It’s Wellness Wednesday!

For this week’s post, our medical director, Dr. Sonya Kashyap, has some healthy pregnancy advice for those who have or are trying to conceive.

1.     Folic Acid Intake:  Folic acid (400 mcg/day) helps to prevent neural tube defects a.k.a. spina bifida in babies.  It works best if taken for at least 3 months prior to conceiving. Some women, including Asians, East Indians, people would a BMI greater than 30, those with a history of diabetes or women with a traditional UK diet, may require extra folic acid (5 mg/day). Recent data suggests that folic acid is also found in the ovarian fluid surrounding the egg and may therefore help egg quality.

2.     Exercise: Listen to your body, but 30 minutes of moderate exercise per day is good for pregnancy women. This may include just brisk walking.

3.     Don’t Smoke:  Smoking decreases egg count, accelerates the time to menopause and is associated with infertility, miscarriage, placental insufficiency, small babies, preterm labor and stillbirth.

4.     Maintain a Healthy BMI:  For women who are trying to conceive, a BMI of greater than 35 is associated with a lower pregnancy rate for similarly aged women;  ideally a BMI between 19 and 30 will help to achieve the best pregnancy rates. It will also minimize the risk of developing diabetes and/or high blood pressure during a pregnancy.

5.     Avoid Alcohol: We all know this but alcohol is not good for babies.  While trying to conceive, it’s best to limit alcohol intake to three to four drinks per week. During the two-week period after ovulation, women should avoid drinking alcohol all together as the pregnancy is trying to establish itself.

6.     Foods to Avoid:  Pregnant women should avoid raw meats, raw fish, deli meats and unpasteurized cheeses.  Parasites that may be found in raw meats and fish can not only make a non-pregnant individual ill, it could be passed onto an unborn child and cause serious and possibly deadly health issues. As for deli meats and unpasteurized cheese, they can be associated with listeriosis which causes a flu-like illness but can be lethal to a baby in the second and third trimester.

7.     Check your vaccine status:  If you are not immune to chickenpox, rubella or measles, consider a vaccine before you start trying to conceive.  You are more likely to come into contact with chickenpox than measles or rubella but all of these are dangerous to an unborn child. Chickenpox is especially dangerous at the time of delivery.  These days with more people declining vaccination for their children, we are seeing a rise in the incidence of rubella and even measles.  If you are exposed to any of this or the parvovirus (a.k.a the Fifth Disease or “Slapped Cheeks” disease; it’s more common in young children so teachers who work with children are at risk) – do not go to your OBGYN’s office as you may expose other pregnant women to the virus. Instead, call to ask them for advice on where to go to be evaluated.

8.     Get Swabbed: Group B streptococcus lives in the vaginal track of many women and it is normal to be found there.  However, it has been associated with preterm delivery and serious infections in babies. Group B strep is treatable prior to delivery, so ask your doctor as to when you should have this test during your pregnancy.

9.     Tell someone else to change the kitty litter: Cats carry a parasite in their feces that causes toxoplasmosis, a disease that is very dangerous for unborn babies.  Changing the litter or even having your cat sleep near your face can increase your exposure to this organism, so ask someone else to change the kitty litter.

10.   Keep your pap smears up to date:  Bleeding in pregnancy is not uncommon.  But one of the first things doctors try to assess is the source of the bleeding.  If your pap smear is up to date, doctors can be sure it is not a lesion in the cervix.  Also, pap smears prevent needing to do more investigations during a pregnancy at which point they can become more difficult and delicate.

11.   Fertility Planning: The most significant determinant of a healthy or chromosomally normal pregnancy is egg age, but fertility planning, although just as important, seem not to be as prevalent as family or contraception planning. We spend a lot of time trying not to get pregnant only to discover when we are older that it is not as easy to become pregnant. The reason is that unlike men who make new sperm, women do not make new eggs. We deplete the ones we were born with as we go through life. For most women, fertility starts to decline significantly after age 37 and very drastically after age 40. In addition, the incidence of miscarriages and chromosomally abnormal pregnancies such as Down’s syndrome increase.

Egg freezing has revolutionized female fertility preservation. When eggs are frozen at a younger age through vitrification, they have the highest potential to be used at later ages. However, since we cannot predict whether someone will develop infertility issues before the eggs will be used, egg freezing should not be considered a guaranteed insurance policy. It is still important to try to conceive as soon as you are ready physically, emotionally, relationship-wise and financially.

What can you do to ensure the pregnancy is more likely to be normal? These days genetic testing is growing leaps and bounds. Doctors can even test an embryo using in vitro fertilization and preimplantation diagnosis to make sure it is chromosomally normal before it goes into the uterus!

The most important thing when utilizing such technology is the experience and skill of the lab as well as the methods used. Success rates vary greatly. Ask your doctor about their success rates, technologies and the lab’s experience with said assisted reproductive technologies.