Preconception

Preconception Tips

  1. Get a preconception checkup. Your OB/GYN will help you know how best to stop your current birth control and will evaluate your overall well-being, including offering genetic counseling, to ensure that you have the healthiest pregnancy possible.
  2. Eat a healthy diet and maintain a healthy body weight. Eating foods rich in vitamins and minerals makes for a healthier mom and baby, and being over- or under-weight can also impair fertility.
  3. If you smoke, stop. Smoking not only inhibits fertility, it damages the unborn baby and is dangerous for newborns as well. Just quit now.
  4. Avoid alcohol. A good rule of thumb: If you wouldn’t give it directly to your baby, don’t put it in your body either!
  5. Take prenatal vitamins. Experts recommend taking prenatal vitamins three months before conception (and all during your pregnancy) to provide the extra folic acid your body needs to protect your unborn baby from some birth defects. There may be a cost benefit to getting a prescription for your prenatal vitamins, so check with your insurer and talk to your May-Grant provider.
  6. Stay active. Being physically active before and during pregnancy many benefits, including helping maintain a healthy weight and being fit for delivery. Talk to your provider about how to incorporate exercise if you are not currently active.
  7. Get to know your cycle. Knowing your menstrual cycle (what is “normal” for you) will aid in conception, and help you know right away when it may be time to take that pregnancy test! Clue is an app approved by the American College of Obstetrics and Gynecology and can help you track your period and fertility window each month.
  8. Know when you ovulate. If you monitor when you ovulate, you can time intercourse to maximize your chances of conception.
  9. Have sex right before you ovulate and wait 15 minutes after sex before getting up. But, certain sexual positions don’t increase your chances, so just do whatever is most comfortable!
  10. Try to keep stress level low. Trying to conceive can be stressful, but pregnancy is more likely to occur when couples are relaxed, and less likely during months when the couples felt tense or depressed. Taking time for yourself every day, exercising, journaling, getting massages, talking with your partner, and getting enough sleep can make it easier to unwind.

Asthma and Pregnancy

Asthma and Pregnancy

Now that you’re pregnant, you may be concerned about how asthma will affect your health and the health of your baby. But asthma doesn’t have to stop you from having a healthy pregnancy. Managing your asthma can keep you and your baby healthy.

Why managing asthma is important during pregnancy

When you’re pregnant and have an asthma flare-up, it affects both you and your baby. The baby gets oxygen from your blood to grow and develop normally. Severe asthma can cause problems getting oxygen to your baby. When asthma isn’t controlled, problems that can develop include:

  • Baby being born too early (prematurity)
  • Need to deliver by C-section
  • Baby being smaller than normal
  • High blood pressure and/or preeclampsia in the mother

Work with your healthcare providers to manage your asthma

You likely have a healthcare provider (HCP) who helps you manage your asthma. During your pregnancy, continue to see this HCP regularly. He or she can continue to monitor your asthma. And medicines can be adjusted as needed. Be sure that this HCP is in contact with the HCP who is caring for your pregnancy. Also be sure both providers know what asthma medicines you take. If you don’t have an HCP taking care of your asthma, tell the provider who cares for your pregnancy.

Prevent flare-ups

Here are tips to prevent flare-ups:

  • Continue using asthma medicines as prescribed.  Follow your HCP’s instructions about using asthma medicines. These will likely be inhaled medicines. These have little or no chance of harming you or your baby.
  • Monitor your lung function. Lung function tests help measure how well your lungs are working. The test results tell you and your providers whether you are getting enough oxygen. You may be tested at your provider’s office or at a hospital. You may also be instructed to monitor yourself at home. This is done using a peak flow meter. Your provider will tell you when and how often you need to use the meter.
  • Control asthma triggers. These are things that cause your airways to react and lead to an asthma attack (flare-up). Triggers can include smoke, scents, and chemicals. They also include allergies to things like pollen, pets, and dust mites. A flare-up can also be triggered by exercise and changes in the weather. Having a cold or the flu can also trigger a flare-up. To prevent the flu, get a flu shot. If you’ve been getting allergy shots, you should continue to do so. However, you should not get allergy shots for the first time when you’re pregnant.

Monitor the health of your baby

Your HCP will monitor your baby’s health closely during your pregnancy. If your asthma is not well controlled, this becomes even more important. So be sure to keep all your prenatal appointments. Monitoring includes:

  • Regular ultrasound tests. Ultrasound is a safe test that allows you and your HCP to see an image of your baby in the womb. The ultrasound shows your baby’s development, including whether the baby’s organs are growing normally.
  • Fetal nonstress test. This test may be done when you are around your third trimester. It checks if your baby is receiving enough oxygen by monitoring the baby’s heart rate. Normally, a baby’s heart rate goes up when the baby moves. If the baby’s activity is low, it may mean that the baby isn’t getting enough oxygen.
  • Fetal movement counting. Your HCP may tell you to track your baby’s movements by doing “fetal kick counts.” This is done by counting the number of movements (kicks) that the baby makes over a certain period. Your provider will let you know how often to count. You’ll also be told when you should call him or her. If the baby’s movement pattern changes or decreases, more tests will likely be done to check the baby’s health.

Know your plan for labor and delivery

Before your due date, talk with your HCP about your labor and delivery plan. You will likely continue taking your asthma medicines during this time. These prevent a flare-up. They can also help relieve a flare-up if you have one. Your provider will tell you more about this.

When to call your healthcare provider

Call your HCP right away if any of the following happen:

  • You have wheezing that does not go away after you take medicine.
  • Your asthma medicines stop working.
  • You cough up bloody, green, or yellow mucus (signs of a lung infection).
  • You develop a temperature above 100.4°F (38°C) with shortness of breath or a cough.
  • Your baby’s movement pattern changes or decreases.
Information from Kramesonline

Obesity and Pregnancy

Being overweight is defined as having a body mass index (BMI) of 25–29.9. Obesity is defined as having a BMI of 30 or greater. Within the general category of obesity, there are three levels that reflect the increasing health risks that go along with increasing BMI:

Lowest risk is a BMI of 30–34.9.

Medium risk is a BMI of 35.0–39.9.

Highest risk is a BMI of 40 or greater.

You can calculate your BMI using the following formula: BMI = (Weight in Pounds / (Height in inches x Height in inches)) x 703 or using an online BMI calculator.

Does being obese during pregnancy put me at risk of any health problems?

Obesity during pregnancy puts you at risk of several serious health problems:

  • Gestational diabetes is diabetes that is first diagnosed during pregnancy. This condition can increase the risk of having a cesarean delivery. Women who have had gestational diabetes also have a higher risk of having diabetes in the future, as do their children. Obese women are screened for gestational diabetes early in pregnancy and also may be screened later in pregnancy as well.
  • Preeclampsia is a high blood pressure disorder that can occur during pregnancy or after pregnancy. It is a serious illness that affects a woman’s entire body. The kidneys and liver may fail. Preeclampsia can lead to seizures, a condition called eclampsia. In rare cases, stroke can occur. Severe cases need emergency treatment to avoid these complications. The baby may need to be delivered early.
  • Sleep apnea is a condition in which a person stops breathing for short periods during sleep. Sleep apnea is associated with obesity. During pregnancy, sleep apnea not only can cause fatigue but also increases the risk of high blood pressure, preeclampsia, eclampsia, and heart and lung disorders.

Does being obese during pregnancy put my baby at risk of any problems?

Obesity increases the risk of the following problems during pregnancy:

  • Pregnancy loss—Obese women have an increased risk of pregnancy loss (miscarriage) compared with women of normal weight.
  • Birth defects—Babies born to obese women have an increased risk of having birth defects, such as heart defects and neural tube defects.
  • Problems with diagnostic tests—Having too much body fat can make it difficult to see certain problems with the baby’s anatomy on an ultrasound exam. Checking the baby’s heart rate during labor also may be more difficult if you are obese.
  • Macrosomia—In this condition, the baby is larger than normal. This can increase the risk of the baby being injured during birth. For example, the baby’s shoulder can become stuck during delivery. Macrosomia also increases the risk of cesarean delivery. Infants born with too much body fat have a greater chance of being obese later in life.
  • Preterm birth—Problems associated with a woman’s obesity, such as preeclampsia, may lead to a medically indicated preterm birth. This means that the baby is delivered early for a medical reason. Preterm babies are not as fully developed as babies who are born after 39 weeks of pregnancy. As a result, they have an increased risk of short-term and long-term health problems.
  • Stillbirth—The higher the woman’s BMI, the greater the risk of stillbirth.

If I am overweight or obese, should I plan to lose weight before getting pregnant?

Losing weight before you become pregnant is the best way to decrease the risk of problems caused by obesity. Losing even a small amount of weight (5–7% of your current weight, or about 10–20 pounds) can improve your overall health and pave the way for a healthier pregnancy.

How can I lose weight safely?

To lose weight, you need to use up more calories than you take in. You can do this by getting regular exercise and eating healthy foods. Your obstetrician may refer you to a nutritionist to help you plan a healthy diet. Increasing your physical activity is important if you want to lose weight. Aim to be moderately active (for example, biking, brisk walking, and general gardening) for 60 minutes or vigorously active (jogging, swimming laps, or doing heavy yard work) for 30 minutes on most days of the week. You do not have to do this amount all at once. For instance, you can exercise for 20 minutes three times a day.

Can I still have a healthy pregnancy if I am obese?

Despite the risks, you can have a healthy pregnancy if you are obese. It takes careful management of your weight, attention to diet and exercise, regular prenatal care to monitor for complications, and special considerations for your labor and delivery. There may be additional tests and consultations that need to be performed to monitor you for complications.

How much should I exercise during pregnancy?

If you have never exercised before, pregnancy is a great time to start. Discuss your exercise plan with your obstetrician to make sure it is safe. Begin with as little as 5 minutes of exercise a day and add 5 minutes each week. Your goal is to stay active for 30 minutes on most—preferably all—days of the week. Walking is a good choice if you are new to exercise. Swimming is another good exercise for pregnant women. The water supports your weight so you can avoid injury and muscle strain. It also helps you stay cool.

How will my weight be monitored during pregnancy?

Your weight will be tracked at each prenatal visit. The growth of your baby also will be checked. If you are gaining less than the recommended guidelines, and if your baby is growing well, you do not have to increase your weight gain to catch up to the guidelines. If your baby is not growing well, changes may need to be made to your diet and exercise plan.

Recommended weight gain is based on your BMI:

  • BMI of 18-24.9: gain 25-35lbs total
  • BMI of 25-29.9: gain 15-25lbs total
  • BMI of 30 and greater: gain 10-20lbs total

How does obesity affect labor and delivery?

Overweight and obese women have longer labors than women of normal weight. It can be harder to monitor the baby during labor. Obesity during pregnancy increases the likelihood of having a cesarean delivery. If a cesarean delivery is needed, the risks of infection, bleeding, wound problems and other complications are greater for an obese woman than for a woman of normal weight. Obese women are also at increased risk for developing DVT (blood clots in their veins).

How can I manage my weight after my baby is born?

Once you are home with your new baby, stick to your healthy eating and exercise habits to reach a normal weight. Breastfeeding is recommended for the first year of a baby’s life. Not only is breastfeeding the best way to feed your baby, it also may help with postpartum weight loss. Overall, women who breastfeed their babies for at least a few months tend to lose pregnancy weight faster than women who do not breastfeed.

(Adapted from American College of Obstetricians and Gynecologists; FAQ182, April 2016)

Pregnancy After Bariatric Surgery

There are two categories of bariatric (weight loss or gastric bypass) surgery: restrictive and malabsorptive. Restrictive surgery limits the amount of food you can eat. Malabsorptive surgery changes the size of the intestine itself, which changes the way you digest food and absorb nutrients. There is also surgery that is a combination of restrictive and malabsorptive. If you become pregnant after bariatric surgery, you will have special nutritional needs that can affect the health of your pregnancy and your baby.

How Does Bariatric Surgery Change My Diet?

The portions of the stomach and intestine that are no longer used after bariatric surgery are where calcium, iron, folic acid, and vitamins B and D are absorbed into the body. You will need to take daily multivitamin supplements of these important nutrients to stay healthy.

You also need to learn to chew your food thoroughly and eat very slowly, because your stomach cannot hold large amounts of food. If you eat too much too quickly, you may feel nauseous (sick to your stomach) and vomit (throw up). You will also need to drink fluids often so you do not become dehydrated.

There is also a condition called ‘‘dumping syndrome’’ that occurs when you eat something too sugary, like candy. Dumping syndrome causes gas pain and diarrhea.

Can I Get Pregnant After Bariatric Surgery?

Yes. In fact, the weight loss after surgery can make it more likely for a woman to get pregnant than it was before she had this surgery. This is especially true if being overweight was part of why she could not get pregnant.

How Soon After Bariatric Surgery Can I Get Pregnant?

Experts recommend you wait at least 12 to 18 months after bariatric surgery before getting pregnant. By that time, your weight loss should have stopped or stabilized (evened out). If you have had bariatric surgery and you are planning to have a baby, it is very important to see a health care provider before you become pregnant.

 Things to Consider Before Becoming Pregnant

  • Am I meeting my nutritional needs?
  • Am I taking a multivitamin regularly before trying to get pregnant?   Do I have any psychosocial needs or medical conditions to address?

 Things to Discuss With Your Health Care Provider Before Becoming Pregnant

  •   What kind of bariatric surgery you had
  •   How much weight you have lost and how stable your weight is now
  •   Any problems you have had since surgery
  •   The adequacy of your storage of iron, calcium, and B vitamins, especially folate (folic acid)

How Will Bariatric Surgery Affect My Pregnancy?

Before you become pregnant, and a few times during your pregnancy, the following may occur:

  • Bloodworktocheckyouriron,folate,calcium,andvitaminstatus.Youmayneedotherbloodworkifyou have medical problems or take medications regularly.
  • Your health care provider will monitor your weight gain and might ask you to keep a food journal.
  • You may be offered additional ultrasound scans to make sure that your baby is developing and
  • growing well.
  • Because of dumping syndrome, you might need to use a different form of testing for gestational diabetes.

Symptoms of possible problems during pregnancy that are related to your surgery include feeling sick, throwing up, stomach pain, heartburn, or cramping. If you have these symptoms, be sure to tell your pro- vider and remind him/her that you have had bariatric surgery.

(Information from the Journal of Midwifery)

Smoking During Pregnancy

SMOKING DURING PREGNANCY 

KEY POINTS

  • Smoking during pregnancy can cause problems for your baby, like premature birth.
  • If you’re pregnant, don’t smoke and stay away from secondhand and thirdhand smoke.
  • If you need help to quit smoking, tell your health care provider.

Why is smoking during pregnancy harmful?

Smoking during pregnancy is bad for you and your baby. Quitting smoking, even if you’re already pregnant, can make a big difference in your baby’s life. Smoking harms nearly every organ in the body and can cause serious health conditions, including cancer, heart disease, stroke, gum disease and eye diseases that can lead to blindness.

How can smoking affect your pregnancy?

If you smoke during pregnancy, you’re more likely than nonsmokers to have:

  • Preterm labor. This is labor than starts too early, before 37 weeks of pregnancy. Preterm labor can lead to premature birth.
  • Ectopic pregnancy. This is when a fertilized egg implants itself outside of the uterus (womb) and begins to grow. An ectopic pregnancy cannot result in the birth of a baby. It can cause serious, dangerous problems for the pregnant woman.
  • Bleeding from the vagina
  • Problems with the placenta, like placental abruption and placenta previa. The placenta grows in your uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. Placental abruption is a serious condition in which the placenta separates from the wall of the uterus before birth. Placenta previa is when the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina.

How can smoking affect your baby?

Tobacco is a plant whose leaves are used to make cigarettes and cigars. Tobacco contains a drug called nicotine. Nicotine is what makes you become addicted to smoking. When you smoke during pregnancy, chemicals like nicotine, carbon monoxide and tar pass through the placenta and umbilical cord into your baby’s bloodstream.

These chemicals are harmful to your baby. They can lessen the amount of oxygen that your baby gets. This can slow your baby’s growth before birth and can damage your baby’s heart, lungs and brain.

If you smoke during pregnancy, your baby is more likely to:

  • Be born prematurely. This means your baby is born too early, before 37 weeks of pregnancy. Premature babies are more likely than babies born on time to have health problems.
  • Have birth defects, including birth defects in a baby’s mouth called cleft lip or cleft palate. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. They can cause problems in overall health, in how the body develops or in how the body works.
  • Have low birthweight. This means your baby is born weighing less than 5 pounds, 8 ounces.
  • Die before birth. If you smoke during pregnancy, you’re more likely to have a miscarriage or a stillbirth. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Stillbirth is when a baby dies in the womb after 20 weeks of pregnancy.
  • Die of sudden infant death syndrome (also called SIDS). This is the unexplained death of a baby younger than 1 year old.

What is secondhand smoke?

Secondhand smoke is smoke you breathe in from someone else’s cigarette, cigar or pipe. Being around secondhand smoke during pregnancy can cause your baby to be born with low birthweight.

Secondhand smoke also is dangerous to your baby after birth. Babies who are around secondhand smoke are more likely than babies who aren’t to have health problems, like pneumonia, ear infections and breathing problems, like asthma, bronchitis and lung problems. They’re also more likely to die of SIDS.

What is thirdhand smoke?

Thirdhand smoke is what’s left behind from cigarette, cigar and pipe smoke. It can include lead, arsenic and carbon monoxide. It’s what you smell on things like clothes, furniture, carpet, walls and hair that’s been in or around smoke. Thirdhand smoke is why opening a window or smoking in another room isn’t enough to protect others when you smoke.

If you’re pregnant or a new mom, stay away from thirdhand smoke. Babies who breathe in thirdhand smoke may have serious health problems, like asthma and other breathing problems, learning problems and cancer.

Is it safe to use e-cigarettes during pregnancy?

Electronic cigarettes (also called e-cigarettes or e-cigs) look like regular cigarettes. But instead of lighting them, they run on batteries. E-cigarettes contain liquid that includes nicotine, flavors (like cherry or bubble gum) and other chemicals. When you use an e-cigarette, you puff on a mouthpiece to heat up the liquid and create a mist (also called vapor) that you inhale. Using an e-cigarette is called vaping.

More research is needed to better understand how e-cigarettes may affect women and babies during pregnancy. Some studies show that e-cigarette vapor may contain some of the harmful chemicals that are found in regular cigarettes. Flavors and other chemicals used in e-cigarettes also may be harmful to a developing baby. If you’re pregnant and using e-cigarettes or thinking about using them, talk to your health care provider.

Just like regular cigarettes, you can become addicted to e-cigarettes. If you drink, sniff or touch the liquid in e-cigarettes, it can cause nicotine poisoning. Signs or symptoms of nicotine poison include feeling weak, having breathing problems, nausea (feeling sick to your stomach) and vomiting. Nicotine poisoning can be deadly. Liquid nicotine in e-cigarettes comes in different flavors and is sold in small tubes that may be bright and colorful. This may make e-cigarettes seem fun and appealing, especially to children.

Can you just cut down on smoking? Or do you have to quit?

If you smoke, you may think that light or mild cigarettes are safer choices during pregnancy. This is not true. Or you may want to cut down rather than quit smoking altogether. It’s true that the less you smoke, the better for your baby. But quitting is best.

The sooner you quit smoking during pregnancy, the healthier you and your baby can be. It’s best to quit smoking before getting pregnant. But quitting any time during pregnancy can have a positive effect on your baby’s life.

Besides, when you quit smoking, you never again have to go outside and look for a place to smoke. You also may have:

  • Cleaner teeth
  • Fresher breath
  • Fewer stains on your fingers
  • Fewer skin wrinkles
  • A better sense of smell and taste
  • More strength and energy to be more active

What are some tips to help you quit smoking?

Try these tips to help you quit smoking:

  • Write down your reasons for quitting. Look at the list when you think about smoking.
  • Choose a quit day. On this day, throw away all your cigarettes or cigars, lighters and ashtrays.
  • Ask your partner or a friend to help you quit. Call that person when you feel like smoking. Stay away from places, activities or people that make you feel like smoking.
  • Keep yourself busy. Go for a walk to help keep your mind off smoking. Use a small stress ball or try some needlework to keep your hands busy. Snack on veggies or chew gum to keep something in your mouth.
  • Drink lots of water.
  • Ask your health care provider about things to help you quit, like patches, gum, nasal spray and medicines. Don’t start using these without your health care provider’s OK, especially if you’re pregnant.
  • Look for programs in your community or where you work that can help you stop smoking. These are called smoking cessation programs. Ask your health care provider about programs in your area. Ask your employer to see what services are covered by health insurance.

Don’t feel badly if you can’t quit right away. Keep trying! You’re doing what’s best for you and your baby.

Information from the March of Dimes