If you know that you'll be starting a family in the not-too-distant future, it's worth starting to prepare your body now to be the ideal environment in which to nurture a new little life. Here's what you can do.
It's ideal if you can plan your pregnancies because a number of useful steps you can take before becoming pregnant will improve your chances of a good outcome.
It's a proven fact that folic acid reduces the risk of having a baby with a neural tube defect such as spina bifida. High-risk women especially - those previously affected, those who have a family history, are diabetic or on anti-epileptic medication - should take 5mg of folic acid a day for at least one month before pregnancy.
Nevertheless, I also recommend this dose for all women who are planning a pregnancy because only at this higher dose can we be sure to prevent most cases of spina bifida.
Do note, however, that the studies that showed the benefits of taking folate before conception also showed that women who took folate were more likely to have a twin pregnancy. This is not a reason not to take folate before falling pregnant, but it is an example of the sometimes unexpected consequences that can occur.
You may have also heard that taking multivitamins can reduce vomiting in the first trimester as well as preventing cleft lip, limb reduction defects, urinary tract defects and childhood brain tumours. I wouldn't advise taking them until further studies are done and we are certain that there are no adverse side effects.
In summary, a folic acid supplement should ideally be taken from at least one month before conception. Good nutrition for a child begins before it is born, and even before it is conceived. A good, healthy diet with fresh fruit and vegetables may be quite adequate until we have more information about the possible benefits of multivitamin supplements.
All teenagers and now all children are vaccinated against rubella, which if contracted in pregnancy can cause major defects in the baby.
Vaccination not only reduces the individual's risk if exposed to the disease but also increases the 'herd' immunity, thereby reducing the incidence of the disease and the chances of exposure. Some women, especially new migrants, may not have been vaccinated as children or teenagers, and should be tested and immunised if they are not already immune.
Women who have been vaccinated but have low levels of circulating antibody are at risk of getting rubella again. Fortunately re-infection does not seem to be associated with the same risk of birth defects as a primary infection. Some five percent of women will not develop high levels of circulating antibody in spite of repeated episodes of vaccination. These women will, however, have protection from congenital rubella syndrome and do not need repeated vaccinations.
In summary, if you are in doubt about whether you were ever vaccinated, you should have a test. If your doctor recommends vaccination, you should avoid pregnancy for at least two months (although there has never been a case of damage occurring even if a woman has been vaccinated during pregnancy before it was realised that she was pregnant!).
Evidence from prospective studies of miscarriage suggest that both partners should avoid X-rays of the genital area, including lumbar-spine X-rays. You should also avoid exposure to oil paints, glues and oven cleaners because these exposures have been associated with an increased risk of miscarriage if they occur near to the time of conception.
However, the vast majority of miscarriages occur because of an error in the embryo probably occurring at the time of fertilisation, so these environmental exposures can only account for a small number of miscarriages.
If there are genetic diseases in your family such as thalassaemias, cystic fibrosis, haemophilias or Tay-Sachs disease, consider carrier testing before becoming pregnant.
It's important to take measures to give up smoking before and during pregnancy because smoking can cause the baby to be smaller at birth, which is not ideal for its overall health.
Women who give up smoking at the beginning of pregnancy are particularly in need of support because of the high relapse rate as the pregnancy progresses.
Useful tools are the "Quit Now" information packages [phone 131848 nationally for a free package] as well as support from family and friends. Your GP will also have a list of options available to help you give up the habit.
The benefits of reduced smoking extend into the postnatal period and the rest of life, giving you extra vitality and a longer life with which to enjoy your children.
Specialised pre-pregnancy counselling is available for women who have chronic conditions which, of themselves, or by the nature of their treatment, impact on planning for pregnancy.
Women with a complex past obstetric history involving foetal loss , damage or abnormality can also be referred for specific counselling. Discuss this with your obstetrician or GP.
Most couples get pregnant without any specific effort: just stop using contraception and it soon happens. About 70 per cent of couples will be pregnant within a year but this reduces to 55 per cent for women 35 and over. Many couples get impatient and wish for help to speed up the process.
If a woman does not fall pregnant (after about one year, but dependent on individual issues and age), the approach is eventually to investigate to find out if there is a major impediment to pregnancy. This could include problems such as not ovulating, poor sperm count or a problem with the tubes such as a blockage.
However, before this stage is reached, it is useful to understand something about the normal menstrual cycle and the best strategies to use to optimise the chances of pregnancy.
In women who are overweight, for example, there is good evidence that weight loss is associated with improved chances of pregnancy. One option is a good program such as those run by Weight Watchers, which can be very effective. There are numerous alternatives available these days for losing weight safely for the long term. Talk to your GP about some of the options open to you. And since diet and exercise are usually the cornerstones of healthy weight loss, you might also consult a good nutritionist, recommended personal trainer or a reputable local gym. The latter two can also provide a fitness assessment, then an exercise and dietary plan to help you achieve your goals.
Knowing when you are ovulating is important if you want to ensure that you have sexual intercourse when pregnancy is most likely to result, so charting the menstrual cycle is a useful exercise.
If we consider the basal body temperature, this has a particular pattern in a normal ovulatory cycle.
The lower phase, about 36.3 degrees C, occurs in the follicular phase, that first part of the cycle, usually day 1-14, when the follicle containing the egg is developing.
When the egg has been released at ovulation, usually about day 14, the temperature rises to about 36.8 degrees C.
If pregnancy occurs, the temperature stays up and there is no period.
On the other hand, if pregnancy does not occur, the temperature drops coincidentally with menstruation.
Charting your temperature during the course of the month, therefore, will tell you when you ovulated. The best time to have intercourse is just before ovulation, so you have to use the temperature chart to tell you when you ovulated last month and expect that you will ovulate at the same time in the next month.
Checking the texture of your cervical mucus can also tell you that conditions are right for fertilisation. This is because as the follicle develops, it produces increasing amounts of oestrogen. Among other effects, this changes the quantity and the quality of the cervical mucus, making it clear and very stringy like egg-white.
This is the receptive mucus in which sperm can survive and voyage up the cervical canal and the uterus to the fallopian tubes. When ovulation occurs these changes are reversed and the mucus becomes thicker and less viscose.
Sperm, placed in the vagina in the days just prior to ovulation, survive by reaching the cervical canal and the safety of the receptive mucus.
For pregnancy to occur, the sperm must be in the fallopian tube at the time of ovulation. However, they can survive for up to six days in the system, so that the optimum situation is to have intercourse every second day for four to six days prior to the expected date of ovulation.
If pregnancy does not result within one year or earlier, if there is a history of tubal damage or ovulation does not seem to be occurring, you should seek a specialist opinion about what to do next.
By Dr Brian Peat