Women's Health Series: Pregnancy

In this final blog in our Women's Health Series, Dr. Nick looks at pregnancy, specifically if you're struggling to conceive...

First of all, if you can’t seem to get pregnant, don’t despair. Do not try and time your ovulation and when you have sex with any device. The majority of patients I see that try this just manage to create more stress and struggle even more. Have sex, then a bit more and then some. 84% of couples will conceive within 1 year and 92% by the end of second year. If you can’t get pregnant after a year of trying, see your GP who should arrange some tests for you. If you can’t get pregnant after 2 years of trying, you can be referred to a fertility clinic. 

So what else should you be doing to ensure a pleasant experience and a healthy baby?

Leading a healthy lifestyle is key to providing the best start in life for your baby and ultimately for your pregnancy and beyond. The first thing to do is to ensure that if you have any underlying medical problems, such as Asthma, Diabetes, Epilepsy, that these are as optimised as possible. Also try and make sure you are up to date with your vaccinations and cervical smears (see related article on Cervical Cancer & Screening  ). Make sure you see your GP and tell him you're looking to get pregnant.

Diet & Lifestyle 

Another very important aspect of a healthy pregnancy is your diet. Regardless of being pregnant, everyone should adhere to a healthy balanced diet, but in pregnancy there are vitamins and minerals you need to consume and food you have to avoid. You may be under the misconception that you need to increase your calorific intake in pregnancy, however this is not the case and the only increase is about 200 Kcal in the last three months. 

Ensure you're having: 

• Food: raw and cooked vegetables (washed), fruits and berries (washed), nuts, vegetable oil, water, whole grain cereals, poultry
• Vitamins and minerals: Vitamin C, Folic Acidand Vitamin D. These can be in the form of a supplement

Try to have less of: 

• Saltysnacks, chocolate and sweets, cakes, chips, white bread, ketchup, sugar, processed meats, sweetened drinks and pasta  

No more than two portions a week of: 

• Mackerel,salmon, sardines, tuna, sea bream, sea bass, halibut and brown crabmeat. These fish may contain a lot of mercury and other chemicals 

Avoid: 

• Raw or undercooked seafood, fish or eggs
• Unripened soft cheeses, such as Brie, Camembert or blue-veined cheese
• Unpasteurisedmilk
• Liver and Pâté, as they contain high levels of Vitamin A that can be harmful 

Caffeine:

• Risk of low birth weight and miscarriage
• 1-2 mugs of coffee or 3 cups of tea per day should be your limit

Alcohol:

• Can lead to low birth weight, pre-term delivery and impaired neurological development
• Avoid drinking alcoholcompletely
• If you can’t stop drink no more than 1–2 units once or twice a week

Smoking & Drugs

Smoking prior to getting pregnant can reduce fertility for both you and your partner. During pregnancy, it can lead to congenital defects, risk of miscarriage, preterm delivery, low birth weight, risk of stillbirth, risk of sudden infant death…should I go on? Make sure you see your GP who can help you with this; but at the end of the day you just need to stop smoking.

The list of problems associated with drug use, is just too great to mention here, but speak to your GP who can get you help and try to stop, before you get pregnant.

Obesity

Having a high BMI (Body Mass Index) has been associated with congenital defects, risk of miscarriage, stillbirth, pre-eclampsia (a condition that causes high blood pressure, organ damage and can lead to seizures) and gestational diabetes (diabetes in pregnancy). You should ideally aim for a BMI of 19-25 by following a low calorie diet and exercise.

Exercise

I saw a patient recently who had just found out she was pregnant and when I asked her “are you exercising”, she replied “no, but surely I can’t start now that I’m pregnant?” Like a lot of women, she thought that exercising during pregnancy is bad for the baby. On the contrary, exercising will help to: 

• Maintain a healthy weight
• Make your pregnancy more comfortable
• Make your delivery easier
• Improve your recover after delivery

 Aim for:

• Aerobic physical activity
• Moderate resistance training
• 30 minutes a day

Avoid:

• Contact sports
• Sports that can lead to injury E.g Horse-riding, cycling, winter sports
• Lying flat on your back after the 4^th month

Other things to think about

• Try and avoid handling cat poo and cat litter, as this can lead to toxoplasmosis
• Handling raw food, the risk of food poisoning is too high to risk.
• Be aware of over-the-counter medication you buy and always inform the pharmacist
• Yes, you can have sex when pregnant, though I’ll let you figure out the positions

Other than that, your pregnancy should be an enjoyable experience and you should at the very least be offered a seat on the bus…