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    Prepping for Pregnancy
    Yvette Smith, MD, MPH posted:
    Planning for pregnancy is so important. When we see that positive pregnancy test, we want to know that baby is growing in the healthiest environment possible. We want to nurture and protect our child. It's really the first act of mothering. So what should you do to prepare? Let's start with the basics.

    Folic Acid: The information is overwhelming; we can dramatically decrease the incidence of spinal cord defects by being sure that women have an adequate dose of folic acid. For those with no family or personal history of spinal cord defects, the recommended dose is 400 mcg of folic acid (0.4 mg) daily. Ideally you would be on an adequate dose of folic acid a full month before you start trying for pregnancy. Since many pregnancies are unplanned, ideally all women of reproductive ages would be getting this dose of folic acid on a daily basis. You will need a higher dose of folic acid if you have a history of a spinal cord defect or someone in your family has a history of a spinal cord defect. This should be discussed with your practitioner.

    Weight Loss: Should you lose weight first? How much weight should you lose? My response: be very realistic. Our goal should be to be the healthiest we can reasonably be. If you attempt to lose weight in a healthy manner, you can probably continue your eating plan in pregnancy. Discuss your concerns with your health care provider. Working with a nutritionist might be beneficial. If you have chosen a surgical approach to manage your weight, then attempting pregnancy must be discussed with your surgeon and obstetrician before getting pregnant.

    Medications: Tell your health care providers that you are trying for pregnancy. There are many medicines that can be used in pregnancy, but the possibility of pregnancy must be considered when prescriptions are being written. If you are on a medication that is not safely used in pregnancy, you need to consult with your caregiver about switching to a safer medication before you attempt pregnancy. It may take a while to stabilize on the new medication so you want to discuss this well ahead of time.

    Excessive Heat: There is some information that exposure to excessive heat may increase the risk of spinal cord defects if the exposure occurs in early pregnancy. For a long time, our advice was to avoid saunas and Jacuzzis while trying for pregnancy. The American College of Obstetrics and Gynecology now recommends that you limit your exposure to no more than 15 minutes.

    Dietary Restrictions: There are no dietary restrictions when you are trying for pregnancy, but this is a good time to begin improving your eating habits. Everything in moderation should be your mantra.

    Truly Bad Habits/Behaviors: I include smoking, excessive alcohol, illicit drugs and similar activities in this category. Stop them. Do it for your baby.

    Above are the general guidelines; however, there are many other special situations that should be factored in. Do you have medical issues? Are there medical issues in your family? Are there medicines you are taking? Have you had surgeries? Are there children in your family or your partner's family who were born with birth defects? You should consult your physician to discuss your plans for pregnancy well in advance so that these and other possible issues can be considered prior to conceiving.

    So what's been the toughest thing about planning for pregnancy for you? Have you had to change any behaviors or habits that were particularly difficult for you? How did you do it? What pearls would you like to pass on?
    Emma_WebMD_Staff responded:
    For me, the hardest part was losing weight in the past to have a baby. Not that I wasn't willing but I usually eat fairly good already, my only problem is I sit all day long working. I was trying to get to the gym to work out on a regular basis but sometimes it was more difficult then others.

    I'd love to hear others chime in with what is difficult for them.
    fiannakyn replied to Emma_WebMD_Staff's response:
    I agree with Emma. trying to lose weight was/is a struggle.
    faliensiu responded:
    Thanks for this! I found it really helpful. I have one question I've been wondering about lately; I'm still on BCPs and my doc suggested that I start prenatal vitamins as soon as I stop this pack, is it possible to start the prenatals earlier (before I finish these pills?

    Also, I have read also about losing weight but I'm in a bit confused there... I'm 5'4, 143 lbs, technically by usual standards/charts I'm close to being overweight for my height, but I'm athletic/medium built and active, but I still worry about what if I gain TOO much with a baby.

    My doc said to just keep doing what I'm doing, and the few people I've told about our plans also think I'm fine and don't need to lose weight. I am fine with the way I look, I've been 143 ( /- a few lbs) for the last 6 years, and if I lose some I'd only want to lose no more than 10lbs.

    Part of me can't imagine me weighing 160 lbs even though I know it's the baby not me. Mainly I worry of the pressure on my knees, I injured myself years ago and sometimes my right knee hurts and I limp.

    So my next two questions would be:
    What would you really suggest about how much should be lost before pregnancy (if any)? After I have conceived?
    Does your body adjust easily as weight is gained (regarding my knee issue)?

    Lastly, I play soccer, my doc told me I can keep doing everything as normal - and I agreed, so that I don't let myself stress over whether I'm pregnant or not I will stay busy/active (as I have been for a while)... But I'm also kind of worried, what if I get pregnant, before I even know it, and I'm playing and I either fall or get hit, is the body strong enough and cushion enough to protect the baby forming inside me? And, until when is it safe to play?

    Thank you in advance for any info you can give...
    rosecam responded:
    Dr. Smith,

    Can a woman be in too good shape - i.e. too low body fat and exercising too much - to conceive and carry a baby?

    I am normally in very good shape. I run, lift weights, do yoga, and eat well. I typically have about 19-20% body fat. I am not underweight, but I am very slim, since a lot of my weight is muscle. I ovulate and have fairly regular cycles.

    I relaxed my work-out routine for the last 6 months and gained a little weight, but several (non-doctor) family members have suggested that I should gain even more fat (some have suggested 20 lbs. or so) to get pregnant and grow a healthy baby. Any thoughts or advice? Can a non-athlete woman be too fit to conceive?

    Thank you in advance.
    Yvette Smith, MD, MPH replied to faliensiu's response:
    Prenatal vitamins are great vitamins in general so there would be no harm in starting them while on the pill. It would give you even more time to get a good habit established.

    It sounds like everyone agrees that your weight is just fine. If you are really concerned about gaining too much weight once you're pregnant, ask your physician if it might be reasonable to see a nutritionist for very specific guidance. Keep in mind, there is a healthy weight gain that is necessary for your baby's wellbeing.

    Early in pregnancy the uterus is well cushioned by your pelvic bones and the uterus. You should be able to continue normal activities and exercise whlie trying for pregnancy.
    Yvette Smith, MD, MPH replied to rosecam's response:
    You sound like you're doing great and were doing great before you relaxed your exercise routine. The concern we have with the avid exerciser is not ovulating. We worry that women will stop ovulating when their body fat drops too low. If there is any question in your mind, you might consider doing an ovulaton predictor kit to confirm that you are ovulating.
    younglove2189 replied to Yvette Smith, MD, MPH's response:
    To my understanding I have normal periods with no ovulation, do you know if it has something to do with me weighing 160 and height 5 feet??
    younglove2189 replied to Yvette Smith, MD, MPH's response:
    Thanks a lot for the information, I have been going to a fertility specialist in regards to my irregular menstrual cycles and they took blood work to confirm that I do not ovulate with my cycles. She's going to put me on clomid to start that process, my question now is if ovulation is the only issue I have with conceiving will it work for me??
    Yvette Smith, MD, MPH replied to younglove2189's response:
    Clomid can be very successful for some women. It is often the first step if you are trying to help someone with ovulatoin problems. There are stronger medications that can be used if you are unsuccessful with clomid. The stronger medications are usually more expensive and require more monitoring to be safely used, so it's nice to begin with something a little easier initially.
    Greenswife replied to Emma_WebMD_Staff's response:
    This year alone I've had 3 major surgeries - 2 spine and a knee replacement. I am on 2 different pain relievers: 1 fast-acting, 1 long-lasting (sustained release), and a 5 mg. muscle relaxer. I understand I will need to go off ALL medication should I become pregnant, but can I stay on them while attempting to get pregnant or are they inhibiting the process?
    Yvette Smith, MD, MPH replied to Greenswife's response:
    You'll need to speak to your gynecologist/obstetrician about your particular situation. There are medications that have no impact and medications that could possibly prevent ovulation. You also need a plan. It's hard to imagine that you will just cold-turkey stop medications when you get a positive pregnancy test. Are there other things you could use that would be safe in pregnancy? Can you wean off of your medications before trying for pregnancy? You need to address these issues with your caregiver. Good luck.
    armywife6878 responded:
    Dr. Smith,
    I read your post and I had some questions. I have already gone to my OB and talked to her about pregnancy. She has already started me on prenantal vitamins and folic acid. We also talked about the medications that I am on. I have severe depression, anxiety/panic disorder, bipolar, and PTSD. I am on several different medications for this disorders and some other medications for migraines, GERD, and high blood pressure. She told me that some of my medications were fine during pregnancy, but some of the others are Class C drugs. She said that once pregnant, we would have to weigh the pros and cons of staying on them.

    I already have 10 yr old twins and they were unplanned, but it seems like everytime I get my cycle and find out that I'm not pregnant again. I feel like a failure. Like it is something that I'm doing wrong. I am over weight and have started an exercise routine and diet. I am hoping to lose at least 2 lbs a week. I'm 31 and my husband is 41. He was adopted and doesn't know anything about his biological family. I have also cut down on my smoking from over a pack a day to around a 1/2 a pack a day.

    I guess what I'm trying to ask is there anything else that I can do in order to conceive? I just feel like I'm doing something wrong.
    lindgren28 responded:
    my boyfriend and i have been trying to get pregnant now for 11 months and nothing is happening could it be i cant get pregnant or he cant have kids?
    An_191545 replied to lindgren28's response:
    i have a question.. i quit taking my bcp 2 weeks into the pack. i had been on them almost 4 years.. .i have been off them for a little over 4 weeks now. still no period.. when do MOST women ovulate and have periods after stopping bcp?? i didnt even have withdrawl bleeding. can you help me please?

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