Planning for pregnancy

Being fit and healthy maximises your chances of a healthy pregnancy. By the time you have missed your first period, you are two weeks pregnant. So, it's best to prepare for a pregnancy before trying to conceive, and to follow the advice that is given to pregnant women.

Stopping contraception

If you’re planning a pregnancy, you will need to think about stopping the contraception you have been using. If you use barrier methods of contraception, such as condoms or diaphragms, it’s possible for you to become pregnant as soon as you stop using these.

You may worry that some other methods of contraception you have been using could affect your chances of getting pregnant. However, most women find that their fertility levels and periods return to normal in a short period of time.

You will regain your normal fertility quickly when you:

• stop taking the contraceptive pill

• have a contraceptive implant removed

• have an intra-uterine device (coil) removed, including one that releases hormones

If you were using the contraceptive depot injection, your periods and fertility may take longer, up to 12 months in some women, to return to normal than after other methods of contraception are stopped.

If you do get pregnant very soon after stopping hormonal contraception, there is no need to worry because this will not harm your baby.

When is the best time to conceive?

If couples have sexual intercourse two to three times a week without using contraception, more than eight in 10 will become pregnant within the first year of trying for a baby.

Some people believe that timing sex to be close to ovulation is the best strategy for getting pregnant, but this is not necessarily the case. Regularly having sex every two to three days prevents the pressure and stress that can occur if you try to time it with ovulation. Stress on either partner is known to affect the chances of conceiving.

If you have been trying for a baby for a year without getting pregnant, you and your partner should see a doctor. If you’re over 35 or you have infrequent or no periods, see a doctor sooner.

Healthy weight

Before you try to conceive, aiming for a healthy weight will increase your chances of ovulation. A healthy body mass index (BMI) for adult women is between 19 and 25.

If your BMI is over 29, losing excess weight will improve your chances of ovulation. It’s not advisable to try to lose weight if you’re already pregnant, so planning to lose excess weight in advance of conceiving is important.

If your BMI is under 19, you may find that you have irregular or no periods. This can indicate that you aren’t ovulating regularly. Aiming to increase your weight to within the healthy range is likely to help regulate your ovulation and periods, which improves your chance of conceiving.

Healthy eating

Eating a healthy diet before pregnancy means that your body has adequate stores of vitamins and minerals. A nutritious, well-balanced diet includes eating a variety of the following foods.

• Plenty of fruit and vegetables (at least five portions a day), which can be fresh, frozen or tinned.

• Starchy foods, which includes bread, pasta, rice and potatoes.

• Protein, such as lean meat, fish, beans and lentils.

• Plenty of fibre, which can be found in wholegrain breads, fruit and vegetables.

• Dairy foods, such as milk, yoghurt and cheese, which are a good source of calcium.

Drink enough fluids every day, but limit your intake of caffeine-containing drinks, such as coffee, energy drinks and other fizzy drinks. Also try not to eat or drink too many foods that are high in sugar, salt or fat.

There are certain types of food that can increase your risk of food poisoning caused by bacteria. As well as making you ill, these bacteria can cause serious problems in your unborn baby. Women who are trying to get pregnant or who are pregnant should not eat:

• soft, mould-ripened cheeses, such as Camembert and Brie

• blue-veined cheeses, such as Stilton and Roquefort

• pâtés (including vegetable pâté)

• uncooked or undercooked ready-prepared meals

• uncooked or cured meat, such as salami

• raw shellfish, such as oysters

• unpasteurised milk or cheeses

• uncooked or lightly cooked eggs and egg products, such as soft-boiled eggs or home-made mayonnaise

There are other foods that you shouldn’t eat because of risks associated with substances found in them. Don’t eat the following foods when you're pregnant.

• Large quantities of liver, liver products, vitamin supplements that include vitamin A and fish liver oils because these all may contain levels of vitamin A that can harm your unborn baby.

• Fish, such as shark, swordfish, fresh tuna and marlin because they contain relatively high levels of methylmercury. This might affect your unborn baby’s nervous system.

• More than two medium size cans of tuna a week because of the high levels of mercury they may contain.

Folic acid

It’s important that pregnant women have enough folic acid, as this helps to prevent your baby developing serious problems of the brain and nerves (such as spina bifida). Your doctor or midwife may recommend that you take folic acid supplements if you are planning to get pregnant, and up to the 12th week of pregnancy.

You may be at a higher risk of having a baby with spina bifida if you have had a previous pregnancy affected by it, or you have a family history of spina bifida. If you take medicines for epilepsy, have diabetes, coeliac disease or thalassaemia, your risk is also increased. Your doctor of midwife may recommend that you take a higher dose of folic acid if your risk is increased.

Vitamin D

If you’re pregnant, your growing baby will need a good supply of vitamin D. Your body produces vitamin D when your skin is exposed to sunlight and you may get some from your diet. However, if you don’t get much exposure to sun, you may be more at risk of vitamin D deficiency.

Your doctor or midwife may advise that you take a daily supplement of vitamin D if you’re pregnant or trying to get pregnant.

What to stop before trying for a baby

Smoking

It’s important to try to stop smoking when planning to get pregnant. If you or your partner smokes, it can reduce your fertility.

If you smoke during pregnancy, you will have a greater risk of:

• miscarriage

• stillbirth

• giving birth too early (premature birth)

• complications during and after pregnancy and labour

• having a low birth weight baby

If your baby has a low birth weight or is born prematurely, he or she is more likely to have health problems and is at higher risk of sudden infant death syndrome (SIDS, or cot death).

If you or your partner needs help, support or practical advice on giving up smoking, talk to a doctor, nurse or midwife. You may be able to get help and advice from your pharmacist.

Alcohol

It’s best not to drink any alcohol when you’re trying to get pregnant and during the whole of your pregnancy. Alcohol, even in small amounts, may harm your unborn baby and lead to problems including damage to his or her facial features, brain, heart and kidneys, as well as learning difficulties and behavioural problems in later life.

If you do choose to drink alcohol, limit the amount you drink to no more than two units of alcohol, once or twice a week.

Medicines

If you take medicines for any reason, tell your doctor that you’re planning to get pregnant because some medicines may affect your developing baby. Don’t stop any medicines you have been prescribed until you talk to your doctor because this could affect your health.

If you need to take a painkiller while you’re trying for a baby or once you’re pregnant, paracetamol (acetaminophen) is recommended. However, if you find paracetamol ineffective, occasional, single doses of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, have not been shown to have negative effects on conception or pregnancy, up to week 30. From week 30, there is evidence that NSAIDs can cause pregnancy complications, so these must only be taken under supervision by a doctor and with regular monitoring of your unborn baby.

If you buy any medicines from a pharmacy (chemist or drugstore), always check with your pharmacist to see if these are safe to take while trying for a baby, or when pregnant. Check that any herbal or alternative remedies, or complementary therapies are safe to use during pregnancy, or while trying to get pregnant.

Very few of these types of medicine have been established to be safe in pregnant women. Ask your doctor, nurse, midwife or pharmacist about these. Keeping the use of all medicines to a minimum during pregnancy is advised.

Hazards at work

It’s possible that substances you’re exposed to at work may put your health or the health of your unborn baby at risk. Certain chemicals, such as mercury and lead, or radioactive substances, such as X-rays, have the potential to be harmful to your baby.

Your physical working environment, such as if you work at height, do heavy lifting, are on your feet all day or work alone, may also be more risky if you’re pregnant. It’s important that you speak to those who are responsible for health and safety in your workplace. Your role at work may need to be adjusted while you’re pregnant.

Existing medical conditions

Before you plan to try for a baby, it’s important that you speak to your doctor if you have any medical conditions, such as diabetes, epilepsy, heart or circulatory problems. The prescription medicines you take for any medical condition may need to be altered in dose, type or gradually stopped. Don’t stop taking any prescribed medicines without seeking advice from your doctor because this could put your health at risk.

If you have any gynaecological problems, such as endometriosis, polycystic ovary syndrome, or have had an ectopic pregnancy (when the fertilised egg implants outside the womb, often in the fallopian tube), it will be useful to talk to your doctor because these conditions may affect your chances of conceiving .Your doctor may be able to refer you for more specialist advice. .

Genetic counselling

If you or your partner have any hereditary conditions in your families, such as sickle cell anaemia, thalassaemia, cystic fibrosis or muscular dystrophy, let your doctor know. He or she may refer you for genetic counselling. This involves speaking to a genetic counsellor who is a specialist in inherited conditions and who can work out your chances of passing on a hereditary condition to your baby.

Immunisations

Rubella is a mild viral infection that is commonly caught by young children, causing a rash and making them generally feel unwell. If you become infected with rubella during pregnancy, particularly if you catch it in the first 12 weeks of pregnancy, it can lead to serious damage to your baby’s heart, eyes and ears.

Many countries have vaccination programmes against rubella in childhood.. Once you’re vaccinated against rubella, the immunity usually lasts for life. However, it’s important to find out before you conceive if you’re still immune.

This can be checked by having a blood test. If it’s found that you’re lacking immunity to rubella, it’s recommended that you have the vaccination. You need to wait a month from when you’re vaccinated until you try to get pregnant.

Another vaccination you may be offered if you’re planning a pregnancy is against chickenpox. If you haven’t been vaccinated against hepatitis B, you may also be able to have this vaccination if you live or work with people who may have this disease.

Please note that availability and use of vaccinations may vary from country to country. Ask your doctor or health professional for further advice.

Advice for fathers

Try to keep to a healthy weight because being overweight can affect your fertility. Smoking can lower your sperm quality. Choosing to quit smoking will increase the number of healthy sperm you can produce, as well as having other health benefits. Once your baby is born, to protect him or her from the effects of passive smoking, don’t start smoking again.

Too much alcohol can also damage sperm quality, so you’re advised to cut down on drinking to increase your chances of conceiving.

Sperm production can be affected by high temperatures. If you’re trying for a baby, there may be an advantage to wearing loose-fitting underwear and trousers to keep your testicles at a lower temperature, but this has not been proven.