Preparing for Pregnancy Before Conception

Why is preconceptional care important?

Caring for your health before you become pregnant -- called preconceptional care -- will help you learn about any risk factors and treat any medical problems that you may have before you become pregnant. Planning for your pregnancy before you conceive will help you make healthy decisions for you and your baby.

What happens during a preconception office visit?

During a preconceptual office visit, your health care provider will ask you questions about the following:

• OB/GYN History: previous pregnancies, menstrual history, contraceptive use, sexually transmitted diseases, Pap smears, vaginal infections

• Medical/Surgical History: surgeries, transfusions, hospitalizations, pre-existing medical conditions, allergies, current medications (including prescribed and over-the-counter medications)

• Family Health History: hypertension, diabetes, twins, genetic factors such as mental retardation, blindness, deafness, congenital anomalies, ethnic-related conditions such as Tay-Sachs, sickle trait/sickle cell, thalassemia

• Lifestyle: stress; exercise; diet; use of caffeine, tobacco, alcohol or recreational drugs; discuss partner's habits

• Home and workplace environment: possible teratogens and hazards, such as exposure to cat feces, x-rays, lead or solvents

Your health care provider may also:

• Perform a Physical Exam (optional): heart, lungs, breasts, thyroid, abdomen and pelvic exam

• Order Lab Tests (optional): rubella, hepatitis, complete blood count (CBC), Pap, Egenital cultures, HIV, others as indicated

• Discuss How to Chart Menstrual Cycles: fertility awareness

• Prescribe a Prenatal Vitamin with 1 mg. folic acid

• Discuss Insurance Coverage: financial planning

• Discuss His or Her Philosophy, Practice Style

There are no data in humans to indicate that pregnant women should limit exercise intensity and lower target heart rates because of potential adverse effects.

American College of Obstetricians and Gynecologists Recommendations for Exercise During Pregnancy and Postpartum

Technical Bulletin -- February, 1994

For women who do not have any additional risk factors for adverse maternal or perinatal outcome, the following recommendations may be made:

• During pregnancy, women can continue to exercise and derive health benefits even from mild-to-moderate exercise routines. Regular exercise (at least three times per week) is preferable to intermittent activity (altering between periods of being active and inactive).

• Women should avoid exercise in the supine position (lying horizontally on the back) after the first trimester. Such a position is associated with decreased cardiac output in most pregnant women. Prolonged periods of motionless standing should also be avoided.

• Women should be aware of the decreased oxygen available for aerobic exercise during pregnancy. They should be encouraged to modify the intensity of their exercise according to maternal symptoms. Pregnant women should stop exercising when fatigued and not exercise to exhaustion.

• Weight-bearing exercises may under some circumstances be continued at intensities similar to those prior to pregnancy. Non-weight-bearing exercises such as cycling or swimming will minimize the risk of injury and facilitate the continuation of exercise during pregnancy.

• Morphologic changes in pregnancy should serve as a relative contraindication to types of exercise in which loss of balance could be detrimental to maternal or fetal well-being, especially in the third trimester. Further, any type of exercise involving the potential for even mild abdominal trauma should be avoided.

• Pregnancy requires an additional 300 kcal/d in order to maintain metabolic homeostasis. Thus, women who exercise during pregnancy should be particularly careful to ensure an adequate diet.

• Pregnant women who exercise in the first trimester should augment heat dissipation by ensuring adequate hydration, appropriate clothing, and optimal environmental surroundings during exercise.

• Many of the physiologic and morphologic changes of pregnancy persist 4-6 weeks postpartum. Thus, prepregnancy exercise routines should be resumed gradually based on a woman's physical capability.

Preconception Care Suggested Reading

American College of Obstetricians and Gynecologists. (1995) Planning for Pregnancy, Birth, and Beyond. 2nd ed.

409 12th St., S.W., Washington, D.C. 20024-2188.

Herman, B. & Perry, S. (1992) The Twelve-Month Pregnancy: What You Need to Know to Ensure a Healthy Beginning for You and Your Baby. Lowell House, Los Angeles. $12.95

Sussman, J. & Levitt, B. (1989) Before You Conceive: The Complete Prepregnancy Guide. Bantam Books, New York. $12.95

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/. This document was last reviewed on: 9/9/2002