Tuesday, September 20, 2005

Photos by Max Ortiz / The Detroit News Dr. Mark Chames of the University of Michigan Health System counseled Sarah Groeneveld months prior to her getting pregnant. It's important to know a patient's family and medical history, he says.

Couples should plan before they conceive

Steps taken before a pregnancy help ensure a healthy mom and baby

By Stories By Lauralee Ortiz / Special to The Detroit News

Christine Eagle, dietitian at Beaumont Hospital in Royal Oak, shows some of the healthy choices for patients planning to become pregnant. Comment on this story Send this story to a friend Get Home Delivery

Nearly six months pregnant, Superior Township resident Sarah Groeneveld is counting her blessings. Her health is good, and the baby she's carrying is developing normally.

"They're 70 percent sure it's a girl," she says. "And she's doing great."

It's a far cry from a year ago when Groeneveld, 23, and her husband Robert, 24, were mourning the miscarriage of their first child.

"We are very fortunate to be at this stage right now," she says, explaining that medical challenges made the decision about whether to attempt to have a baby difficult.

"My husband and I weren't sure we wanted to risk it," Groeneveld says. "Besides the concern that I would even be able to carry a baby full term, I have a disease (diabetes) that has to be highly controlled."

Fortunately, she shared her plans and concerns with her doctor long ago, when he gave her pointers specific to her condition aimed at having a healthy pregnancy.

Talking to a doctor is one of several steps that medical experts say more people should take toward having a healthy pregnancy and baby before even attempting to conceive.

Get a physical

"It's probably a good idea to get in and speak with a physician prior to conceiving, so you can go through family and medical histories and identify any problem areas," says Dr. Mark Chames, assistant professor of Obstetrics/Gynecology at the University of Michigan Health System in Ann Arbor.

Chames, who specializes in high-risk pregnancies, says genetics, prior illnesses, diet, exercise habits and environmental exposures of both partners play a role not only in conception itself, but the health of the baby.

For couples with pre-existing medical conditions, close monitoring by specialists may be necessary before and throughout the pregnancy. For others, whose doctors see no medical obstacles in their path to becoming parents, there is still plenty they can learn prior to conception.

"It's a good idea to touch base to see if we can identify anything as a risk factor," Chames says, adding you should start with the family ob/gyn. "If there are things that indicate problems, they would be referred to a high-risk physician."

Your doctor will need to know a personal history on both prospective parents. Be prepared with information on sexually transmitted diseases, heart disease, high cholesterol, weight problems, genetic birth defects and chronic health issues.

Hopeful moms most likely will receive a complete physical, be tested for certain infectious diseases and have immunizations updated.

Get healthy

Even if your physical and tests come back fine, don't make a beeline for the bedroom just yet -- well, at least with the intention of conceiving right away. Brad Imler, Ph.D., president of the American Pregnancy Association in Irving, Texas, says couples should take some time to improve their lifestyles before trying to conceive.

"If a couple is anticipating moving into getting pregnant, our recommendation is that they take three to six months to begin focusing on their own overall health."

Christine Eagle, clinical dietitian and certified diabetes educator at William Beaumont Hospital in Royal Oak, agrees.

Among the obvious improvements, she says, are that if you are a smoker, quit. Same goes for drinking alcohol.

Medical experts agree women planning to conceive should start taking prenatal vitamins early. Of particular concern, Eagle says, is that women get enough folic acid, a B vitamin that research has proven plays a powerful role in preventing neural tube defects such as spina bifida.

The Centers for Disease Control recommends 400 milligrams of folic acid daily.

Among the important minerals in these megavitamins is calcium, a nutrient that gets depleted from a woman's body during pregnancy. The recommended dosage is 1,000 milligrams daily, or no more than 2,000 milligrams a day.

Next, hopeful parents -- particularly moms-to-be -- should work toward a normal weight.

"There is so much research out there that shows that being overweight going into pregnancy carries a lot of risk factors including gestational diabetes and high blood pressure for the mom and an increase in the risk of obesity for the baby," Eagle says.

Underweight women carry separate risk factors that include fertility problems, premature pregnancy and retardation of the baby.

Eat well

In addition to leaning on a multivitamin for nutrients that support healthy pregnancies and babies, moms-to-be should choose foods that have vitamin C, calcium, folic acid and proteins.

They include fruits, dark leafy green vegetables, dairy products, fortified orange juice, pastas, enriched grains and fortified breakfast cereals, poultry, fish and beans.

Lean red meat is fine, but eat it in moderation -- no more than three servings a week, Eagle says.

Hopeful mothers should start following these nutritional guidelines before the test comes back positive. The reason for getting enough folic acid early is that spina bifida occurs within 18 to 30 days after conception, often before a woman even knows she is pregnant.

That you may become pregnant before realizing it is also why you should circumvent certain foods. Nutritionists strongly recommend you avoid eating undercooked meat, sushi and soft cheeses because of the very slight risk of contracting listeriosis, an uncommon infection in humans but one that can have a devastating and usually fatal consequences for the developing baby.

The FDA also says that women who are pregnant or trying to get pregnant should stay away from swordfish, shark, king mackerel and tilefish because they accumulate high amounts of mercury pollution by eating smaller fish. Mercury can damage an unborn child's developing nervous system.

Caffeine is OK for women planning to get pregnant, Eagle says, but they should limit intake to about 300 milligrams a day. That's two 6- to 8-ounce cups of coffee.

Cats

Also, women hoping to conceive should beware of the cat. It can harbor toxoplasmosis, a parasite that can be harmful if passed on to an unborn child. In early pregnancy, it can cause blindness, deafness and mental retardation. Your safest bet is to keep the family cat indoors, and have someone else clean the litter box.

Dentist

Doctors also suggest would-be mothers include a dental visit in preconception planning. There is mounting evidence that a chemical in plaque called prostaglandin may be linked to higher incidences of pre-term or low birth weight babies.

Finally, relax

Even under the best circumstances, experts say, it takes most couples one year to conceive. Once you've done your part, you can "focus on the ultimate goal -- conceiving a healthy child," Imler says.

A healthy child is certainly the goal for the Groenevelds, whose baby is due Jan. 3.

"Everything is going great," says Robert Groeneveld. "My wife is doing everything she can for our baby. I'm really proud of her."

Lauralee Ortiz is a Metro Detroit freelance writer.