Conscious Preconception

By Alan Greene, MD, FAAP

The “trimester” before pregnancy is an important window of opportunity for a baby's health, whether this is a first pregnancy or a later one. And during pregnancy, the weeks between when conception happens and when a woman knows she is pregnant are especially important - where good nutrition or unhealthy exposures can have their biggest impacts.

But most women don't have a prenatal visit until after they know they are pregnant, when these windows of opportunity have already closed. In light of this, the Centers for Disease Control and Prevention (CDC) made sweeping April 2006 recommendations to improve preconception health and health care. The cornerstone of these recommendations is a pre-pregnancy (and between-pregnancy) check-up, which should be covered by insurance, to help be sure your body is ready to welcome a new baby.

This is an excellent opportunity to a look at specific issues that could affect your next baby before you know you are pregnant, including a review of any prescription and over-the-counter medications you are taking, tests for key illnesses you may not know you have, checking your immunization status, considering possible toxic exposures, and thinking about lifestyle issues such as nutrition, exercise, alcohol and tobacco use. The good news is that making even small changes in your lifestyle can make a big difference for your baby. Perhaps the easiest change is to begin taking a vitamin that is high in folic acid. Folic acid is a nutrient that is important for helping to prevent neural tube defects, when women get at least 400 mcg (0.4 mg) a day. It is found in many foods, such as legumes and dark leafy green vegetables, but most women in the United States only get about 200 mcg from their diets - when 600 mcg or even 1000 mcg would be better. All prescription prenatal vitamins have plenty of folic acid to supplement the diet for healthy women. Many over-the-counter prenatal vitamins contain the proper levels as well. I recommend that all teenage girls and women of childbearing age take a prenatal vitamin or the equivalent. The benefits far outweigh the cost.

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