Pregnancy Planning. Eat a nutritious, well-balanced diet

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1 Pregnancy Planning Your health and habits affect a baby from the earliest days of a pregnancy. Before you find out for sure that you are pregnant, a great deal has already happened. Your baby's major organs (like the heart and kidneys) form during the first eight weeks. Before you try to get pregnant, therefore, make sure you are as healthy as you can be. Call your clinician to schedule a pre-pregnancy counseling visit to discuss your personal health needs and possible risks. Consider taking a class at a hospital or health care site about planning and having a healthy pregnancy. Following the tips in this list will help, too. Eat a nutritious, well-balanced diet Eat a well-balanced diet for your health and the baby's: Fruit, vegetables, and grains (such as rice or grains found in bread, tortillas, or cereal) Dairy foods like low-fat milk, cheese, and yogurt Protein-rich foods like lean meat, poultry, fish eggs, beans, or tofu Avoid junk food! Talk with your clinician if you eat a vegetarian, macrobiotic, or non-dairy diet, or if you need help bringing your weight into a healthy range. Take a daily vitamin Vitamins are very important to your baby's health and growth. The vitamin folic acid is especially important because it helps prevent one kind of birth defect. Take one multivitamin or prenatal vitamin a day (more than that could harm you and the baby). Check the label to be sure the vitamin has at least 0.4 to 0.8 (400mcg to 800mcg) of folic acid. If you smoke, quit If you smoke, ask your clinician about ways to quit. Smoking (and second-hand smoke) is bad for you and your baby. It can even make it harder to get pregnant and increase your risk for miscarriage and other health problems during pregnancy. Avoid drinking alcohol Experts aren't sure if it's safe to drink any alcohol during pregnancy. But they do know that too much alcohol can cause birth defects, learning problems, and mental retardation. It is safest to stop drinking alcohol before you try to get pregnant. If you need help stopping, talk with your clinician or call Alcoholics Anonymous (listed online or in the phone book). Limit Caffeine intake It is best to limit daily caffeine intake to 250mg a day or less. (Amounts of caffeine in various types of coffee and caffeinated beverages vary greatly so you should be aware of the portions that you typically intake.) There have been studies suggesting excessive caffeine intake can decrease fertility and increase the risk of miscarriage. Don't take any illegal drugs

2 If you use illegal drugs, stop before you try to get pregnant. Drugs harm you and may cause your baby to be born very sick or addicted to drugs. Even occasional use of illegal drugs can hurt. If you need help ending drug use, ask your clinician to refer you to counseling or call Narcotics Anonymous (listed in the phone book). Make sure you are safe Being slapped, kicked, or beaten is never right. When you're pregnant, it puts your baby in danger, too. If this ever happens to you, tell someone who can help you, like your clinician, religious leader, or a social worker. You can also call a crisis hotline number in your state for help: In Massachusetts, call (800) In Rhode Island, call (800) Discuss any medicines you take with your clinician Talk with your clinician about any medicines you take (even those you take occasionally, like asthma medicine). Some medicines can harm your baby. This includes prescription drugs and any over-the-counter medicines including herbal supplements you buy in a drug store or supermarket. If a medicine you use is not safe, your clinician often can suggest safer ones. In general, avoid all medicines except acetaminophen (Tylenol ). However, never discontinue prescription medications that you need without consulting your clinician. Discuss any health problems with your clinician If you have diabetes, talk with your clinician about having a special blood test to make sure your diabetes is under control before you try to get pregnant. When diabetes is not well controlled, it can cause birth defects and other health problems. Your clinician can tell you if you need to change the way you eat or exercise. You may also need to change your dose of insulin or type of medicine and test your blood sugar more often. If you have high blood pressure, ask your clinician about the best way to lower it. If it's not under control, high blood pressure can cause serious problems for you and the baby. If you're already on blood pressure medicine, ask about the safety of the one you are taking. You may need to take a different one while you are pregnant. If you have epilepsy, talk with your clinician about the medicine you are taking. Some drugs for epilepsy can harm your baby. You may need to switch to another one or take extra folic acid before you get pregnant. If you have any other health problem, discuss it with your clinician. You may need to try a medicine that's safer for your baby or make changes in your diet. Make sure you have all your vaccines At least three months before you try to get pregnant, ask your clinician if all your vaccines are up-to-date. This is important because some diseases, especially German measles (rubella), can be serious for your baby if you get them while you are pregnant. If you have not had chickenpox, you can now get a vaccine for that, too. Make sure you don't have an STD Sexually transmitted diseases (STDs) can infect a baby during pregnancy or birth, and can cause health problems for you. STDs include herpes, chlamydia, gonorrhea, and

3 other diseases. Since many STDs cause no symptoms, it's best to ask your clinician if you should be tested. Some STDs can be cured or controlled with medicine. Consider a test for HIV You and your partner should consider being tested for HIV (the virus that causes AIDS) before you try to get pregnant. HIV can be passed from an infected mother to her unborn baby. (If you are pregnant and you have AIDS or HIV, there is medicine that will improve your health and lessen the chance that your baby will get the virus.) Discuss any problems with earlier pregnancies with your clinician If you've had problems with earlier pregnancies, get your medical records from other health care institutions and talk with your primary or obstetric clinician.. S/he will try to find out what caused the problem and how likely it is to happen again. Your next pregnancy may be watched carefully or special tests will be done, if needed. Consider the risk of birth defects and genetic disorders Your age during pregnancy, family health history, and racial or ethnic background can affect the health of your baby. Before you try to get pregnant, talk with your clinician about the information below. S/he can explain tests that can be done before or during pregnancy to help find out if your baby could have certain birth defects or genetic disorders. Your clinician may also refer you to a genetic counselor to help review your family history. Age Women over age 35 have a greater chance than younger women of having a child with chromosome problems and a higher risk of early miscarriage. Tests during pregnancy (prenatal testing) can determine whether your baby has a chromosome problem that could cause mental retardation or birth defects. Family History If you or a family member have any of the following conditions, you may have an increased chance of having a child with the same condition: Birth defects such as a heart, spine, or kidney problem present at birth Mental retardation including Fragile X syndrome and Down's syndrome Genetic disorders such as muscular dystrophy, hemophilia, Huntington's disease, and cystic fibrosis Racial and Ethnic Background Some genetic disorders are more common in certain racial and ethnic groups. Healthy people can carry an abnormal gene that can cause diseases in their children if both parents have the same abnormal gene. Tests can screen parents for the gene and the fetus for the disease. Listed below are several groups and some genetic disorders that are more common in them. Background Genetic Disorder Mediterranean and Asian Thalassemia African-American, Latino Sickle cell anemia E European Jewish (Ashkenazi) Tay-Sachs disease, Canavan's disease French-Canadian Tay-Sachs disease N European Caucasian (incl Ashkenazi Jewish) Cystic fibrosis For more information on birth defects and genetic disorders, call the March Dimes Resource Center at MODIMES ( ).

4 Avoid lead paint and dangerous chemicals Lead paint and some chemicals may harm a baby during pregnancy by causing mental retardation and health problems. This includes some household cleaners, garden products, and chemicals used at work. Avoid using them, or wear gloves and wash your hands carefully afterward. If you use paints and solvents, keep windows open and get a special mask at the hardware store that will prevent you from breathing in fumes. Ask your clinician what chemicals to avoid, or call the Pregnancy/Environmental Hotline at (or in Massachusetts). Most states also have groups that oversee safety and health in the workplace. In Massachusetts the Department of Health and Human Services Website about work safety can be accessed on line here. Your local health department can tell you how to find out if your home has lead paint and how to safely remove or cover it. Avoid infection Washing your hands frequently helps prevent many kinds of infection. If you eat meat, have a cat, or spend time working in a garden, take the additional steps below to avoid getting the disease called toxoplasmosis. It is passed on in raw or undercooked meat, cat droppings, and soil where there are cat droppings. This disease can seriously harm your baby if you get it while you're pregnant. Cook meat until it is medium to well-done Ask someone else to clean the litter box, or wear gloves and a mask. Wear gloves when gardening Wash your hands especially carefully after handling meat, cleaning a litter box, or gardening. Get in shape Get in shape ideally before you try to get pregnant. Regular exercise will make you healthier and tone and stretch muscles you'll need during pregnancy and birth. Being very overweight can make it harder to get pregnant as well as increase complications of pregnancy and risk of some birth defects. Don't get overheated Avoid saunas and hot tubs while trying to get pregnant. They can raise the temperature inside your body, which can harm a developing baby. If you have a fever of more than F, take acetaminophen (such as Tylenol ) to bring the fever down. See your dentist Have a dental checkup. If you need an x-ray or work on your teeth, have it done before you try to get pregnant. Record your periods Keep a written record of your periods to help your clinician estimate your due date if you do get pregnant.

5 Take these healthy steps By taking these steps, you'll improve your health. And if you do become pregnant, you'll know you've given your baby the best possible start in life. If you have been trying to get pregnant for a year (or six months if you are over 35) and haven't been successful, ask your clinician if you should be checked for fertility problems. Want more information about early pregnancy? Websites the Center for Disease control has lots of information, a Q and A and other links. Birth defect prevention is the mission of the March of Dimes. Book Planning for Pregnancy, Birth, and Beyond, 4th Edition by The American College of Obstetricians and Gynecologists. ACOG (Washington, DC: 2005).