Planning to Become Pregnant?

Folic acid supplements

You should take folic acid tablets for at least the first 12 weeks of pregnancy - even if you are healthy and have a good diet. Folic acid is a vitamin which occurs naturally in certain foods. However, you need a good supply of folic acid when you are pregnant. If you take folic acid tablets in early pregnancy you reduce the risk of having a baby born with a spinal cord problem such as spina bifida. You can buy folic acid tablets from pharmacies.

• You should start taking folic acid tablets before becoming pregnant (from the time you plan to become pregnant). If the pregnancy is unplanned then start taking folic acid tablets as soon as you know that you are pregnant.
• For most women the dose is 400 micrograms (0.4 mg) a day.
• If you have an increased risk of having a child with a spinal cord problem then the dose is higher (5 mg a day - you need a prescription for this higher dose). That is, if:
• you have had a previously affected pregnancy
• your partner, or a first-degree relative, have a spinal cord defect
• you are taking medication for epilepsy
• you have coeliac disease, diabetes, sickle cell anaemia, or thalassaemia.

Alcohol

Advice from the Department of Health is that you should not drink at all if you are pregnant or trying to become pregnant. It is known that if you drink heavily you have an increased risk of miscarriage, and it may cause serious harm to the baby's growth and brain development. A condition called fetal alcohol syndrome develops in some babies born to mothers who drink heavily. A baby with this syndrome can have severe physical and mental problems.

However, the exact amount of alcohol that is safe during pregnancy is not known. This is why the advice is not to drink at all. If you do chose to drink when pregnant then limit it to one or two units, once or twice a week. And never get drunk. If you find it difficult to cut down or stop drinking alcohol, then seek advice and help from your practice nurse or GP.

Smoking

If you smoke, you are strongly advised to stop smoking before getting pregnant. Tobacco smoke contains poisonous chemicals which pass into the baby's blood and can slow the baby's growth. The risk of having a miscarriage, premature birth, or stillbirth are higher if you smoke. Babies born to mothers who smoked when pregnant also have an increased risk of developing attention deficit hyperactivity disorder (ADHD) when they are older. Also, after the birth, children of smoking parents have an increased risk of developing chest infections, asthma, 'glue ear' and sudden infant death syndrome (cot death).

For many women who smoke, planning to become pregnant is a good incentive to stop smoking. It is often a good time to persuade partners to give up too. If you find it difficult to stop smoking then seek advice and help from your practice nurse, GP, or pharmacist.

Street ('illicit') drugs

If you take or inject street drugs, you are strongly advised to stop taking them before getting pregnant. Their effects on pregnancy are not fully known, but they are likely to pose a risk. If you cannot come off drugs easily, see your doctor for help. For example, an option if you inject heroin is to take prescribed methadone instead which is safer during pregnancy.

Food and diet

Eat a healthy balanced diet

Aim to eat a 'healthy diet' (which everyone should be eating!) Briefly, the bulk of most meals should be starch-based foods (such as bread, cereals, potatoes, rice, and pasta), with fruit and vegetables. Eat protein foods such as meat, fish, pulses, chicken, etc, in moderation.

Don't 'eat for two' and over-eat when you become pregnant. Too much weight gain increases your risk of developing problems later in the pregnancy. Also, extra weight is difficult to lose after the birth. If you are already obese or overweight, try to lose some weight before becoming pregnant to reduce the risk of pregnancy complications.

Include foods with plenty of iron, calcium and folic acid

A growing baby needs these nutrients right from the start of the pregnancy.

• Iron is mainly in red meat, pulses, dried fruit, green vegetables and fortified cereals.
• Calcium is mainly in dairy products such as milk, cheese, and yoghurt. (Low-fat milk, cheeses and yoghurts usually contain just as much calcium as the full-fat varieties.)
• Folic acid is mainly in green vegetables, brown rice, and fortified cereals.

Foods and drinks to avoid

You should not eat the following if you are pregnant or trying to become pregnant.

• Anything with a lot of vitamin A. You need a small amount of vitamin A to keep healthy. However, large amounts can harm an unborn baby. So, avoid:
  • Liver and liver products such as liver p?t? and cod liver oil supplements.
  • Vitamin tablets or supplements which contain vitamin A.
• Food which may have high levels of listeria. This bacterium (germ) does not usually cause problems in people who are not pregnant. However, pregnant women are more likely to become infected with listeria, and it sometimes causes miscarriage, stillbirth, or infections in the baby after birth. Foods which are most at risk of carrying listeria are:
  • Undercooked meats and eggs. For example, this may occur in some pre-cooked meats and pre-prepared meals. Make sure all meat foods are cooked until piping hot. Eggs should be cooked until both the white and yolk are solid.
  • Soft cheeses such as brie. (Hard cheeses and processed cottage cheese are safe.)
  • P?t?s.
  • Shellfish and raw fish.
  • Unpasteurised milk. Note: goat's milk is often unpasteurised, and goat's milk products such as cheeses are often made from unpasteurised milk.
• Fish which may contain a lot of mercury. A high level of mercury can damage the developing nervous system of an unborn baby. So:
  • Do not eat shark, marlin, or swordfish.
  • Limit tuna. You should eat no more than two medium sized cans (drained weight = 140 gm per can), or one fresh tuna steak per week. (This would be about six tuna sandwiches, or three tuna salads per week.)
• Limit the amount of caffeine to no more than 300 mg per day. Having a lot of caffeine increases your risk of having a miscarriage and a baby with low birth weight. The main sources of caffeine are coffee, tea, chocolate, cola. It is also added to some 'energy' drinks and to some cough and cold remedies. As a rough guide:
  • One cup of instant coffee has about 75 mg caffeine
  • One cup of brewed coffee has about 100 mg caffeine.
  • One cup of tea has about 50mg caffeine.
  • One 50g chocolate bar has about 50 mg caffeine.
  • One can of cola, and half a can of an 'energy' drink has up to 40 mg caffeine.
• Peanuts. If you have an atopic disease such as asthma, eczema, or hay fever, or if a close family member has one of these conditions, then you may wish to avoid eating peanuts when you are pregnant. This may reduce the risk of your child developing peanut allergy in later life (which can be a serious and life-threatening allergy). This advice about peanuts in pregnancy is precautionary and further research is needed to clarify this issue.

Animals

Avoid contact with sheep and lambs at lambing time. This is because some lambs are born carrying the germs that cause listeriosis, toxoplasmosis and chlamydia. These may be passed on to you and your unborn baby. See below about cats and kittens.

Medication

The effects of some prescribed drugs have been well studied and it is known that certain drugs are safe in pregnancy. For example, paracetamol at normal dose is safe and useful for headaches, backache and other aches and pains that may occur during pregnancy. However, some drugs are not safe, and may be harmful to a developing baby, particularly if you take them in the early weeks of pregnancy.

Therefore, always tell a doctor or dentist who prescribes you medication that you are pregnant, or intend to become pregnant. Also, don't take drugs that you can buy (including herbal remedies) unless they are known to be safe in pregnancy. The pharmacist will advise.

If you already take regular medication, (for example, for epilepsy), it is important to discuss this with a doctor before becoming pregnant. If you have an unplanned pregnancy, discuss any medication that you take with your doctor as soon as possible.

Infections

Rubella (German Measles)

If you plan to become pregnant for the first time, you should check that you are immune to rubella before becoming pregnant. See your practice nurse for a 'pre-pregnancy' blood test. Most women are immune to rubella as they have been immunised as a child. However, childhood immunisation does not work in every child and you may not be immune. If you are not immune, you can be immunised.

Note: you should not become pregnant for one month after the injection, and ideally until your immunity has been confirmed by a further blood test.

The rubella virus causes a mild illness, but can seriously damage an unborn baby, especially in the early stages of growth. So, until you know that you are immune (from the result of the blood test), you should avoid anyone who has rubella, especially in the first 16 weeks of pregnancy.

Toxoplasmosis

This germ is commonly found in raw meat, sheep, lambs and cat faeces. It can sometimes cause serious harm to an unborn baby. To avoid it:

• Wash your hands after handling raw meat.
• Do not eat raw or undercooked (rare) meat.
• Wash salads and vegetables as any dirt may have been contaminated by cat faeces.
• Wash your hands after handling cats and kittens.
• Get someone else to clean out any cat litter trays when you are pregnant.
• Always wear gloves when gardening.
• Avoid sheep, especially during the lambing season.

Chickenpox

Having chickenpox when pregnant can be a nasty illness, and there is some risk to the developing baby. A vaccine is offered to healthcare workers (doctors, nurses, etc) who have not previously had chickenpox and so are not immune and may catch chickenpox. (About 1 in 10 adults have not had chickenpox as a child.) Therefore, non-immune healthcare workers should consider having this vaccination before getting pregnant.

If you are not sure if you have had chickenpox, a blood test can check if you have previously had it.

Hepatitis B

A mother who is infected with hepatitis B has a high risk of passing it on to her new-born baby. If you are at high risk of catching hepatitis B you should be immunised against this virus before becoming pregnant. You are at increased risk and should be immunised if:

• Your job puts you at risk of contracting hepatitis B. For example, health-care personnel and staff at day care or residential centres.
• You inject street drugs.
• You change sexual partners frequently.
• You live in close contact with someone infected with hepatitis B.

Screening blood tests

Ideally, you should have a blood test before you become pregnant to screen for hepatitis B, syphilis, and HIV. Ask your practice nurse for a 'pre-pregnancy' blood test.

Consider your working environment

If you think that your occupation may pose a risk to a pregnancy, then ideally you should discuss this with your employer before becoming pregnant. For example, if you work with chemicals, fumes, solvents, etc, which may pose a risk, or if you work with animals such as cats or sheep which may be carrying germs (see above).

You and your employer may wish to download information guides from the Health and Safety Executive website at www.hse.gov.uk.

Medical conditions

Women with certain medical conditions may benefit from other advice before becoming pregnant. See your doctor if you have concerns about a medical condition which may affect pregnancy. For example:

• For some conditions, the medication or treatment may possibly affect the pregnancy or the unborn child. For example, epilepsy.
• For some conditions, the condition itself may require special attention during the pregnancy. For example, diabetes.
• If a hereditary condition runs in your family, you may benefit from genetic counselling.

Summary and checklist

Most pregnancies go well and without any major problems. But it is wise to reduce any risks as much as possible. So, a reminder of things to consider before becoming pregnant, or as soon as you realise that you are pregnant ...

• Things you should do
  • Take folic acid tablets before you get pregnant until 12 weeks of pregnancy.
  • Have a blood test to check if you are immune against rubella, and to screen for hepatitis B, syphilis, and HIV. Ask your practice nurse to do this.
  • Eat a healthy diet. Include foods rich in iron, calcium and folic acid.
  • Wash your hands after handling raw meat, or handling cats and kittens.
  • Wear gloves when you are gardening.
• Things you should avoid
  • Too much vitamin A - don't eat liver or liver products, or take vitamin A tablets.
  • Listeriosis - don't eat undercooked meat or eggs, soft cheese, p?t?, shellfish, raw fish, or unpasteurised milk.
  • Fish which may contain a lot of mercury - shark, marlin, swordfish, or excess tuna.
  • Sheep, lambs, cat faeces, cat litters, and raw meat which may carry certain infections.
  • Peanuts - if you have a personal or family history of eczema, hay fever, or asthma.
• Things you should stop or cut down
  • Caffeine in tea, coffee, cola, etc, - have no more than 300 mg per day. This is in about three cups of brewed coffee, or four cups of instant coffee, or six cups of tea.
  • Alcohol - you are strongly advised not to drink at all.
  • Smoking - you are strongly advised to stop completely.
  • Street drugs - you are strongly advised to stop completely.
• Other things to consider
  • Immunisation against hepatitis B if you are at increased risk of getting this infection.
  • Immunisation against chickenpox if you are a healthcare worker and have not previously had chickenpox and so are not immune.
  • Your medication - including herbal and 'over the counter' medicines.
  • Your work environment - is it safe?
  • Medical conditions in yourself, or conditions which run in your family.

Further information

Food Standards Agency - Advice for Pregnant Women
www.eatwell.gov.uk/agesandstages/pregnancy/

Department of Health - The Pregnancy Book
Go to their website - www.dh.gov.uk - and search for 'Pregnancy Book'.