You’ve done it! You’ve taken that last birth control pill, removed your IUD, or stopped using your contraceptive method of choice. You’ve made the decision to try to conceive a pregnancy, and while this is an exciting time in your life, it can also feel overwhelming. There is so much advice around fertility and pregnancy, and sifting through it all just isn’t possible. For many mothers, their goals crystallize around ensuring that their baby is healthy.
Evidence-based steps that may prevent birth defects
January is Birth Defects Prevention Month, so we want to focus on things you can do to reduce the risk of birth defects. I always encourage my patients to think about the steps they can take to make sure their baby is healthy. Scheduling a preconception visit is a good place to start. At that visit, we can review any medical problems women have, which medications they are taking, and which medications they can continue during pregnancy. While many medications are safe during pregnancy, there are others that should be stopped prior to conception, as those are known to cause birth defects. It is particularly important that women with other medical problems, such as diabetes, attend a preconception counseling visit, as having better control of their diabetes can decrease their risk of birth defects.
It is also important that women are up to date with their vaccinations, including the ones for measles, mumps, and rubella (MMR), influenza, and varicella (chicken pox, which some women may be naturally immune to if they had it as a child). Rubella exposure and infection can cause birth defects, and rarely chicken pox can develop into a severe infection in some pregnant women, as can the flu, so protecting yourself and your baby by ensuring that you are adequately vaccinated is extremely important.
Lifestyle changes can help prevent birth defects, especially taking folic acid daily
This preconception visit can also encourage women to maintain a healthy weight and lifestyle. I counsel all of my patients that they will gain weight in pregnancy, and so they should start the pregnancy at a healthy weight. I encourage regular exercise even prior to becoming pregnant, and then continuing that level of activity during pregnancy. Being at a healthy weight prior to conceiving and maintaining a healthy weight throughout pregnancy can help decrease your risk of developing diabetes or elevated blood pressure during pregnancy. Having a body mass index (BMI) of 30 or above can also increase your risk of birth defects, which is why maintaining a healthy weight is also important.
All women who are trying to get pregnant should start a daily prenatal vitamin containing at least 400mcg of folic acid, at least one month prior to attempting to conceive. Folic acid helps to decrease the risk of certain birth defects, such as neural tube defects. Another risk factor for neural tube defects is increased core body temperature in a pregnant woman, particularly during the first trimester. I recommend that all of my patients avoid hot tubs, saunas, and hot yoga, and that they treat any fever promptly with acetaminophen (which is safe during pregnancy, unlike ibuprofen).
Reduce substances that can increase the risk of birth defects
Similarly, it is important to avoid substances that increase the risk for birth defects, such as alcohol, tobacco, drugs, and retinoid medications. There is no safe limit of alcohol use during pregnancy, and while it is known that binge drinking during pregnancy increases the risk of fetal alcohol syndrome, there has been no clear definition of the amount of alcohol intake that is connected to fetal alcohol syndrome. I recommend that my patients abstain from alcohol during their pregnancies.
If you are smoking or using alcohol or other drugs, an ideal time to quit is prior to pregnancy. Planning for a pregnancy can be a powerful motivator to quit unhealthy habits, not just during pregnancy but beyond. There are many resources that can help you quit smoking, including medication and nicotine replacement. There may be clinics that specialize in recovery from drug use for pregnant women in your area; starting the conversation with your doctor will help you better understand how to ensure a safe pregnancy for you and your baby.
Doing all you can to ensure a healthy baby
Unfortunately, knowing and following these guidelines does not guarantee that your baby will not have a birth defect. Many birth defects are detected by specialized ultrasounds of the fetal anatomy, although some may not be detected until birth. At the very least, following these recommendations will help ensure that you have done all that you can to ensure a healthy pregnancy and baby.