How To Improve Your Preconception Health

It was these worrisome trends that led the government’s Centers for Disease Control and Prevention (CDC) in Atlanta last April to release a list of recommendations for improving preconception health and healthcare across the country. These recommendations, aimed at more than 60 million women of childbearing age, as well as healthcare professionals, policymakers, and insurance companies, had one goal: to start protecting babies’ and mothers’ health long before a woman is pregnant.

At the heart of the CDC’s campaign is a simple request: asking women to think about a reproductive life plan, says Hani K. Atrash, M.D., M.P.H., associate director for program development at the CDC’s National Center on Birth Defects and Developmental Disabilities and the preconception initiative lead. “A reproductive life plan is simply encouraging women and couples to consciously and actively think about their reproduction and plan for it rather than leave it to chance.” The plan itself isn’t a physical document, but rather a woman’s careful consideration—ideally from puberty to menopause—of whether she wants to get pregnant now, months from now, years from now, or not at all, and sharing that information with her doctor over the years.

“A reproductive life plan isn’t carved in stone,” says Dr. Atrash. “It changes with time. It’s something you discuss with your healthcare provider at 15, 30, 35, 45. As long as you’re sexually active and capable of being pregnant, it applies.” This lifelong conversation with your physicians ensures you’ll be on the contraception that’s right for you when you don’t want to have a baby, that you discuss your fertility and how to preserve it, and also that you’re in optimum health when you are ready to start a family.

“Women who plan to be pregnant and actively try to conceive have better outcomes than women who have ‘Oops!’ pregnancies,” says Peter Bernstein, M.D., M.P.H., a maternal-fetal specialist at Montefiore Medical Center/Albert Einstein College of Medicine in the Bronx, New York, and a member of the CDC’s committee.

Read on for seven recommendations that will make a healthy difference to you now...and your family-to-be soon.

1. Make A Preconception Appointment

In a perfect world, a preconception visit with your doctor would take place three to four months before you conceive. That allows enough time to get vaccines for rubella (German measles) and varicella (chicken pox) if you need them. “At the first prenatal visit we typically test women for rubella to see if they still have immunity from the German measles shot they got as a kid, but it really should be done before you’re pregnant,” explains Dr. Bernstein.

In addition to your immunization records, you should bring a complete list of the medications you’re taking (including herbs, dietary supplements, and over-the-counter medications) to this preconception visit, and be prepared to share your personal and family medical histories. Your doctor should screen you for chlamydia and gonorrhea, as well as any other sexually transmitted diseases you might be at risk for. Depending on your family history and ethnicity, the discussion may turn toward genetic tests for inheritable diseases. In short, this preconception medical appointment is “a very long conversation where a doctor is trying to get a complete picture of a woman’s life—past and present,” says Michele G. Curtis, M.D., M.P.H., an associate professor of obstetrics and gynecology at the University of Texas-Houston and the American College of Obstetricians and Gynecologists representative for the CDC initiative.

Some women may not even need to make a special pre-pregnancy appointment, notes Dr. Bernstein. “The bottom line is that having good, routine primary care is preconception care. If your doctor [knows you want to conceive and] is making sure you’re healthy, that you’re not smoking and drinking, that you’ve had a Pap smear, that you’re at your optimal weight, that you’ve been screened for domestic violence, and that you have any medical conditions under control—these are preconception issues. It’s getting that tune-up and making sure you’re as healthy as you can be before pregnancy.”

Unfortunately, since few insurance companies cover preconception care at present, be aware that the cost of this visit will likely come out of your pocket.

2. Take Folic Acid

You might call folic acid supplements a public health home run: If all women of reproductive age took the B vitamin before getting pregnant and during early pregnancy, as much as 70 percent of cases of devastating neural tube defects such as spina bifida and anencephaly could be prevented, reports the March of Dimes. Timing is crucial: The neural tube (the earliest version of the spinal cord) is formed by day 28 following conception, before many women even know they’re pregnant. So taking the vitamin before conception is all-important. “If women take 400 micrograms of folic acid daily prior to pregnancy, the number of spina bifida cases can be reduced dramatically,” confirms Margaret Comerford Freda, Ed.D., R.N., professor of obstetrics and gynecology and women’s health at Albert Einstein College of Medicine at Montefiore Medical Center in Bronx, New York, another member of the CDC’s panel. “By the time the pregnancy reaches 12 weeks, all of the development of the fetus is finished; all it’s going to do at that point is grow.”

Some 40,000 babies—the equivalent of one in 100 births—are born each year with problems related to alcohol exposure in the womb, reports a 2003 study in the Journal of the American Medical Association. Drinking puts a baby at risk for fetal alcohol syndrome, which causes facial malformation, impaired growth, and damage to the child’s central nervous system. Since about half of women of childbearing age imbibe, and there’s no known threshold at which a woman can drink safely without endangering a fetus, the safest bet is to become a teetotaler from preconception until after delivery. Freda says it’s a myth that an embryo or fetus is protected from outside influences early in pregnancy. “The fetus is affected by most things that happen in a woman’s body. There’s no time during the first 12 weeks when you’re safe.”