret results due to changes on the cervix. Also, many treatments cannot be undertaken during pregnancy.
- Do you need a review for sexually transmitted disease?
If you do have a suspicion that you have been exposed to STDs explain this to w your gynaecologist and have some blood tests and swabs taken. Some of these infections might harm both you and your baby and are better treated prior to pregnancy e.g. chlamydia.
- Have you been to the dentist?
Any oral problems need to be dealt with before getting pregnant as infections are more likely to flare up during pregnancy because immunity levels are lower. It is safer to have dental X-rays and antibiotic prior to pregnancy.
- Why is Folic acid so important?
Taking Folic acid as a supplement is the most preventive measure against birth defect. You should start on 400 micrograms per day three months before getting pregnant and continue for another three months following conception. Diet alone is not sufficiently reliable (green vegetables for example).
Please note, if you have a family history of Neural Tube defect (NTD), or have had a previous pregnancy affected by NTD you are at high risk. This also applies to anyone on epileptic medications, with Coeliac disease, or diabetes. You will notice that high BMIs also qualify as high risk. If you fall into any of these categories you need 5mg daily. Diseases of the blood such as as thalassemia or sickle cell anemia dictate continuous use of the 5mg daily throughout pregnancy.
- What is your weight and why does it matter?
If you have a healthy weight prior to pregnancy you will get pregnant more quickly. There will also be less risk of miscarriage, preterm delivery and having a baby with a congenital abnormality. If you are obese you will be more at risk of needing a caesarean section delivery, developing diabetes, a blood clot, hypertension (high blood pressure) and cardiac problems.
- Your weight and BMI ( Body Mass Index)
Normal weight is defined as a BMI =18.5 kg/m2-24.9 kg/m2
Overweight is defined as a BMI between 25 kg/m2 and 29.9 kg/m2
Obesity is defined as a BMI of 30 kg/m2 or more.
Under weight is BMI =<18.5kg/m2
The body mass index (BMI) is calculated by dividing the body weight in kilograms by the square of the height in metres.
70 kg and 1.7 tall
1.7×1.7 = 2.89
70 / 2.98= BMI 24.2
- If you are obese (BMI of 30 kg/m2 or more) take folic acid 5 mg daily starting at least three months before conception and continuing during the first trimester.
- Similarly if you are underweight may find getting pregnant difficult and be at risk of more pregnancy-related complications.
- Eating Healthily
Whilst it is often impractical to achieve ideal body weight, you should be aware of the increased risk of adverse pregnancy outcomes associated with high weight, particularly at BMIs >40 ( see above). This risk is proportional to a person’s BMI. If you lose 5–10% of your weight (a realistic target), it will have significant health benefits and could increase your chances of becoming pregnant. You and your whole family should always be aiming to eat well. Your child will learn from you.
Here are some ideas to help you achieve this:
- Only a third of your meal should be starch-based foods as bread, potatoes, rice and pasta. You need protein as meat, fish, and chicken in moderations. You need to eat variety of fruit and vegetables.
- You need food rich in iron, calcium and folic acid. What you eat before getting pregnant is essential to have a healthy start.
- If you are vegetarian you might be having some nutritional deficiencies and might need dietary review and advice.
- Review your eating habits.
- Avoid uncooked egg, meat, and fish.
- Avoid unpasteurized milk or soft cheese because of danger of toxoplasmosis and listeriosis
- Avoid liver products, as they are high in vitamin A, which could harm the baby.
- Always wash fruit, vegetable and salad to remove traces of soil. The soil may contain toxoplasmosis, which could damage your baby. Make sure you wash all surfaces and utensils and your hand after preparing raw meat to avoid infection with toxoplasmosis.
- Ready meals should be hot all the way through especially if contain poultry.
- Pregnancy doesn’t mean eating for for two! Quality of food is more important than quantity.
- Your Environment
The environment you live in and the home and work life you have are all important contributory factors to preconception care. Here are some things to consider:
- Some animal might be potential hazards. Cats, farm animals and sheep for example. Wash your hands after gardening and avoid cleaning the cat litter during pregnancy.
- Before using any domestic chemicals always read the product warning and handle with gloves.
- If you are working in a work place with exposure to hazardous substance like infections, chemicals and radiations, you need to have a risk assessment with your employer. You might not wish to discuss that with your employer, in that case obtain information about the risk and search for the potential consequences of exposure.
As I said in my first column, starting today, here at nina-iraq, we have a platform we can speak from. We can use it to share the knowledge we do have. If you have any questions you can contact me directly. If you have anything you would specifically like me to address moving forwards please also get in touch at [email protected].
I look forward to hearing from you!