Ask a Female GP: What things should I do before I start trying for a baby?

Yep, there's some prep

Dr Deb Cohen-Jones answers all your questions about ore-pregnancy. Image: iStock.

Dr Deb Cohen-Jones is here to help guide you through your pre-pregnancy journey, because there's more to conceiving that just rolling around in the hay.

The decision to commence trying for a baby is a big one which can take some time to reach. There are many factors involved in this decision including career and relationship factors, both of which are equally important.

There is, however, the subject of your health and screening tests too, which are frequently overlooked in this decision-making stage. As a result, many women present as pregnant having not had the important pre-pregnancy tests or preparation which are often equally important.

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Supplements

The first factor to consider before commencing trying is folic acid supplementation. The current recommendation is to supplement with folic acid 0.5mg for at least a month, ideally three-months prior to conception to prevent spina bifida. There are many pre pregnancy multivitamins on the market which contain many extra vitamins in addition to folic acid, the main factor in selection is ultimately personal but must contain the minimum folic acid requirement.

Genetic screening

Pre-pregnancy genetic carrier screening is relatively new (around three-four-years-old) in routine practice and many doctors who don’t specialise in antenatal care are unaware of their availability. The standard panel is a three-test screening for the three most common inherited genetic conditions (spinal muscular atrophy, fragile x syndrome and cystic fibrosis). The test is a simple blood test done ideally pre-pregnancy on the female.

If the female partner tests positive, then the male is tested as well and if both are positive then further genetic counselling is arranged to prevent unplanned conception of a baby affected by these three conditions which are all severe and associated with reduced life span.

A more detailed or extended panel is also available testing for hundreds of genetic conditions. I personally don’t recommend this option as many of us will come up with a positive carrier status for some condition but the chances of our partner having the same, and of it having significant impact on the baby, are very low and often cause unnecessary stress and angst. All these genetic carrier tests are private but only need to ever be done once and are definitely worthwhile doing before starting to try and conceive.

Immunity testing

Immunity testing is also very important prior to trying as certain infectious diseases, primarily rubella and varicella, if contracted during pregnancy, can cause birth defects. If you are checked pre-pregnancy and found not to be immune, vaccinations can be given to prevent infection whilst pregnant. If these tests are delayed until pregnancy and immunity is insufficient, the vaccines aren’t unfortunately safe to administer and will have to be delayed until after delivery leaving the pregnancy vulnerable to infection.

Other blood tests including iron, vitamin d, b12 and folate are also very helpful pre pregnancy to enable supplementation prior to conception.

Checking or updating private health cover if you wish to deliver in a private hospital should also be done pre-pregnancy to avoid disappointment.

Track your cycle

Tracking your cycle with one of the many apps available and working out when ovulation is likely can be very helpful to assist in swift conception. The cycle commences from day one which is the first day of the period. For an average 28-day cycle ovulation takes place on day 14 and the recommendation is to try every second day starting four to six days before and then continuing four to six days after ovulation. The ovulation date is by and large 14 days before menstruation so generally counting backwards by 14 days from the last day of the cycle is the ovulation date.

If you are confused about when and how often to try or are concerned about how long you have been trying, check in with your GP to look at your hormones and possible arrange some cycle tracking.

Diet and lifestyle

Finally, try to make dietary and lifestyle modifications which adhere to pregnancy recommendations. Ideally after ovulation time try not to consume alcohol or take any illicit drugs and treat your body as you would when you are pregnant, with a healthy balanced diet, regular exercise, and sufficient sleep.

The advice given in this column does not apply to women or couples who have a family history of genetic conditions or other significant illness which may require extra pretesting and counselling. As a general rule, when starting to plan pregnancy I suggest finding a GP you are confident in, who has experience in obstetrics and paediatrics to ensure you are adequately prepared and ideally can see you through the pregnancy and early parenthood with knowledge and understanding.

Originally published as Ask a Female GP: What things should I do before I start trying for a baby?