Pregnancy planning

Whether you are thinking about having a baby for the first time or have been pregnant before, with a little planning you can give yourself the best chance of a healthy pregnancy and baby.

Preparing for pregnancy at least a few months out is ideal to help make sure you’re physically and mentally ready for pregnancy and parenthood. But it’s never too late - those who find themselves unexpectedly pregnant can also benefit from a few simple lifestyle changes and a health check to ensure you are on the right track.

Pre-pregnancy check up

Your first step when planning a pregnancy should be to see your GP (general practitioner). Take your partner along too, if possible.

Your doctor will ask about any previous pregnancy problems you have had and whether there are any illnesses that run in your family. Your doctor will also want to get a good picture of your overall health.

Existing illness

Your doctor will ask if you have any chronic (ongoing) illnesses. Pre-existing conditions may affect your pregnancy, and can also be affected by pregnancy, meaning that they may get worse or better while you are pregnant. Your doctor will want to make sure any conditions you have are as well-controlled as possible to reduce any possible health risks for you and your baby.

Medicines and supplements

Tell your doctor about any medicines you are taking, including prescription or over-the-counter medications, as well as any herbs or supplements. Because some medicines and complementary medicines are not safe to take during pregnancy, your doctor may recommend you temporarily stop taking them or switch to a safer alternative. Never stop or change your medicines without talking to your doctor first.

Routine health checks

Your doctor will want to check that you are up to date with your regular health screenings (such as cervical cancer screening tests) and immunisations. They may also suggest a blood pressure check, breast examination and testing you and your partner for sexually transmitted infections (STIs).

Lifestyle changes

Finally, your doctor will recommend which supplements you should take and any lifestyle changes that will help improve your health before you get pregnant.

Make sure you discuss any concerns you have about pregnancy and getting pregnant. Ask your doctor how long you should try to get pregnant before seeking help. In general, it’s recommended that women younger than 35 years seek help if they are not pregnant within 12 months of trying, and those 35 and older should see their doctor after 6 months of trying.

Stopping contraception: when and how

Obviously, you’ll want to stop using contraception when you are ready to try for a baby. But your doctor may recommend stopping some types of hormonal contraception, such as the combined oral contraceptive pill or hormonal contraceptive injection, several months before you plan to start trying. That’s because it can take time for your periods to return to a regular pattern.

If you’d prefer not to get pregnant straight away after stopping hormonal contraception, you can use a barrier method of contraception (such as condoms or a diaphragm) while your body re-establishes its normal menstrual cycle.

Healthy lifestyle

Fine-tuning your lifestyle choices can help you get as healthy as possible before conceiving.

Try to get to a healthy weight

Being overweight (or underweight) can make it harder to get pregnant and increase the risk of health problems for both you and your baby.

If you are overweight, talk to your doctor about a weight loss strategy before getting pregnant. Dieting to lose weight is generally not recommended once you are pregnant. However, eating a healthy, balanced diet is a good idea at any time.

Exercise

Moderate amounts of exercise can help improve your fertility and prepare your body for pregnancy, labour and childbirth by improving your energy levels, muscle strength and stamina. So, get into the routine of doing some regular exercise - try visiting the gym, swimming, or going for long, brisk walks.

If you are healthy, it should be safe for you to continue with your usual exercise programme when trying to conceive and into the early part of your pregnancy. Check with your doctor before starting a new programme, especially if you have pre-existing health problems or are already pregnant.

Eat well

It’s obvious that the food you will be eating when you are pregnant will be nourishing your growing baby. Start eating well before you get pregnant so that by the time you do conceive you are already reaping the benefits of healthy eating.

In general, eat a high fibre, well balanced diet, with plenty of:

  • fruits and vegetables (choose a variety);
  • grains (cereals);
  • dairy products (which are high in calcium); and
  • foods rich in protein, such as poultry, lean meat, fish, eggs and nuts.

Try to cut out:

  • highly processed foods;
  • foods and drinks that are high in calories but low in nutrition;
  • artificial sweeteners and sugar; and
  • foods that are high in salt.

In addition, pregnant women need to increase their intake of several nutrients to cover their own needs and those of the baby. These include:

  • folate, which is found in many fresh fruits and vegetables (especially green leafy vegetables such as broccoli and spinach), as well as nuts, chickpeas and dried beans;
  • iodine, which is found in seafood, vegetables grown in iodine-rich soil, and iodised table salt;
  • foods rich in iron, including red meat, pulses and green leafy vegetables; and
  • calcium from foods such as dairy products or tinned fish with bones (e.g. sardines or salmon).

Folic acid (folate) and iodine supplements are also recommended before and during pregnancy (see below).

Watch your caffeine intake

It’s recommended that pregnant women avoid excessive amounts of caffeine - this means aiming for less than 300 mg per day (about 3-4 cups of brewed coffee).

Suddenly stopping drinks and foods containing caffeine can cause headaches, so if you are planning a pregnancy, you may want to gradually reduce your caffeine intake.

Limit alcohol

Drinking alcohol can reduce the fertility of both men and women, so cutting down is a good idea if you are planning a pregnancy.

Most doctors recommend that you completely avoid alcohol during pregnancy because it is not possible to identify what level of drinking is safe for pregnant women.

Quit smoking

Smokers are less fertile than non-smokers, so you should stop smoking to improve your chances of getting pregnant. Quitting before you get pregnant will also greatly improve your chances of a healthy pregnancy and healthy baby. There is no safe level of smoking during pregnancy.

Your partner should also kick the habit because smoking also affects male fertility. Exposure to second-hand tobacco smoke can increase the risk of health problems for you and your baby.

Stop taking any recreational drugs if you happen to use them. They can harm your health and be dangerous for you and your baby when pregnant.

Vitamin and mineral supplements

There are some supplements that are recommended for all women planning a pregnancy and during pregnancy.

Folic acid

It’s recommended that women planning a pregnancy begin taking a folic acid (folate) supplement every day. The supplement should contain at least 0.4 mg of folic acid, and should be taken for at least one month before conceiving and during the first 3 months of pregnancy. This is to reduce the risk of having a baby with a neural tube defect, such as spina bifida.

It is important to take folic acid while you are trying to get pregnant because the baby needs adequate amounts in the first weeks of life — when you may not know you have conceived — for normal neurological development.

If you have a known increased risk of neural tube defects your doctor may advise you to take a daily supplement containing 5 mg of folic acid. This higher dose of folic acid is usually recommended for women who are overweight, taking anticonvulsant medicines, have diabetes or have a family history of neural tube defects.

Iodine

Iodine supplements of 150 mcg (micrograms) per day are recommended before you get pregnant as well as during pregnancy and breast feeding. An adequate amount of iodine during pregnancy is important for the baby’s brain development.

Pregnancy multivitamins

It can sometimes be difficult to eat a balanced diet when you are pregnant, especially if you have morning sickness. Look for supplements that are specifically designed for women who are pregnant or trying to conceive, with adequate amounts of all the things you need and without too much vitamin A, as this may harm the baby. Your pharmacist can help you select the most appropriate multivitamin.

Vaccinations

There are several infectious diseases that your doctor will want to make sure that you are immune to before you get pregnant. That’s because catching these infections while you are pregnant can be dangerous for you or your baby (or both).

Your doctor will ask about your vaccination history and whether you have had certain infectious diseases in the past. They may also recommend blood tests to check your immunity to infections, including hepatitis B, chickenpox, measles, mumps and rubella.

If you are not immune or your immunity has waned (decreased) over time, your doctor will recommend vaccination or a booster shot.

Hepatitis B

Women who have not previously been immunised against hepatitis B should be immunised before becoming pregnant. Hepatitis B immunisation is not routinely recommended during pregnancy.

Measles, mumps and rubella

Rubella infection during pregnancy can lead to serious birth defects. Most people are vaccinated against measles, mumps and rubella as children or teenagers. But because immunity sometimes wanes by the time women are ready to start a family, it is important to have a blood test before you become pregnant to find out whether you need a booster shot.

You need to take care to avoid getting pregnant within 28 days of having a measles, mumps and rubella booster shot.

Chickenpox (varicella zoster)

Women who contract chickenpox for the first time in pregnancy are at risk of passing it on to their unborn child where it can have very serious effects. A simple blood test can tell if you are immune to chickenpox, and if not, vaccination before getting pregnant is advised.

The vaccine should not be given during pregnancy, and women should avoid becoming pregnant for 28 days following vaccination.

Whooping cough

Whooping cough (pertussis) can cause serious illness in babies, and newborn babies are especially vulnerable to infection because their first scheduled vaccination against whooping cough is not until 2 months of age.

While most people are vaccinated against whooping cough during childhood, immunity wanes over time. It’s recommended that all adults who will be in frequent contact with the baby are given a booster dose of diphtheria, tetanus and pertussis vaccine (dTpa). In general, pregnant women should be vaccinated early in the third trimester of each pregnancy.

Influenza

Yearly influenza vaccination is recommended for all people wanting to avoid getting the flu. This includes women planning a pregnancy and pregnant women.

Vaccination is important because pregnancy increases the risk of having severe influenza. Getting immunised also helps protect your newborn baby from getting flu during the first few months after birth.

Pregnant women can be vaccinated against influenza at any stage of pregnancy. It is particularly recommended for those who will be in their second or third trimester during the flu season (winter).

Overseas travel while trying to conceive

You may want to put your baby plans on hold while travelling overseas, especially when travelling to countries where you are at risk of getting certain infectious diseases. Talk to your doctor about any special precautions you may need to take before travelling overseas.

Visiting a Zika virus affected country is generally not recommended if you are planning a pregnancy. If you or your partner have been in a Zika virus affected area, you should avoid trying to get pregnant until your doctor advises it is safe to conceive.

Genetic counselling

Genetic counselling may be recommended for some women or couples when planning a pregnancy. Genetic counselling involves talking to genetic counsellors about your risk of having a baby with an inherited genetic disorder and the implications of the condition for you and your family.

During genetic counselling, you will be asked detailed questions about your family health history. You will also be asked about any previous pregnancies or miscarriages.

Reasons you may be referred for genetic counselling before getting pregnant include:

  • having a family history of an inherited disease (such as cystic fibrosis);
  • being from an ethnic background that increases your risk of certain genetic disorders (such as thalassaemia); and
  • having difficulty conceiving or staying pregnant.

Carrier screening tests may be offered to you and your partner before you get pregnant. Your doctor or genetic counsellor will explain these tests and what the results will mean for you and future pregnancies.

Pregnancy planning in older women

The average age that women have their first baby in Australia has been steadily rising for some time, with many women delaying having children and planning pregnancies in their 30s or even 40s. However, once you are approaching your 40s, your chances of becoming pregnant are significantly reduced compared with when you were younger.

Most women aged 35 years or older have normal pregnancies, but there are some particular things you need to think about before becoming pregnant at this age.

Once a woman reaches 35 years she has a greater chance of:

  • fertility problems, including taking longer to get pregnant;
  • miscarriage and pregnancy loss;
  • premature birth;
  • developing diabetes or high blood pressure while pregnant;
  • giving birth by Caesarean section (surgery to deliver the baby);
  • having a baby with chromosomal problems, such as Down syndrome; and
  • having a multiple pregnancy (e.g. twins) which increases your risk of various health problems during pregnancy and delivery.

Some studies have shown that the age of the father at the time of conception also impacts on the health of babies. More research is needed to establish what impact a man’s age can have on his offspring’s health.

Regular antenatal care from a GP, midwife or obstetrician (doctor specialising in pregnancy and childbirth) at any age gives you the best chance of having a healthy pregnancy. Additional tests during early pregnancy may be offered to women older than 35 years.

Last Reviewed: 24 May 2018
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References

1. Royal Australian College of Obstetricians and Gynaecologists (RANZCOG). Planning for pregnancy (updated 28 Jul 2016). https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Patient%20information/Planning-for-pregnancy-pamphlet.pdf?ext=.pdf (accessed Apr 2018).
2. Royal Australian College of Obstetricians and Gynaecologists (RANZCOG). Pre-pregnancy counselling (reviewed July 2017). https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Pre-pregnancy-Counselling-(C-Obs-3a)-review-July-2017.pdf?ext=.pdf (accessed Apr 2018).
3. Family Planning NSW. Pre pregnancy planning (updated May 2013). https://www.fpnsw.org.au/health-information/individuals/pregnancy/pre-pregnancy-planning (accessed Apr 2018).
4. Australian Government Department of Health. The Australian Immunisation Handbook, 10th Edition. 3.3 Groups with special vaccination requirements (updated 1 Aug 2017). http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home~handbook10part3~handbook10-3-3#3-3-2 (accessed Apr 2018).
5. Centers for Disease Control and Prevention (CDC). Planning for pregnancy (updated 23 Jan 2018). https://www.cdc.gov/preconception/planning.html (accessed Apr 2018).
6. Mayo Clinic. Getting pregnant. Pregnancy after 35: Healthy moms, healthy babies (updated 5 Aug 2017). https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy/art-20045756 (accessed Apr 2018).
7. American College of Obstetricians and Gynaecologists (ACOG). Frequently asked questions: Having a baby after age 35 (updated Sep 2017). https://www.acog.org/Patients/FAQs/Having-a-Baby-After-Age-35 (accessed Apr 2018).
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