Preparing for pregnancy

A number of health factors can reduce your chance of conceiving, increase the risk of miscarriage or increase the risk of damage to your developing baby. These risks can often be avoided or minimised by simple precautions before and during pregnancy.

RUBELLA (GERMAN MEASLES)

If you have a rubella infection in the first few weeks of pregnancy, it can affect your baby’s development. You will probably have been immunised against rubella in your early teens. However, unlike a natural rubella infection, immunisation does not necessarily give lifelong immunity. It is therefore important that you have a blood test to check your immunity. If necessary, you will need another immunisation. As the vaccine is a weakened form of the rubella virus, you should avoid trying for a pregnancy for four weeks after­wards. You should then have a repeat blood test to check that the immunisation has been effective.

FOLIC ACID SUPPLEMENTS

If your diet is low in folic acid, you are at increased risk of conceiving a child with spina bifida or similar defects. The Department of Health advises that all women who are planning a pregnancy should take a 400-microgram (0.4-milligram) folic acid supplement daily to reduce this risk. You should begin taking this about four weeks before you start to try for a baby, to build up your folic acid stores, and continue for the first 12 weeks of pregnancy. Folic acid is available over the counter at any pharmacy and in most super­markets. You should also eat more folic acid-rich foods, such as green leafy vegetables and fortified bread or breakfast cereals. If you are taking medicines for epilepsy, or you have had a previous pregnancy affected by spina bifida, consult your GP, as you may need to take a higher dose of folic acid (five milligrams daily).

DIET AND FOOD HYGIENE

A healthy well-balanced diet is important while you are trying to conceive and during pregnancy. If you are vegetarian, you may have reduced reserves of iron, which is mainly found in red meat. You may need to have a blood test to check this before trying for a pregnancy, in case you need to take iron supplements.
Caffeine-containing drinks (coffee, tea and Coca-Cola, for example) taken in above-average amounts can reduce the fertility of men and women. Limit your consumption of these drinks to no more than six cups daily or change to decaffeinated equivalents.
You will need to avoid certain foods during fertility treatment and pregnancy. These include soft, ripened cheeses, especially those made with unpasteurised or raw milk, as these may carry a small risk of infections (such as Listeria) that can lead to miscarriage. Liver and liver products (such as pâtés) should also be avoided. These contain very high levels of vitamin A, which can lead to abnormalities in a developing baby. For the same reason, don’t take food supplements containing vitamin A.

Basic food hygiene is important to minimise any risk of food poisoning. Cook meat and poultry thoroughly and avoid seafood and shellfish. When using a microwave oven for reheating food, make sure the food is piping hot all the way through. Use a separate knife and board for meat and poultry, and clean any work surfaces and wash your hands thoroughly before and after food preparation. Keep raw and cooked foods separate, preferably wrapped or in containers. Store raw meat on the lowest shelf of your refrigerator to avoid juices dripping onto other cooked food.
Some women who are over­weight, particularly those with polycystic ovary syndrome, will be able to improve their chance of pregnancy and reduce their risk of miscarriage by losing weight. Women who are underweight can also increase their chance of conceiving and minimise their risk of pregnancy complications by gaining weight.

TOXOPLASMOSIS AND CHLAMYDIA

Toxoplasmosis is a mild infection in most people. However, if it is passed from a mother to her developing baby during pregnancy, it can cause severe damage, particularly to the baby’s eyes and brain. The parasites called Toxoplasma that cause the infection can be carried by cats, dogs and sheep. If you have a cat, don’t handle or change soiled litter. If this is unavoidable, wear rubber gloves and wash your hands afterwards. You should also wear gloves during gardening, and wash your hands afterwards, as soil can be contaminated with Toxoplasma. Even if your cat or dog is clean and healthy, you should wash your hands after handling them or their food bowls.

Chlamydia causes a sexually transmitted disease. Although it doesn’t always cause symptoms, it can block or damage the fallopian tubes, leading to infertility problems. It may also be responsible for an ectopic pregnancy (when a fertilised egg implants in the fallopian tubes, rather than in the uterus), which can be life threatening. Chlamydia can affect the health of a baby, causing conjunctivitis of the eyes and possibly pneumonia. If you think you are at risk of chlamydia infection, ask your GP for advice. It can be treated with antibiotics.

SMOKING AND ALCOHOL

A couple’s chance of conceiving naturally, or with fertility treatment, is greater if they are both non­smokers, avoid passive smoking and limit their alcohol intake to no more than 6 units weekly or better still, to none at all.

It is best to avoid any drugs during pregnancy, particularly during the first few weeks when most of the important organs in your baby will be developing. If you are taking any medicines, it is important to check with your GP or local fertility clinic that these are not potentially harmful or likely to reduce your fertility.
If you have a chronic medical condition, you may need to have your treatment reviewed or adjusted, before trying for a pregnancy. This is particularly important if you have diabetes, epilepsy, thyroid disease, heart disease or a blood-clotting disorder. In addition, some drug treatments for arthritic problems can reduce your fertility and may need to be altered. You should seek advice from your GP.
Recreational drugs should be avoided while you are trying to conceive and during pregnancy. In particular, cannabis can interfere with ovulation and cocaine crosses the placenta and may lead to addiction for the unborn baby.
The use of anabolic steroids in men will build up muscle mass, but will also shut down the man’s own testosterone and suppress sperm production. They should be avoided if trying to conceive.

FOREIGN TRAVEL

If you plan to travel abroad during pregnancy or fertility treatment, you’ll need to take precautions, particularly with your diet and food hygiene. Some immunisations, such as those for yellow fever, cholera, typhoid and poliomyelitis, use modified live material and should be used only if the risk of infection is high at your destination. In addition, some anti-malarial drugs (such as primaquine and maloprim) are best avoided; with others (such as pyrimethamine), you may need to take a higher dose of folic acid. However, the benefits of preventing malaria greatly outweigh the risk from the disease, and there are alternative safe drugs. Ask your GP or clinic nurse for advice.