There's nothing like a fetus to keep you honest. No matter how much health sense you might choose to ignore when the consequences are only yours, it's a different ballgame with a baby on the way. So it's natural for women to shun unhealthful substances or behavior during pregnancy.
But prenatal sages have a new message these days: You'd better come clean first.
The standard pregnancy do's -- eat right, cut out cigarettes and alcohol, ease up on caffeine -- should all crank into gear three months before conception, not after the fact, experts warn. "Pregnancy is no longer nine months -- it's 12," says Dr. Robert Cefalo, a maternal-fetal medicine specialist at the University of North Carolina at Chapel Hill and coauthor of "Preconceptional Health Care: A Practical Guide."
Why all the fuss? Allowing extra prep time to deal with medical, social or environmental factors that could complicate your pregnancy is critical because it's during the very early weeks after conception -- when most couples still don't know they're pregnant -- that a baby's organs are developing. "The fetus is most sensitive to any little adverse event or drug between 17 and 56 days," Dr. Cefalo says.
If you are thinking about getting pregnant, consider these factors first.
Make sure you're up-to-date on annual physical and dental exams, and schedule a preconception exam with your OB-Gyn to review any medical conditions, lifestyle habits or hereditary diseases that could complicate your pregnancy. Your doctor will want to know, for example, if you have diabetes, high blood pressure or another condition that needs to be closely monitored while you're pregnant.
"In reality, the vast majority of women are perfectly fine, but it's just a good idea to get all of this on the table beforehand to minimize anything unexpected," says Michael Zinaman, director of reproductive endocrinology at Loyola University Medical Center in Chicago.
Your doctor also will scrutinize medications you may be taking to make sure they aren't harmful because even some over-the-counter drugs, like some nasal sprays, can cause birth defects. And if you're taking birth control pills, you may be advised to use another method until you've had two normal periods before you attempt pregnancy; this will reduce the risk of miscarriage.
The few extra months can help because some conditions are more difficult -- or even impossible -- to resolve during pregnancy. Vaccination for rubella (German measles), for instance, must be administered at least three months before getting pregnant. Even minor surgeries or X-rays, which may take time to schedule, are safer to get out of the way before conception, says Dr. John Queenan, chairman of the department of obstetrics and gynecology at Georgetown University School of Medicine and author of "A New Life" and "Preconceptions: Preparation for Pregnancy." It also takes time to quit smoking and drinking, and to rid the body of harmful toxins.
Nutrition and Weight
A growing fetus needs plenty of protein, calcium and iron right from the start, so make sure your nutrient level is up to snuff before you get pregnant. "Preconceptionally speaking, eating for two means eating twice as well," says Diane Dimperio, a nutritionist and director of the Maternity and Infant Care Project at University of Florida at Gainesville.
That means eating all the recommended servings of fruits, vegetables and other food groups -- something most people don't typically do. "That's why the preconceptional period can be so important," she says. "If you can develop good eating habits and they become part of your lifestyle ahead of time, then pregnancy will be more fun because you won't have to be thinking so much about your diet."
One of the most critical nutritional requirements before pregnancy is folic acid, which can reduce by one-half or more your baby's risk of neural tube defects, such as spina bifida. Since the right amount of this essential B vitamin can't be assured through diet alone, women should begin taking 0.4 milligrams of folic acid daily, either as a supplement or by taking a prenatal vitamin three months before conception, Dr. Queenan says. Also, avoid megadoses of vitamins, especially the fat-soluble ones like vitamins A, D and K, he cautions.
Experts also urge women to get close to their recommended body weight before getting pregnant -- no more than 20% above or 10% below, according to Bonnie Berk, a registered nurse and personal trainer. Either extreme can make it more difficult to get pregnant and could put women at greater risk for certain complications. Overweight mothers-to-be are more susceptible to high blood pressure and diabetes, and underweight mothers-to-be are at greater risk for low-birth-weight babies, miscarriage and premature labor. Avoid dieting during pregnancy, too, because it can rob your baby of essential nutrients.
Get on a balanced exercise program that includes aerobic activity, muscle strengthening and flexibility training, says Berk, who is also president and co-founder of Motherwell, a training program for instructors who teach pregnancy exercise classes. Working out will not only help prepare your body for the rigors of childbirth, but it'll help you feel better throughout your pregnancy. Because pregnancy puts extra stress on your lower back, exercises that strengthen that part of your body are particularly helpful, Berk adds.
It's much easier to maintain an exercise routine once you get pregnant if you've been working out all along. "Pregnancy isn't a time to begin new exercise techniques, it's a time to continue them," says Zinaman. Check with your doctor to make sure the activities you're doing are safe for pregnancy, and if you're just starting out, try yoga and a low-impact exercise like swimming or brisk walking for 30 minutes two or three times a week.
Keep the intensity of your workouts moderate since extremely strenuous activity (like marathon running, for instance) can make it harder to conceive and could even be dangerous to a developing fetus, Berk says. A good rule of thumb is to keep you heart rate between 60% and 80% of your maximum. To calculate your range, subtract your age from 220, then multiply by 60% for the low end and by 80% for the high end.
Kick the Habits
"Short of an occasional glass of wine periodically, you should not be drinking, and you should never be smoking," says Dr. Robert Stillman, medical director of Shady Grove Fertility Centers in the Washington, D.C., area. "Not only do they have a profound effect on maintaining a healthy pregnancy, but most women don't know they can have a profound effect on the ability to conceive, too."
During pregnancy, smoking can cause low birth weights, premature labor and miscarriage, and heavy drinking is one of the leading known causes of mental retardation in the U.S. Studies haven't proven how much alcohol is enough to cause problems -- although the numbers are getting more conservative -- so doctors suggest that it's better to be safe than sorry and eliminate alcohol consumption entirely, especially during the first 12 weeks. By quitting alcohol and nicotine early, you also avoid the unpleasant task of battling withdrawal symptoms and morning sickness at the same time.
As for caffeine, researchers are less clear about its effects on pregnancy, but since large amounts have been suspected of contributing to miscarriage and low birth weight, doctors suggest playing it safe and limiting yourself to one or two cups per day.
A Father's Place
A father-to-be should be thinking about his role in contributing to a healthy pregnancy, too, although the list of hazards is significantly shorter than his partner's.
In most cases, the risks are associated with reduced fertility, not complications during pregnancy, says Zinaman. "Even chemotherapy hasn't been shown to cross through the seminal plasma into the woman and the pregnancy." (One exception to this is passive smoking: A fetus can be adversely affected by a father's smoke.)
Men trying to help conceive a child should cut back on smoking and drinking -- or quit altogether -- a few months before the attempt, since both substances can reduce sperm levels. Certain medications, like antihypertension blood pressure drugs, also can affect fertility. Pesticides, dry cleaning solvents, paints and lead can also cause problems, although actual risks are unlikely since environmental and occupational safety regulations typically prevent exposure to dangerous levels, Zinaman says.
"The bottom line is that women and men have a responsibility in terms of deciding when to get pregnant and then keeping themselves in a healthy condition. It's not just something that happens to you and you'll deal with it," says Joyce Thompson, a preconception expert and director of the nurse midwifery program at University of Pennsylvania School of Nursing.