Preconception health for every woman, every time...

for wellness. for women by Jan Herr, M.D.; Kaiser Permanente San Rafael-

If you ask most women, they would agree that when a pregnant woman drinks or smokes, she risks harming her baby. The real worry is that all the other little known risks to a baby start even before the sperm fertilizes the egg.

A new patient of mine, "Sally" had her first baby before she became my patient. During her pregnancy, Sally developed diabetes. Happily everything turned out well and she delivered a strapping 9 lb 8 oz baby boy, who is now 18 months old. Sally was tested after her pregnancy and was no longer diabetic.

When I met Sally, she was 34 and eager to try for a second child. She was still overweight, having gained 40 pounds in the last pregnancy and only lost 20, otherwise she looked and felt well. She had stopped breast feeding 3 months before our first meeting and she had also stopped taking her multivitamins.

During our initial visit, we talked about how she could improve her health before getting pregnant again. Looking at her first pregnancy's medical history, I ordered a blood test and discovered that her fasting blood sugar was high, falling in the pre-diabetic range.

Women who are overweight before becoming pregnant are at high risk for developing diabetes during pregnancy, and those who gain more weight early in their pregnancy have an increased risk for gestational diabetes. Reaching a healthy weight before pregnancy is just one of the preventive measures you can take before becoming pregnant.

Here are other important things a woman needs to do BEFORE getting pregnant:

• Take folic acid (0.4 mg) every day, in a pre-natal or multivitamin. Also eat dark green leafy vegetables, citrus fruits, whole grains, legumes and fortified cereals. Studies have shown that folic acid helps to decrease chances of birth defect of the brain and spinal cord.
• If you smoke, quit. Smoking can make it harder to get pregnant and can also create problems during pregnancy and childbirth.
• If you drink alcohol or use recreational drugs, take time before becoming pregnant to stop. Kaiser Permanente has a program to help called Early Start. Here is a link for more information: http://xnet.kp.org/earlystart/
• Exercise daily, at least 30 minutes most days. Start slowly with a 5-10 minute walk and work up from there. Check with your doctor if you have a health condition before you begin an exercise program.
• Have regular GYN appointments and discuss get appropriate testing for sexually transmitted diseases.
• Use an effective method of birth control so that you can get pregnant when the time is right.
• If you are taking prescription or over the counter medications for an ongoing condition, talk with your doctor during the planning stage.
• Make sure your immunizations are up to date.
• If there is a history of birth defects in your or the baby’s father’s family, meet with a genetics counselor and determine possible tests you might need.
• If you are exposed to toxic substances or radiation, follow safety recommendations for use of such chemicals and avoid contact with products containing lead or mercury. Call the California Teratogen line at 1-800-532-3749 if you are worried about a chemical or exposure in your home or work place.
• Has your partner ever hurt, hit or threatened you or made you afraid? Abuse can start or increase when you become pregnant. Examine your relationships and if you need to talk – or if you need help- contact your doctor or call the National Domestic Violence Hotline at 1-800-799-7233.

Conclusion:   Believe me, not all my patients really hear me when I say that they need to take their health into their own hands and make some serious changes. I am always optimistic that they will. Happily, Sally did. She restarted her daily multivitamin, signed up for a weight management program, and changed her eating patterns and starting a daily aerobic exercise program. She lost 15 pounds, looked great and felt empowered. Sally conceived, did not develop diabetes or any other problems in her pregnancy and recently had a healthy, beautiful 8 lb baby girl.

Admittedly, planning for a pregnancy is not always this straightforward and simple. But, the bottom line is that her future and the health of her unborn child was in her hands, and what she did to improve their health made a world of difference.

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Jan L. Herr, M.D., a board certified OB/Gyn at Kaiser Permanente San Rafael, is a women’s health champion with a passion to help women live the healthy lives they deserve. A doctor, a wife, a mother and an avid cyclist, she bikes to work daily from her San Anselmo home. Dr. Herr is a frequent speaker and writes educational materials for physicians and patients. Her passion... women’s health, her avocation... family, home, hiking, biking and word games.

Dr. Herr writes about women's health in her column for MoreMarin, "for wellness. for women."