Preconception Planning
in Boca Raton, FL

Birth Control
If you’ve been taking birth control pills, we recommend discontinuing them and waiting approximately three months before attempting to conceive.

This break not only allows your body to acclimate to prenatal vitamins and/or folic acid supplements, it allows you to experience several normal menstrual cycles before becoming pregnant, which in turn enables us to more accurately predict when you ovulated and conceived (and thus contributes to establishing a more reliable due date). During this period you should use condoms or another barrier form of birth control.

Current & Past Health Issues
If you have any on-going medical condition — such as high blood pressure, diabetes, or asthma — it’s best to ensure your condition is under control before becoming pregnant. Even if your condition has been stable, you may require special care and monitoring during pregnancy since your growing baby will put many new demands on your body. Medicines should be evaluated for safety during pregnancy and prior to conception.

Previous Pregnancies
We need to know about your previous pregnancies (if applicable), including any complications you might have had. These include high blood pressure, gestational diabetes, preterm labor, delivery by cesarean section, and any other complications. This information allows us to take proactive measures to increase your probability of having a safe and healthy pregnancy.

Prenatal Vitamins & Folic Acid
You get most of the vitamins and minerals you need from a healthy diet. However, it’s difficult to get enough calcium, iron, and folic acid (a B-vitamin that helps prevent fetal defects of the brain and spinal cord) from the food you eat. Therefore we recommend that you take a prenatal vitamin or folic acid supplement every day. According to the Centers for Disease Control and Prevention, up to 70% of neural tube defects can be prevented if women have adequate levels of folic acid leading up to and immediately following conception.

Because neural tube defects occur during the first month of pregnancy (before many women know they’re pregnant), it’s important for women planning to become pregnant to take a folic acid supplement (either a prenatal vitamin or 1mg of folic acid daily) before conception. This reduces the risk of neural tube defects. If you prefer to take a folic acid supplement instead of a prenatal vitamin during the preconception period, we recommend you switch to prenatal vitamins once you conceive.

Medications
We need to know about all medications you’re currently taking. These include prescription drugs, over-the-counter medications, herbs and other supplements. Some herbs, medications, and supplements should not be taken during pregnancy. We’ll provide you with information about medications that are safe to take during pregnancy and the preconception period.

Family History
We’ll ask you and your partner about your families’ medical history. Histories of potentially inheritable conditions (such as seizure disorders, diabetes, or high blood pressure) or genetic diseases (such as cystic fibrosis, sickle cell anemia, Tay-Sachs, or Duchenne muscular dystrophy) may increase your risk of having a baby with these conditions or other birth defects.

If this is a concern, we may refer you to a genetic counselor for evaluation. We’ll also recommend that you and your partner be tested for specific genetic diseases (such as sickle cell trait), especially if you’re uncertain about your history. Even if you don’t have the disease yourself, you or your partner might carry the defect in your genes and can pass it along to your child.

Immunities
We need to know if your immunizations for tetanus, rubella, and chicken pox are current. If you’re unsure, we may want to perform a blood test to confirm your immunity. Diseases such as rubella and chicken pox can cause serious complications during pregnancy. If you’re not immune, you can receive vaccinations to help protect you against these diseases. After vaccination, you should wait at least one month (preferably two to three) before becoming pregnant.

Diet
If you want to lose weight, we encourage you to do so before you become pregnant (pregnancy is not the time to diet). To help your baby get a head start in life, we encourage you to eat a balanced diet that includes lean meats, fresh fruits and vegetables, whole-grain breads and cereals, dairy products and other calcium and iron-rich foods. Limit your intake of caffeine to the equivalent of two caffeinated beverages per day.

The Food & Drug Administration (FDA) has assured the general public that the safety of aspartame (Nutrasweet™ / Equal™), including during pregnancy, is clear-cut; that aspartame is one of the most thoroughly tested and studied food additives of all time. The FDA and the joint FAO/WHO (Food & Agriculture Organization of the United Nations and the World Health Organization) Expert Committee on food additives have deemed sucralose (Splenda™) safe for everyone to consume, including pregnant women. However, some still question the safety of these sweeteners during pregnancy.

Therefore, especially if you have concerns, we recommend limiting your intake of these sweeteners. (Patients with PKU should not use aspartame at all while attempting to conceive or during pregnancy.) There are many questions about the safe use of saccharine (Sweet’N Low™) during pregnancy.

You may eat up to 12 ounces (approximately 2 average meals) per week of fish or shellfish that are low in mercury, including salmon, canned light tuna, pollock, catfish, and shrimp. Avoid shark, swordfish, king mackerel and tilefish. Based on U.S. Food & Drug Administration (FDA) and Environmental Protection Agency (EPA) recommendations, we advise that you eat no more than 6 ounces of albacore (white) tuna per week while attempting to become pregnant and during pregnancy.

You should avoid eating any game fish without first checking its safety with your local health department. For more information about the risks of mercury in fish and shellfish, or for information about specific types of fish, visit the FDA Food Safety website. For information about the safety of locally caught fish and shellfish, visit the EPA Fish Advisory website or contact your state or local health department.

Exercise
Establishing a regular exercise routine before pregnancy will help improve your fitness level (which will be beneficial during labor and delivery), relieve stress and help prevent health problems such as high blood pressure. Maintaining your exercise routine during pregnancy will help relieve some common discomforts (such as backache and constipation) and will help you feel your best. There is some evidence that exercise may help prevent gestational diabetes.

If you do not already exercise, we’ll provide you with guidelines for exercise based on your current condition and medical history, as well as parameters to follow once you become pregnant.

Dental Care
We encourage you to make an appointment with your dentist prior to pregnancy. Let your dentist know that you’re trying to conceive so that adequate precautions can be taken. You may have dental X-rays with a shield, and the dentist may use local anesthesia. Your dentist may call our office if there are questions regarding medications to be prescribed.

Body Temperature
Raising your core body temperature to 102 degrees or more (measured orally) can be dangerous to your unborn baby, especially during the early weeks of pregnancy. You should therefore avoid hot tubs, saunas, or any prolonged exposure to hot water that might increase your body temperature while you’re trying to become pregnant. Treat high fever with acetaminophen (Tylenol™) and avoid environments or events that might significantly increase your body temperature.

Other factors
Other factors that should be considered during the preconception period are occupational and environmental exposure to substances that may be harmful during pregnancy, such as organic solvents, agricultural or household pesticides and insecticides, chlorinated hydrocarbons, alkylating agents, polychlorinated biphenyls and radiation. We’ll want to know if you work at a chemical plant, laboratory, dry cleaners, pharmacy or compounding shop; are employed or live in an agricultural area; or if you work or live in an environment where you’re exposed to chemicals, radiation or other potentially harmful substances.

If you need X-rays for any reason, be sure to let the technician know you might be pregnant so that you can be properly shielded beforehand.

Smoking
Smoking nearly doubles the risk of having a low-birth weight baby, which puts your baby at risk of serious health problems during the neonatal period. Smoking has also been linked to a number of complications and puts a woman at twice the risk of developing serious placental problems (such as placenta previa and abruption). Studies suggest that women who smoke have more problems conceiving than non-smokers. If you smoke, we’ll provide you with resources to help you kick the habit before you become pregnant.

Alcohol
Alcohol can cause serious mental and physical defects. When a woman drinks alcohol it passes through the placenta to her unborn baby. The baby’s immature system takes much longer to break down the alcohol than an adult’s system, so the alcohol level in the baby’s blood remains elevated longer than the alcohol level in the mother’s blood. This can lead to serious and life-long damage to the baby.

Babies born to women who drink excessively or have repeated episodes of binge drinking during pregnancy are at great risk of developing Fetal Alcohol Syndrome (FAS), a combination of physical and mental defects and one of the most common known causes of mental retardation. It’s unlikely that a drink or two (before a woman realizes she’s pregnant) will harm her baby, but no amount of alcohol has been proven safe. Therefore we recommend that you do not drink any alcohol during pregnancy.

If you’re attempting to become pregnant, you should abstain from alcohol. If you have a drinking problem, you should address it before becoming pregnant.

Illicit Drugs
Everything taken into your body during pregnancy has an impact on your growing baby. Use or abuse of illicit drugs can cause serious complications for you and your baby. The risks for complications to mother and baby are as varied as the drugs themselves. However, birth defects and pregnancy-related problems caused by illicit drug use are completely preventable. As with smoking and alcohol abuse, pregnancy should be delayed until a substance abuse problem is resolved. If you have a drug problem, please discuss it with a trusted person and seek help.

Domestic Violence
Unfortunately, domestic violence is all too common in women’s lives, including during pregnancy. If this is a problem for you, please let us know — we’ll help you get the help you need to be safe.

Smoking, alcohol abuse, drug abuse and domestic violence are all issues that should be addressed prior to pregnancy — for your health and your baby’s health. More importantly, your baby will be safer, happier and more secure in a home where these are not issues.

Planning Ahead
While nothing is risk-free, taking all these factors into consideration before you conceive is a smart plan — one that will move you closer to your goal of delivering a healthy and happy baby. Eighty to ninety percent of couples who are trying to conceive will do so within one year. Occasionally, it takes a bit longer. If you and your partner have been unable to conceive after a year of unprotected intercourse, there’s a possibility that one of you has a fertility problem.Infertility usually does not mean that you cannot have a baby, but instead that it will be more challenging for you to become pregnant. We can help you take measures to increase the likelihood that you’ll conceive, or refer you to a specialist who treats infertility problems.

Basic Information
On your initial obstetrical (OB) visit you’ll receive a packet of information about pregnancy. You’ll also have an opportunity to discuss insurance or financial details regarding your prenatal care.

If you need to inquire about starting prenatal vitamins or folic acid, please call our office at 561.488.9719. Prenatal vitamins can be refilled as needed throughout your pregnancy by calling your pharmacist.

During your pregnancy you’ll usually be seen every four weeks until 28 weeks; every two to three weeks until 36 weeks; then weekly until delivery. We’ll administer a number of routine tests throughout these visits to assess your health and that of your baby. These include a standard blood pregnancy profile, a Pap Smear and cultures at your first visit; blood tests for diabetes and anemia in the second trimester; and a vaginal culture for Group B Strep at 35-36 weeks.

We offer a Quadruple Screening Test at 15-18 weeks to screen for Spina Bifida and Down’s Syndrome. Amniocentesis will be offered (as indicated) to women age 35 or over, or to any woman who has other risk factors for genetic abnormalities. We offer everyone a routine screening sonogram at 18-22 weeks. (This test is not always covered by insurance; please check with your provider.)