"I'm considering have a childBut I don't know if it's a good moment, maybe I would have to prepare myself... "
This is a thought that crosses many women's minds at some point when we consider having a child. Most of us are clear that there will have to be... changes in our lifestyle when we are pregnant, but we should also know that it is advisable to start making changes before we got pregnantLet's break down some of the recommendations to make the pregnancy as peaceful as possible, with fewer complications and a healthy baby.
Planning pregnancy
When we consider having a child it can be useful to ask ourselves some questions:
- How old would I like to be when I have my first child?
- How old would I like to be when I have my young child?
- How many children do I want to have?
- How many years of difference do I want my children to take?
- What contraceptive method am I going to use to prevent pregnancy until I am ready to have children?
- Am I sure that both I and my partner will be able to use the chosen contraceptive method without any problem?
- What do I want change, about my health, relationships, home, studies, work or any other aspect of my life to be ready to have children?
- What steps can I take to be as healthy as possible, even if I am not ready to have children yet?
- What illnesses (such as diabetes, obesity, and high blood pressure) or other concerns (such as smoking, drinking alcohol, and using drugs) should I discuss with my doctor?
Keep in mind that your plan shouldn't be unalterableCircumstances can change. Make a plan today. Check it periodically and be prepared to adjust it over time. If you have 35 or more yearsIt is advisable that you be informed about the increased risk of chromosomal abnormalities in the offspring and on the prenatal screening and diagnostic options available when pregnancy begins; this conversation usually starts in the preconception stage.
Planning also includes assessing the interpregnancy interval desired (time between pregnancies) and decide when to stop using contraception so that conception occurs in the optimal momenttaking into account health, work, studies and social support.
Preconception consultation
Currently it is possible to arrange a consultation with your primary care doctor or midwife. During this consultation, the doctor will assess the possible chronic diseasesThe midwife will explain the treatments you may be taking and whether you need to change them or schedule an appointment with a specialist. Healthy lifestyle habits and dietary recommendations. You may need to have some tests and a blood sample taken. cytology (Your midwife can perform this test). It's also important to assess your vaccinationsThey may recommend updating some vaccines and to delay pregnancy until you have acquired immunity against the corresponding disease.
The preconception consultation is usually structured in three blocks: risk assessment, complementary explorations y educational actionsThis approach allows for the identification of conditions that can be optimized before conception.
Preconception risk assessment
It is performed on all women who attend the consultation and includes a detailed medical history (personal and family background, habits, social and employment situation) and physical explorationIt is especially important to review:
- Reproductive history: previous pregnancies, abortions, preterm births, cesarean sections, complications (preeclampsia, gestational diabetes), previous congenital defects, perinatal deaths.
- Menstrual and gynecological history: regularity of cycles, dysmenorrhea, sexually transmitted infections, gynecological surgeries, cytology and updated cervical screening.
- Habits and lifestyle: consumption of tobacco, alcohol and other substances; physical exercise; hours of sleep; emotional support.
- Work and environmental settingExposure to solvents, pesticides, radiation, metals (such as mercury), or carbon monoxide; assess the need for protection measures or temporary changes.
- Family history: chromosomal abnormalities, neural tube defects, cystic fibrosis, mental retardation or other birth defects; if there is a history, it is offered genetic counseling.
In women with chronic diseasesThe optimal time to begin pre-pregnancy planning is during the preconception period. This allows for the study of the disease without the limitations of pregnancy, adjustment of treatments, and selection of the appropriate treatment. best time for conception and adopt measures to protect the fetus from drugs and procedures during the first weeks, when embryonic development is most vulnerable.
Recommended additional tests
Remember that in addition to the basic explorationThey usually recommend:
- Weight, height and BMI, and taking of blood pressure.
- Transvaginal ultrasound If necessary, to assess the uterus and ovaries (to rule out polyps, fibroids or malformations that hinder implantation).
- General analytics: blood count, biochemistry (renal and hepatic function), blood glucose, thyroid hormones, blood type and Rh, and serologies (rubella, lues, hepatitis B and C, HIV, toxoplasm (depending on the context). Analysis of urine when indicated.
- Vaccination schedule: check immunity against rubella and chickenpox, assess hepatitis B, tetanus-diphtheria-pertussis; schedule the indicated vaccines and resolve doubts about the optimal time.
One of the main reasons for seeking this consultation is having had a poor reproductive outcome Previous (recurrent miscarriages, birth defects, perinatal deaths). Identify the causes and act before Attempting a new pregnancy improves the prognosis.
Chronic diseases that particularly benefit
Among other, asthma, diabetes, inflammatory bowel disease, Bipolar disorder, autoimmune diseases, heart disease, nephropathies, hypertension, thyroid disease, thromboembolic disorders, epilepsy, tuberculosis o HIVInforming your doctor of your intention to become pregnant allows for better planning. controls and settings therapeutic.
Medication and pregnancy
Take certain drugs During pregnancy, it can cause serious birth defects. This includes prescription and over-the-counter drugs. herbal productsDuring the childbearing years, when prescribing medication, it is necessary to treat the woman as if she might be pregnantSince some pregnancies are detected late, review all medications, supplements, and herbal teas you take with your doctor to confirm your pregnancy. safety and, if necessary, replace them.
The role of the midwife and educational actions
The midwife, as a reference in sexual and reproductive health, plays an essential role in this consultation: promotes healthy habits, identifies risk factors, offers health education and follows up. Any contact a woman of childbearing age has with the healthcare system is an opportunity to offer preconception careEducational activities include:
- Food: balanced diet, safe during pregnancy, iodine and folate adjustment, weight control to achieve a Healthy BMI.
- Physical activityRegular, moderate exercise to improve cardiovascular health, fertility, and mental well-being.
- Quitting toxic substances: quitting tobacco, alcohol and other substances with professional support.
- Mental health: detection of anxiety or depression, and guidelines for stress management (sleep, social support, relaxation techniques).
What should I consider?
- Health problems: If you have a chronic illness or infection, it is important to make sure you have it controlled and to carry out the appropriate treatment and compatible with pregnancy. These conditions include: sexually transmitted diseases (STDs), diabetes, thyroid gland diseases, phenylketonuria, high blood pressure, epilepsy, or problems that lead to seizures, arthritis, eating disorders, and other chronic diseases. It is important that notify the specialist of your intention to seek the pregnancy so that it evaluates the necessary controls or changes of medication.
- Abuse habitsSmoking, consuming alcohol or taking drugs, living or working in a stressful environment or around toxic substances can be a problem during pregnancy, potentially causing many complications. complications for a woman and her baby, such as premature birth, birth defects, and newborn death. Primary Care professionals can help you with advisory, treatment and other support services.
- Pharmaceutical products: Taking certain medications during pregnancy can cause serious birth defects. These include some prescription and over-the-counter medications, as well as dietary or herbal supplements. If you plan a pregnancy, it is important on request Talk to your doctor about the medications you need to take before getting pregnant and make sure you're only taking the ones you really need. Learn about the safety of all the herbal products or infusions that you use regularly.
- Vaccines: Some vaccines are recommended before, others during pregnancy, and others immediately after delivery. It is important that you get vaccinations appropriate at the right time, this can help you stay healthy and prevent your baby from getting serious illnesses or health problems for life.
- Take a folic acid and iodine supplement: It is convenient to take since before you got pregnant, it will prevent our baby from having any congenital defectIn addition, depending on our doctor's assessment, we may need a more complete supplement, with iron, calcium, and vitamins, specifically designed to prepare our body. These are available at pharmacies. specific preparations preconception supplements that provide iodine, folic acid, iron and vitamins in a single tablet.
Environmental and occupational exposure: what to avoid
Exposure to certain Chemicals Exposure to physical agents is associated with embryofetal abnormalities in a small percentage of cases. Avoid or reduce prolonged exposure to pesticides, solvents, plastic specific, mercury, carbon monoxide y radiationsIf your job involves risk, consult a professional for an assessment. protection equipment or temporary changes. If you consume cocaine, heroin, or cannabis, requests help for detoxification.
Folic acid supplementation: dosage and groups
El neural tube It closes between the 15 28 days and After conception, when many women don't yet know they are pregnant. That's why it's recommended to start taking folic acid at least a month before of trying to get pregnant. Evidence shows that periconceptional folate supplementation reduces risk of neural tube defects (NTDs). Usual recommendations:
- General population without a history of NTDs: 0,4 mg/day, starting one month before conception and during the first trimester.
- Diabetes or treatment with certain antiepileptic drugs (e.g., valproic acid or carbamazepine): 0,8–5 mg/day, with specialist assessment because high doses may require adjustment due to the neurologist.
- Personal background pregnancy affected by NTD: 4 mg/day, starting three months before and during the first trimester.
In addition to folate, it is recommended iodo during pregnancy and breastfeeding, and sometimes Vitamin B12 If there is a risk of deficiency. If you take a long time to get pregnant, maintaining folate levels is not harmful and can be beneficial. cardiovascular benefits.
BMI, exercise and nutrition
El BMI The previous factor is modifiable. Overweight and obesity reduce the probability of conceiving and increase complications such as diabetes and hypertension during pregnancy. Achieving a BMI between 20 and 25 Taking precautions before trying to conceive can prevent future problems. Combine a balance diet with exercise moderate (walking, swimming, gentle strength training) and proper sleep habits.
Vaccines: when to get them
Check your vaccination record. If you are not immune to rubella o chickenpoxThey may recommend that you get vaccinated and postpone conception the indicated time after receiving live attenuated virus vaccines. Vaccination against hepatitis B It may be advisable before pregnancy depending on the risk. Other vaccines, such as tetanus-diphtheria-pertussisThey are scheduled before or during pregnancy according to protocols.
Practical advice before conception
- Quit smoking or reduce the number of cigarettes you smoke per day to a minimum. There is no safe number. During pregnancy.
- Do not drink alcohol nor drugs.
- Make sure that the medication Which medications are compatible with pregnancy?
- Find out about your labor agreement to find out what rights you have in case of pregnancy and assess the risks of the position.
- Keep controlled any chronic illnesses you may have.
- Take care of your diet; try to maintain your BMI enjoyed between 20 and 25.
- Take the regular exercise to keep your body agile.
- Get the health checkups that are required for you: gynecologist, dentist, ophthalmologist, etc.
- Find out about the Vaccines pending and discuss with your doctor whether to get them now or postpone them.
- Take a vitamin supplement specifically, at least one or two months before conception.
- Reduces stressIt's difficult, but important to face the first few weeks, which are usually demanding.
- Go to one preconception counselingAt your Health Centre, the midwife can give you individualized recommendations, and sometimes there are first trimester talks with guidelines applicable from before conception.
Taking the step towards motherhood is more serene when it has been planned: a preconception consultation It allows you to detect risks, adjust treatments, complete Vaccines, Start folic acid And get enough iodine on time, and align your habits and expectations with your life plan. With that foundation, the path to pregnancy begins in better conditions for you and your baby.