Preconception and Periconception Care and Health

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Preconception health refers to the woman's and man's health before getting pregnant. It’s the health of women and men during their reproductive years, which are the years when they can have a child.

Preconception care is a growing field to improve a woman's and man's health before pregnancy. Preconception or periconception care can have a significant impact on your and your baby's health. Preconception care involves several steps and often starts with meeting with a doctor or another healthcare provider who is experienced in this specialty, before pregnancy.

In general, preconception counseling usually consists of an assessment of the health of both potential parents, though a greater emphasis is usually placed on that of the mother.

Here are the steps involved in preconception care:

Among the items covered in preconception counseling will be:

A thorough personal, medical, and family history of the potential mother.
A thorough personal, medical, and family history of the potential father. A genetic evaluation.
A review of prior pregnancy problems.
A physical exam of the mother including a Pap and other tests.
A physical exam of the father, if indicated. Blood samples and other tests of both parents if indicated (for example, HIV, infectious diseases, genetic predisposition).

There are several aims of all this attention, among which are:

Helping you to become pregnant.
Decreasing the risk of a pregnancy loss.
Decreasing the chance of birth defects.
Improving your health.
Identifying medical conditions in you that might affect your pregnancy.
Decreasing any negative effects of pre-existing medical conditions.
Identifying medications that might possibly affect the fetus and changing them to safer ones.
A discussion about the findings and your lifestyle.

Below are some real examples:

Taking folic acid before and during the first months of pregnancy has been shown to significantly decrease certain birth defects.
Stopping smoking before pregnancy will improve your chances of getting pregnant and decrease certain adverse effects on the fetus.
Doing a mammogram before pregnancy if you need one is safer and more sensitive.
Changing certain high blood pressure pills to safer ones improves the baby's health.
Taking small amounts of aspirin before and early in pregnancy might prevent miscarriages in women with certain conditions.

I suggest that you see your doctor before you get pregnant and discuss issues related to your pregnancy.

Percentage distribution of fertility problems

About 25% of cases of infertility are due to ovulation problems such as anovulation and polycystic ovary syndrome (PCOS);
30% are caused by pelvic factors such as endometriosis, adhesions, or tubal disease, and
35% are due to male factors such as an abnormal sperm count (for example, oligospermia or not enough sperm, increased semen viscosity, decreased sperm motility, or decreased semen volume).
Less than 5% of infertility is caused by abnormal cervical mucus penetration, antisperm antibodies, or corpus luteum defects (CLP).
In about 10-15% of couples, no specific reason for infertility can be found on initial evaluation. This is called (unexplained infertility). But on further evaluation and treatment, occasionally factors such as poor sperm penetration or abnormal-appearing oocytes (eggs) are discovered.

Before heading out for a flight, pilots must prepare the plane for the journey. The same can be said for pregnancy. Physical pregnancy may last 40 weeks or about nine months, but preparation for that journey starts months or years in advance. Simple changes to diet and lifestyle may take days or weeks to complete, but other health issues can take longer to resolve.

Your preconception health is extremely important to your pregnancy health

You Want Less of This

You can start your preconception journey by focusing on things you need to reduce, but not eliminate from diet and life.

Caffeine: Caffeine intake is safe during preconception and pregnancy, but limit intake to less than 200 mg per day. If you are having trouble leaving behind that extra morning cup of coffee switch to a half-caf variety. You can drink the same amount of coffee, but you will consume half the caffeine.

Stress: Few people have the luxury of living a stress-free lifestyle, but you can attempt to limit stress at work and home. When feeling stressed, remove yourself from the situation for a few minutes of relaxation. Try practicing yoga or stretching exercises to improve mood and relieve stress.

You Want None of This

Some preconception changes may be harder to adopt and take longer to resolve. Remember to seek professional help for drug or alcohol abuse before attempting to conceive.

Street Drug Use: Street drugs are associated with pregnancy complications, fetal complications and birth defects. Some drugs can cause premature birth, miscarriage or stillbirth.
Alcohol: Fetal alcohol syndrome is associated with alcohol consumption during pregnancy. For some women quitting is difficult. If you attempt to stop drinking prior to pregnancy and find it difficult, seek professional help before conceiving.
Chemicals: Some hazardous chemicals can affect growth and development of the fetus and others may cause fetal death.
Supplements and Herbs: None of the supplements or herbs you find in retail stores is approved by the Food and Drug Administration and most have never been tested on pregnant women.

You Want More of This

Not all preconception changes are about eliminating things. There are plenty of positive changes you can make prior to conception.

Folic Acid: Folic acid intake of at least 400 mcg per day prior to pregnancy may reduce the likelihood of neural tube defects. Development of the neural tube occurs before most women find out they are pregnant.
Exercise: Starting an exercise program before getting pregnant is much easier than starting one after conception. The ideal exercise plan incorporates aerobic, anaerobic and stretching exercises. Yoga is the perfect example of a preconception and pregnancy-safe exercise.
Relaxation and Sleep: Relaxation and sleep go hand-in-hand for women who want to conceive. Relaxation helps women reduce stress and relieve tension. Improving sleeping habits has the same effect.

You can start getting your body ready for pregnancy years in advance of attempting conception. The better your health before getting pregnant the easier and safer your pregnancy will be in the future.

Not only women have to consider the health of their bodies before conception – men also need to get life in order and start working toward a healthier, happier body and life. Many of the same changes women should make prior to conceiving are mirrored in suggestions for men. Taking a couple’s approach to preconception health may make it easier to adopt lifestyle changes.Get a Preconception Check-Up couple seeing a doctor

Every man needs a check-up once a year even if they feel healthy. Yearly check-ups and physicals help doctors keep an on-going medical record of overall health. You may not notice small changes in blood pressure, blood glucose or cholesterol, but your doctor can quickly compare test results from this year to previous years to recognize changes. Early detection of health conditions is the best way to head off long-term disease and chronic illness.

Skip OTC Medications that Affect Fertility
Talk with your doctor about the OTC (over-the-counter) and prescription medications you are currently taking. Medications used to treat ulcers, even OTC varieties, may affect sperm count and production. It can take some time to change prescription medications, especially if the current regime is working well, so schedule that check-up early.

If you have had radiation or chemotherapy your doctor may need to order a semen analysis to determine if you are able to conceive a child. Cancer treatments often leave men sterile or in a situation of significantly reduced fertility that may make conception difficult or impossible.

Change Up That Exercise Routine

Certain exercises are associated with reduced male fertility. Cycling is at the top of the list. Cycling causes excess heat in the testicles. Excess heat can damage sperm and affect sperm production. Other heated conditions to avoid include saunas, hot tubs and even long showers. Further reduce testicular temperature by switching from briefs to boxers.

Cut Down on That – Skip That

Cut down on your intake of saturated fat, alcohol and processed foods as they may reduce sperm count, sperm quality and erectile function, including your ability to ejaculate. Skip illegal drugs and smoking, if possible. Smoking may not have an impact on sperm count, but second-hand smoke can affect pregnant women and the fetus. Second-hand smoke can be carried on clothing, skin and hair.

Making Positive Changes

While you are getting that check-up, changing up your exercise plan and cutting down on saturated fat intake you can also be making positive changes to diet, mood and exercise. Add a multivitamin to your daily supplement schedule or start a new schedule if you do not currently take supplements or medications. Multivitamins support overall health and provide zinc. Zinc and folic acid are associated with improving sperm count according to a recent study.

Reduce stress at work and home whenever possible. Adopt breathing exercises, start yoga classes or simply take a walk when you feel stress building.

Exercise is just a part of becoming a better you. If you do not currently exercise on a regular basis – start. Make this a couple’s change because also she needs to exercise to prepare for pregnancy.

Preconception To Do List

There are several things you should do before you try to conceive. You need to make sure your vaccines are up to date. Medications should be approved by your doctor and there are medical tests that should be run prior to conception.

Vaccines

There are many diseases that are very dangerous for an unborn baby if the mother should be infected. Some of these include chicken pox, rubella, and hepatitis B. All of these are largely preventable with a vaccine. Since these conditions are preventable it is important that you take the steps necessary prior to conception to insure you do not contract these diseases. By making sure your vaccines are up to date you reduce the risk of later complications.

Medications

There are different classifications for medications that depend on how safe they are for expecting mothers. It is important that you tell your doctor all of the prescription and non prescription medicines you are taking as well as any herbal supplements. If you are currently taking anything that could have a harmful affect on the baby your doctor will need to find an alternative medication or have you stop taking them altogether. This is also the time to start taking prenatal vitamins because it is during the first month of pregnancy that many of these vitamins are vital to the development of the fetus.

Weight Loss, Exercise and Vitamin Supplementation

Before attempting to conceive, moms will want their bodies to be the epitome of health. Losing any excess weight and adopting a healthy exercise regime can help to make the pregnancy and birth processes far easier. Taking a prenatal vitamin for a few months before conception helps to build optimal levels of vitamins, nutrients and folic acid in the body. Folic acid is most important during the first few weeks after conception and helps to prevent neural tube defects of the fetus.

Exercise programs adopted before conception can be maintained for the length of the pregnancy. In addition to normal exercises, Kegel exercises will help during the birthing process. Kegel exercises are used to tighten the muscles used to push baby out during childbirth.

Preconception Tests

There is a lot you can do and some tests you can take before you get pregnant to improve both your chances getting pregnant as well as your chances having a healthy baby.

Most couples follow the famous slogan "Just Do IT" when trying to conceive. What most couples do not realize is that there is a lot you can do before you get pregnant to improve both your chances getting pregnant as well as your chances having a healthy baby.

For one, taking folic acid and starting it 1-2 months before conception decreases your risk of a miscarriage and decreases your risk of having a baby with a congenital malformation.

Going to see your doctor for a periconception visit is an important first step. Your doctor will take a history and examine you. In addition there are some tests you may want to take prior to getting pregnant.

When you first see your doctor for a prenatal visit there are a lot of tests being done. We recommend that women who TTC consider having the following tests BEFORE getting pregnant:

Pap Smear
TSH (checks thyroid)
Sperm analysis
Postcoital test (PCT)
Check Ovulation with the basal body temperature curve (BBT)
Cycle Day 3 tests if problems with TTC
HIV
Herpes
Hepatitis A
Hepatitis B
VDRL
Vaginal tests for GC and Chlamydia
Rubella titers
Chickenpox titers
Parvovirus B-19 (Fifth Disease) titers
Cytomegalovirus titers
Toxoplasmosis titers
Type and Rh both partner's blood
CBC and hemoglobin electophoresis
Genetic screening (based on ethnicity): Sickle Cell Screen, Thalassemia Screen, Jewish Genetic Diseases

Tests

In addition to a routine pelvic exam there are several other tests that should be ideally performed prior to conception. If you think there is a possibility that you have a sexually transmitted disease it is best to find out as soon as possibility because it can affect the development of the pregnancy. Some of these are treatable and treatment should be completed prior to conception. Additionally, if there are genetic disorders that are common in your family you may want to be tested for those genetic abnormalities.

Preparing for baby is about far more than just setting up that beautiful room. The female body will undergo dramatic changes immediately after conception and for the ensuing 40 weeks of fetal growth. The idea is to prepare the body before baby is conceived and make the growth process all the more enjoyable for mom and for baby. If you are thinking about getting pregnant, talk with your gynecologist before conceiving about any health concerns you may have.

>>Fertility 101 Course - Lesson #1: Roadblocks to Getting Pregnant>>

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