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Seventeen things you should do before you try to get pregnant

You've decided to take the plunge into parenthood. But wait just a second or a month or two, at least. To give yourself the best chance for a healthy pregnancy and a healthy baby, there are some important things you need to do before you head down the road to conception.

1. Schedule a preconception visit


You don't have to have a doctor or midwife lined up yet to deliver your baby, but call your ob-gyn, midwife, or family practice doctor now for a preconception checkup. Your practitioner will review your personal and family medical history, your present health, and any medications you're taking. Certain medications are dangerous during pregnancy, and some have to be switched before you even try to conceive because they're stored in your body's fat and can linger there. Your practitioner should also discuss diet, weight, exercise, and any unhealthy habits (such as smoking, drinking, and taking drugs) with you; recommend a multivitamin; make sure you're up to date on your immunizations; test you for immunity to childhood diseases such as chicken pox and rubella; and answer any questions you have. If it's been a year since you had a checkup, you can also expect to have a pelvic exam and a pap smear, and to be tested for sexually transmitted diseases if you're at risk. Many couples may also want to pursue genetic testing for specific conditions, such as sickle cell disease, Tay-Sachs, or cystic fibrosis, based on their ethnic background or family history.

2. Take folic acid (and watch out for vitamin A)


Taking a folic acid supplement is crucial. By taking 400 mcg of folic acid a day for at least one month before you conceive and during your first trimester, you can cut your chances of having a baby with neural-tube defects such as spina bifida by 50 to 70 percent, according to the Centers for Disease Control (CDC). Taking folic acid helps prevent some other birth defects as well. You can buy folic acid supplements at the drugstore, or you can take a prenatal or regular multivitamin. Check the label on multivitamins to make sure they contain the 400 mcg of folic acid you need. Also check to make sure that your multivitamin doesn't contain more than the recommended daily allowance of 770 mcg RAE (2,565 IU) of vitamin A, unless most of it's in a form called beta-carotene. Getting too much of a certain kind of vitamin A can cause birth defects. If you're unsure about what to take, ask your healthcare provider to recommend a supplement.

3. Give up drinking, smoking, and drugs and get help if you need it
If you smoke or take drugs, now's the time to stop. Numerous studies have shown that smoking or taking drugs can lead to miscarriage, premature birth, and low-birthweight babies. Keep in mind that some drugs can stay in your system even after their noticeable effects have worn off. What's more, research suggests that tobacco use can affect your fertility and lower your partner's sperm count. In fact, studies have shown that even secondhand smoke may affect your chances of getting pregnant. Alcohol can also get in the way of getting pregnant, so it's a good idea to cut back when you start trying. Abstain altogether during the last two weeks of your cycle in case you've conceived. Drinking alcohol during pregnancy can cause birth defects and a host of other problems for your developing baby. Stopping unhealthy habits can be very difficult. Don't hesitate to talk with your healthcare provider. She can talk with you about aids for quitting smoking or refer you to a program to help you stop taking drugs, for example. Your local health department may also be able to help by putting you in touch with counselors, group programs, and other assistance.

4. Stock your fridge with healthy foods


You're not eating for two yet, but you should start making nutritious food choices now so that your body will be stocked up with the nutrients you need for a healthy pregnancy. Try to get at least 2 cups of fruit and 2 1/2 cups of vegetables every day, as well as plenty of whole grains and foods that are high in calcium -- like milk, calcium-fortified orange juice, and yogurt. Eat a variety of protein sources, such as beans, nuts, seeds, soy products, poultry, and meats.

5. Give those cups of joe the heave-ho


While there's no consensus on exactly how much caffeine is safe during pregnancy, experts agree that pregnant women and those trying to conceive should avoid consuming large amounts. Some studies have found an association between high caffeine consumption and decreased fertility. And too much caffeine has also been linked to a risk of miscarriage in some (but not all) studies. The March of Dimes advises pregnant women to limit their caffeine consumption to 200 milligrams per day, about the amount in one cup of coffee, depending on the brew. That would be a good goal to aim for now. See a chart showing the amount of caffeine in various coffee brews, other drinks, and select foods, in our article on caffeine during pregnancy.

Which foods and beverages contain caffeine?

Coffee is one, of course. The amount of caffeine in a serving of coffee varies widely, depending on the type of bean, how it's roasted, how it's brewed and, obviously, on the size of the coffee cup. (Although espresso contains more caffeine per ounce, it's served in a tiny cup, so a full cup of brewed coffee will deliver more caffeine.) To manage your caffeine intake, though, you'll need to be aware of other sources, like tea, soft drinks, energy drinks, chocolate, and coffee ice cream. Caffeine also shows up in herbal products and over-the-counter drugs, including some headache, cold, and allergy remedies. Read labels carefully.

What are the concerns about caffeine consumption during pregnancy?


A highly publicized 2008 study found that women who consumed 200 mg or more of caffeine a day had double the risk of miscarriage of those who took in no caffeine. However, not all studies show a link between caffeine consumption and a higher risk of miscarriage. A study in Denmark found that the risk of stillbirth more than doubled in women who drank eight cups of coffee or more each day compared with women who didn't drink coffee. Other research has shown that newborns whose mother consumed more than 500 mg of caffeine a day had faster heart rates and breathing rates and spent more time awake in the first few days after birth. Some studies show an association between high caffeine consumption and a slight reduction in the baby's birth weight, but other research has shown no link. There does not appear to be an association between moderate caffeine consumption and preterm birth. And caffeine consumption does not appear to increase the risk of gestational hypertension or preeclampsia. One thing's for sure: You'll feel better if you don't consume a lot of caffeine. It's a stimulant, so it raises your heart rate. Plus, it can make you feel jittery and cause insomnia. Caffeine can also contribute to heartburn by stimulating the secretion of stomach acid. These effects may be more pronounced as your pregnancy progresses. That's because your body's ability to break down caffeine slows, so you end up with a higher level of it in your bloodstream. During the second trimester, it takes almost twice as long to clear caffeine from your body as when you're not pregnant. During the third trimester, it takes nearly three times as long. This can affect the amount of caffeine that crosses the placenta and reaches your baby, who can't process it efficiently. (This is true for newborn babies as well, which is why it's also a good idea to limit caffeine if you're breastfeeding, especially for the first few months.) Finally, there's one more reason to cut back on coffee and tea, whether it's caffeinated or not. These beverages contain compounds called phenols that make it harder for your body to absorb iron. This is particularly important because many pregnant women are already low on iron. If you have coffee or tea, drink it between meals so it'll have less of an effect on your iron absorption.

Amount of caffeine in common foods and beverages

Coffee coffee, generic brewed coffee, Starbucks brewed coffee, Dunkin' Donuts brewed caff latte, misto, or cappuccino, Starbucks caff latte, misto, or cappuccino, Starbucks espresso, Starbucks espresso, generic coffee, generic instant coffee, generic decaffeinated

Amount 8 oz 16 oz (grande) 16 oz 16 oz (grande) 12 oz (tall)

Caffeine 95-200 mg 330 mg 211 mg 150 mg 75 mg

1 oz (1 shot ) 75 mg 1 oz (1 shot) 64 mg 1 tsp granules 31 mg 8 oz 2 mg

Tea black tea, brewed green tea, brewed black tea, decaffeinated Starbucks Tazo Chai Tea latte instant tea, unsweetened Snapple Lipton Brisk iced tea

Amount 8 oz 8 oz 8 oz 16 oz (grande) 1 tsp powder 16 oz 12 oz

Caffeine 47 mg 25 mg 2 mg 95 mg 26 mg 42 mg 5 mg

Soft drinks Coke Diet Coke Pepsi Diet Pepsi Jolt Cola Mountain Dew 7-Up Sierra Mist Sprite

Amount 12 oz 12 oz 12 oz 12 oz 12 oz 12 oz 12 oz 12 oz 12 oz

Caffeine 35 mg 47 mg 38 mg 36 mg 72 mg 54 mg 0 mg 0 mg 0 mg

Energy drinks

Amount Caffeine

Red Bull SoBe Essential Energy, berry or orange 5-Hour Energy

8.3 oz 8 oz 2 oz

77 mg 48 mg 138 mg

Desserts dark chocolate (70-85% cacao solids) milk chocolate coffee ice cream or frozen yogurt hot cocoa chocolate chips, semisweet chocolate milk

Amount 1 oz 1.55-oz 8 oz 8 oz 4 oz 8 oz

Caffeine 23 mg 9 mg 2 mg 8-12 mg 53 mg 5-8 mg

6. Get your weight in check


You may have an easier time conceiving if you're at a healthy weight. Having a low or high body mass index (BMI) makes it harder for some women to become pregnant. (In one study, having a BMI below 20 or over 24 negatively affected fertility.) Calculate your BMI. If you're not in a healthy range, losing or gaining weight may give you the boost you need to conceive. Getting to a healthier weight can also help you get your pregnancy off on the right foot. Talk to your healthcare provider about the best way to achieve your weight goals.

7. Pay attention to the fish you eat


If you're a big fan of fish, start watching your intake. While fish is an excellent source of omega-3 fatty acids (which are very important for your baby's brain and eye development), as well as protein, vitamin D, and other nutrients, it also contains mercury, which can be harmful. Most experts agree that pregnant women should eat some fish, and that the best approach is to avoid those fish that are highest in mercury and limit your consumption of all fish. The FDA recommends that women of childbearing age not eat shark, swordfish, king mackerel, or tilefish, and eat no more than 6 ounces (1 serving) of solid white canned tuna per week. Other experts suggest a longer list of fish to avoid. It's also a good idea to avoid fish you've caught in local waters unless you're certain there are no contaminants. The FDA and EPA recommend that pregnant women eat up to 12 ounces (2 servings) a week of fish that are not high in mercury. (Good choices include herring, farm-raised rainbow trout, salmon, and sardines.)

8. Create and follow an exercise program

Start and stick to a fitness plan now, and you'll be rewarded with a healthy body that's fit for pregnancy. Plus, working up a little sweat is a great way to relieve the stress that can get in the way of getting pregnant. A healthy exercise program includes 30 minutes or more of moderate exercise, such as walking or cycling and weight training, on most days of the week. To increase flexibility, try stretching or yoga, and you'll have a really well-rounded fitness program. Once you're pregnant, it's okay even recommended to continue exercising. (That's unless if you have pregnancy complications and have been told not to, of course.) If exercising hasn't been a priority for you lately, you'll need to ease into an exercise routine. Start with something tame, like walking ten to 20 minutes a day. Add more activity into your daily routine by taking the stairs instead of the elevator or parking your car a few blocks away from work.

9. See your dentist


When you're preparing for pregnancy, don't forget about your oral health. Hormonal shifts during pregnancy can make you more susceptible to gum disease. Increased progesterone and estrogen levels can cause the gums to react differently to the bacteria in plaque, resulting in swollen, red, tender gums that bleed when you floss or brush. The good news is that women who take care of their periodontal health before they get pregnant cut down on their chances of experiencing gum complications in pregnancy. See your dentist for a checkup and a cleaning now if you haven't done so in the last six months.

10. Get in touch with your medical roots


Find out what you can about your and your partner's family medical history, including any genetic or chromosomal disorder like Down syndrome, sickle cell anemia, cystic fibrosis, Tay-Sachs disease, or bleeding disorders. You'll also want to know if any relatives have mental retardation or other developmental delays or were born with an anatomical birth defect, like a cardiac or neural tube defect. Your practitioner will ask you a series of questions at your preconception visit, and your answers will help determine whether specific prenatal tests should be recommended, or if you or your partner should consider genetic counselingbefore you even start trying.

11. Consider money matters


According to a 2009 report from the U.S. Department of Agriculture, families in the middleincome group will spend $286,050 to raise a child from birth through age 17. Find out how much you're likely to spend with our Cost of Raising a Child Calculator. For the more immediate future, you'll want to consider the cost of pregnancy and delivery. Without insurance, a typical vaginal delivery can cost about $9,000 and a cesarean section about $15,000. Neonatal intensive care can cost $2,000 to $3,000 a day.

If you have health insurance, give the company a call and find out what kind of prenatal coverage they offer. If you're lucky enough to have a choice of plans, compare coverage and providers. If you have a particular doctor or midwife in mind, find out if she's in your plan or how much it would cost to go out of network for her care. Find out what your deductibles are for prenatal visits and delivery, and ask what tests and procedures your insurance covers. If you have a high deductible, try to put a little aside now so you won't be slammed with exorbitant bills when the baby arrives. If you're one of the millions of women without health insurance, contact your local health department to see what programs and resources are available in your area to help pregnant women and babies get the medical care and other services they need. Call 1-800-311-BABY (1-800-311-2229) to be connected to your local Health Department. (For Spanish, call 1-800504-7081.)

12. Consider your mental health


Women who suffer from depression are twice as likely to have problems with fertility as women who don't, according to Alice Domar, director of the Domar Center for Mind/Body Health at Boston IVF. As she points out, "If someone is clinically depressed, she can barely take care of herself, much less a baby. From an evolutionary point of view, it makes sense that it's hard to get pregnant when you're depressed." Domar suggests that all women, but especially those with a personal or family history of depression, do a mental health check before they get pregnant. If you notice signs of depression, such as a loss of interest and pleasure in things that you used to enjoy, a change in appetite, a change in sleep pattern, a loss of energy, or feelings of hopelessness and worthlessness, ask your practitioner for a referral to a therapist or psychiatrist for a consultation. The two most effective treatments for depression are cognitive-behavioral therapy (CBT) and medication, and many patients do best with a combination of both. If medication becomes necessary, a psychiatrist can help you find an antidepressant that's safe to take while you're trying to conceive and during your pregnancy. You also may want to try stress management techniques, such as yoga and meditation, which research suggests can help depressed women conceive.

13. Avoid infections


It's important to steer clear of infections when you're trying to get pregnant, especially those that could harm your baby-to-be. You'll want to stay away from certain foods such as unpasteurized soft cheeses and other dairy products, cold deli meats, and raw and undercooked fish and poultry. These foods can harbor dangerous bacteria that cause listeriosis, a food-borne illness that can lead to miscarriage or stillbirth. You should also avoid unpasteurized juices because they can contain bacteria such as salmonella or E. coli. Be sure to wash your hands frequently when preparing meals, and make sure your fridge is set between 35 and 40 degrees Fahrenheit (2 and 4 degrees Celsius) and your freezer is at or

below 0 degrees F (-18 degrees C) to keep cold foods from going bad. It's a good idea to wear gloves when digging in the garden or sandbox, and to get someone else to change the litter box to avoid contracting toxoplasmosis, another infection that can be dangerous for a developing baby. Finally, make sure you get a flu shot, to avoid coming down with flu when you're pregnant. Get vaccinated as soon as the vaccine for the coming season becomes available. Getting the flu while pregnant can lead to serious complications, such as pneumonia and preterm labor.

14. Reduce environmental risks


You may not be able to entirely eliminate all environmental dangers, but you can do your best to keep as many of them as possible out of your life now. Some jobs can be hazardous to you and your unborn children, for example. If you're routinely exposed to chemicals or radiation, you'll need to make some changes before you conceive. Also, keep in mind that some cleaning products, pesticides, solvents, and lead in drinking water from old pipes can be dangerous for a developing baby. Talk to your doctor or midwife about your daily routine, and see if you can come up with ways to avoid or eliminate hazards in your home and workplace.

15. Think your decision through


Having a child is a lifetime commitment. Before you try to conceive, consider whether you're ready to take on this responsibility. Some key questions to think about:

Have you thought through how you'll handle childcare responsibilities and balancing work and family? Are you prepared to parent a special-needs child if you have one? If you have a partner, are you both equally committed to becoming parents? If you and your partner have religious differences, have you discussed how they will affect your child?

16. Figure out when you ovulate


Some women simply stop using birth control when they're ready to get pregnant and let fate decide when they'll conceive. Others take a more calculated approach by charting their periods and tracking symptoms to try to pinpoint their fertile days each month. Use our ovulation calculator to get a rough estimate. If you want to be more exact, start charting your basal body temperature (BBT) and the changes in your cervical mucus. Tracking these symptoms over several months can help you figure out when you're ovulating during each cycle. Ovulation predictor kits can also help you figure out when you're ovulating by detecting hormones in your urine, or changes in chloride in the saliva or on the skin, that signal ovulation is about to occur. These kits cost $10 to $50 per cycle and are available at drugstores.

17. Toss your birth control


So you're ready to bid adieu to birth control. For some people, ditching contraception is as easy as moving the condoms or diaphragm to the back of the dresser drawer. But going off hormonal contraception can require a bit more planning. If you've been using the Pill, for example, you may want to finish your current pack to avoid irregular bleeding. It may take a few months for your cycle to return to normal, but many women are fertile the first month after they stop taking the Pill. Some become fertile almost immediately. The same holds true for the contraceptive patch and ring. Some practitioners recommend using a barrier method (such as a condom) until you have a normal period after stopping the Pill, the patch, or the ring. Waiting until you have a normal period can help you establish a more accurate due date and schedule any tests you plan to have in your first trimester. (It's a good idea to start keeping track of your cycles now, if you don't already. You can simply mark on a regular calendar any days you have bleeding.) If you do get pregnant before your periods become regular again, don't be concerned. You can have an early ultrasound to date your pregnancy. If you're using Depo-Provera, it can take up to a year after your last shot for you to start ovulating again, even if your period returns to normal sooner. Find out what you need to know about quitting other kinds of birth control, including IUDs Good luck! If you'd like to share stories and advice, and receive support from other women in the BabyCenter community who're trying to get pregnant, visit our Trying to Conceive forums.

Caffeine
Caffeine is a stimulant that affects people differently. Caffeine can cause nervousness, irritability, anxiety, irregular heartbeats and problems sleeping. How caffeine affects an unborn baby is still under investigation. Some scientists believe caffeine can cause premature or smaller than normal babies or possible birth defects. Precautions

Cut down or eliminate food and drinks that contain caffeine such as coffee, tea, colas and other soft drinks, cocoa and chocolate. Caffeine is an ingredient in many non-prescription medicines such as headache, cold, allergy, and pills made to combat drowsiness. If you have been consuming caffeine in large quantities, gradually decrease your intake. Stopping all at once can cause severe headaches, nausea, fatigue and other symptoms. Check with your health care provider for more information.

Food additives
Precautions Whenever possible, try to minimize your use of:

Processed food items, such as hot dogs. Foods containing sodium nitrate, such as cured meats like ham or bacon. These substances may be carcinogenic (cancer-causing).

Be sure to wash fruits and vegetables and peel carrots to avoid eating pesticides used on farms to kill insects.

Medications and herbs


Some medications and herbs may harm your baby. Before taking any medication or medicinal herbs during your pregnancy, ask your health care provider these questions:

What is this medicine/herb? What does it treat? What are the side effects my baby or I may experience? What is the smallest effective dose? How long will I need to take this medication?

Precautions

Be cautious about using medications that contain multiple ingredients. They are more likely to contain extra substances that may harm your baby.

Saunas and hot tubs


Avoid saunas and hot tubs that maintain a temperature greater than body temperature. They can potentially cause overheating and affect the development of your baby. Precautions

Avoid possible overheating. Check with your health care provider for recommendations.

Video Display Terminals (VDTs)


At this time, there are no solid research findings regarding the effects of computer monitors or Video Display Terminals (VDTs) on a developing baby. Precautions

Reduce your exposure to VDTs whenever possible. Be sure to take frequent stretch breaks and look away from the computer screen whenever possible.

Other precautions and concerns


Rh Negative Mothers and Rhogam If you (mother) are Rh negative and your babys blood is Rh positive there is an Rh incompatibility. Because some of the babys red blood cells leak into your system, your body will produce antibodies to fight the Rh factor as if it were a harmful substance. These antibodies will remain in your body and may affect your next baby. If you are Rh negative, you will be given an injection of Rhogam at about 28 weeks of pregnancy, and within 72 hours after a birth, miscarriage, abortion or amniocentesis. The Rhogam will prevent your body from making these harmful antibodies. If your baby is Rh negative, you will not need Rhogam after delivery. Talk with your health care provider for more information. Preeclampsia Preeclampsia is also called Pregnancy Induced Hypertension (PIH) or toxemia. The cause of Preeclampsia is unknown. It occurs in about 5% of pregnancies and is most common in:

First pregnancies Twin or other multiple pregnancies Women with high blood pressure before 20 weeks of pregnancy Teenage pregnancies Women with diabetes Women who have had preeclampsia during a previous pregnancy

Symptoms of preeclampsia include a rise in blood pressure, protein in your urine and rapid weight gain due to fluid retention. If left untreated, preeclampsia can cause many problems that could be life threatening to you and your baby. Early preeclampsia can be diagnosed during a routine visit with your health care provider. Call your health care provider immediately if you experience blurred vision, headache, upper abdominal pain, rapid weight gain or increased swelling. Gestational Diabetes Gestational diabetes only occurs during pregnancy. The changes in your body during pregnancy can cause your blood sugar (glucose) levels to be high, which can cause problems for you and your baby. You will receive specific education on how to care for yourself if you develop gestational diabetes. It is very important to follow the diet, exercise and blood sugar monitoring plans given to you. Gestational diabetes is most likely to develop if you:

Are overweight Have a family history of diabetes Gave birth to a baby weighing 9 pounds or more Had a baby who died before birth Had gestational diabetes in the past Are of Latin, American Indian, African, Asian or Pacific Islander descent

You and your baby may have the following problems if you don't keep your blood sugar under control:

Baby Big baby Premature birth Jaundice Low blood sugar Stillborn (although this is rare) Mother o High blood pressure o Bladder or kidney infection o Shortness of breath o Harder birth and longer recovery time
o o o o o

Increased chance of cesarean delivery

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