• The period of time before you become pregnant is known as pre-conception and is a perfect time to prepare physically and emotionally for pregnancy and parenthood. Planning should start about three to four months before trying to fall pregnant.  
• Please note: the health tips provided are from the perspective of a paediatrician and concern the wellbeing of the baby. They are not intended to provide information about maternal health and fertility. We hope they will complement information from a preconception practitioner of your choice which may include a doctor, midwife or alternative health practitioner.

VISIT YOUR FAMILY DOCTOR 

• If you have relatively few health problems, then you may not have seen your family doctor for a while or may not even have a regular GP. Now is an important time to form a good relationship with a family practice, as it will become an important part of your health and well being network over the next few years.
• A general medical assessment is recommended that includes a detailed examination of your medical history, a physical examination, blood tests and resulting advice.
• The assessment should consider the following:
  • The detection of any significant pre-existing medical conditions that may affect you or your baby's well being during pregnancy such as:  
  • • High Blood Pressure;
    • Diabetes;
    • Epilepsy;
    • Thyroid disease;
    • Asthma;
    • Kidney problems; 
    • Gynaecological problems;
    • Heart Disease;
    • Liver problems. 
  
  
  • Pap smears when appropriate;
  • Breast examination;
  • Routine blood tests to check iron status (full blood examination and ferrritin) and other tests as indicated.

• Immunisation: Check your immunity to chicken pox (varicella) and German measles (rubella) and conduct a review of general immunisations you may have had.
• The Australian Immunisation Handbook (AIH) recommends the following for women planning pregnancy: 
  • Measles, mumps, rubella, varicella, diphtheria and tetanus immunisations should be assessed. Where previous immunisation is uncertain, relevant blood tests that measure the levels of protective antibodies should be undertaken to determine immunity;
  • Influenza vaccine should be offered routinely;
  • Pneumococcal vaccination is recommended for women with risk factors such as asplenia and other disorders associated with impaired immunity and women who are smokers;
  • Follow the link below, in the I want to know more section, to the Australian Immunisation Handbook. It contains an excellent table that explains the vaccines recommended for both pre-conception and pregnancy.
  • It is standard practice to test for rubella immunity despite a history of previous immunisation. The AIH reports that in 2000 it was estimated that around 2.5 per cent of women of childbearing age in Australia are non-immune i.e. they do not develop sufficient protective antibodies. If antibodies are low it is advised that women are vaccinated (prior to pregnancy) and that a further test for immunity should be performed six to eight weeks later and a further vaccine given if needed.
  • Tests for chicken pox immunity are performed when there is uncertainty about previous infection or immunisation. If antibodies are low then it is advised that women are vaccinated with two doses at least four weeks apart as one dose does not provide adequate protection. A blood test to check for immunity after two doses is not recommended.
  •   Because both varicella and rubella vaccines contain live viruses, women of child-bearing age should be advised against falling pregnant within 28 days of vaccination.
    • Whooping cough, or pertussis, is prevalent in the community and it is especially important for parents and any adults who may come in close contact with a newborn baby to have up-to-date immunity against whooping cough. This is known as cocoon immunisation.  It only requires the adult receive a booster dose and is the most effective way to protect your newborn. 
    • Whooping cough causes a very serious and potentially fatal disease in non-immune babies especially in the period from birth until completion of immunisation at six months.
    • Many adults are not up-to-date with their immunisations and can develop a cough that is often not diagnosed as whooping cough, or they may even carry the organism in their throats without actually becoming unwell, and spread this to the newborn.

ADOPT A HEALTHY LIFESTYLE

• Taking care of your own health will have a direct impact your baby's health and wellbeing.
• Now is the perfect opportunity to take stock of your lifestyle and attend to those things you may have been putting off.
  • A healthy diet is vital during pregnancy and there's a whole list of foods you should add to your diet as well as many to avoid that could harm the development of your baby.
  • Regular exervise is now even more important. Familiarise yourself with the exercises that you should limit or avoid once you are pregnant. In general these include scuba diving, parachuting, waterskiing, martial arts, gymnastics, horse riding, and trampolining. Make sure you inform your exercise instructor that you could be pregnant or are pregnant so that unsuitable exercises are avoided or modified.
  • Avoid over heating e.g. in saunas and hot tubs as these activities have been linked to birth defects in the first trimester. 

VITAMINS and SUPPLEMENTS

• During pregnancy you and your baby both need extra vitamins and minerals to strengthen your immune system and for the baby's healthy development. 
• There are multivitamin supplements specifically designed to meet your body's extra needs in pre-conception, pregnancy and lactation. Don't be tempted to simply increase the dose of your usual multivitamin because some vitamins taken in excessive amounts can harm your baby e.g. Vitamin A.
• It is a good idea to supplement your healthy diet with folic acid, 400 micrograms (mcg) daily, at least one month before conception and three months after you fall pregnant. Folic acid has been shown to significantly reduce the incidence of neural tube defects. This can be taken as a single supplement but it is preferable to take a pregnancy-specific supplement that also contains iodine. Find out more at Flourish Folate in pregnancy.
• There are a number of pregnancy-specific supplements available. It can be confusing deciding which one is the right one for you. Flourish has prepared a comparative table to help you decide. Find out more at Flourish Pregnancy Specific Supplements: which one.
• If you are Vegetarian, now is a good time to check your Vitamin B12 status. Find out more at Flourish  B12 in pregnancy.

TERATOGENS

• Teratogens are substances that cause or increase the incidence of birth defects or congenital abnormalities by interfering with the development of the foetus during pregnancy. It is important to familiarise yourself with the potential for harm from medications and X-rays as well as toxins in the environment.
• Many medications can be taken safely during pregnancy and lactation. Now is a good time to review any prescription drugs and other medications you are taking, including over the counter, herbal or complementary medications to make sure they do not pose a risk to your pregnancy or the developing baby.  
• The developing baby is sensitive to effects of radiation exposure. X-rays should only be considered in women who may be pregnant or who are pregnant if the benefits outweigh the risks. As a reminder, there are usually signs in the Radiology department such as  “If it is possible that you might be pregnant, notify the radiographer or other staff before you have the X-ray examination.”  Standard X-ray request forms usually include a specific question asking all women of child-bearing age if they are, or maybe, pregnant.

THE FOOD YOU NORMALLY EAT

• Pregnancy lowers your immunity and you and your unborn baby are more susceptible to infections from bacteria, viruses and parasites that can make you ill from food. Even though pregnant women may not develop any noticeable symptoms when infected with food borne illnesses, some foods can cause serious problems in the unborn child e.g. listeria. Your baby is also much more sensitive to toxins from food, such as mercury in certain types of fish.
• There are a range of foods that pose a risk in early pregnancy: raw and undercooked foods such as eggs, meats, poultry, seafood, pate, ice cream and many delicatessen items. Now is good time to familiarise yourself with the risks.
• Certain fish contain significant amounts of methyl mercury, which is toxic to a baby's developing neurological system. Australian guidelines have been developed that recommend limiting the amount and type of fish that is eaten during pre-conception, during pregnancy and in the child's first six years of life. There is no specific period recommended before conception, however at least two to three months before is probably the best time to start changing the way you eat fish. This is because the mercury ingested is stored in fat tissue, brain and bones. Our bodies can remove mercury but it is a slow process which sometimes takes several months. The daily excretion is 1 per cent of the total body stores and the half-life of mercury is estimated to be 70-80 days. Find out more at Flourish Mercury and Fish.
• Invest in a food thermometer so you can check the temperatures of cooked food.
  To help you remember what's safe and what's not, Flourish has prepared a checklist for you to refer to. Find out more at Flourish Checklist: Foods to Avoid in Pregnancy . Carry the checklist with you to help keep you and your baby safe.

 CMV and YOUNG CHILDREN

• If you work closely with very young children, perhaps in childcare for example, you are at higher risk of being infected with Cytomegalovirus (CMV). If you become infected early in pregnancy and are not already naturally immune, there is a one in three chance that it can be transmitted to the foetus. This may cause significant birth defects. Find out more at Flourish CMV in Pregnancy.
• There is currently no vaccine available to protect against CMV. If you are at high risk you may wish to discuss the risks of CMV with your doctor and ask about testing for immunity for CMV. You should also inform your employer if you work with children.
• The following preventative measures are recommended for pregnant women:
  •   Wash hands with soap and water often and thoroughly, especially when in contact with young children (nappy changes, etc.);
  •   Avoid kissing young children on the mouth;
  •  Do not share food or eating utensils with young children;
  •  Preferably work with children over three years of age.
• Useful and more comprehensive guidelines for childcare workers have been published by Queensland Health. Go to  I want to know more, below, for further information.
  

PETS and PREGNANCY

• Owning a cat when pregnant can be a concern because of the risk of transmission of toxoplasmosis to the developing baby. This occurs when humans come into contact with cat faeces e.g. when gardening and also from eating undercooked meat. If you work in an animal related occupation, or own a cat, you may wish to discuss testing for immunity to toxoplasmosis with your doctor. Find out more at Flourish Toxoplasmosis in Pregnancy.
  •  Simple safety tips have been suggested by the US Centre for Disease Control (CDC), Healthy Pets Healthy People website. These include: 
    • If you own a cat, have a non-pregnant person change the litter box every day. If there is no one else to change the litter box, wear gloves and wash hands with soap and running water after changing the litter;
    •  Risk may be reduced if the litter box is changed every day;
    •  Keep cats indoors;
    •  Avoid adopting or handling stray cats;
    •  Feed cats only canned or dried commercial cat food, never undercooked or raw meat;
    •  Do not bring a new cat into your house that might have been an outdoor cat or might have been fed raw meat.

• Dogs do not pose any health risks for you or the developing baby
• Reptiles and amphibians such as lizards, turtles, frogs, snakes and others often carry Salmonella. Infection with salmonella in pregnancy causes a gastroenteritis-like illness and, albeit rarely, can trigger miscarriage. It is also a risk for children under five years of age. Now is the time to either remove them from your house or, if you decide to keep them, ensure that you adhere to strict hygiene practices.

TAKE CARE OF YOUR ORAL HEALTH

• During pregnancy a rise in hormones increases the blood flow to the gums and makes them more sensitive to existing gingivitis (inflammation of the gums commonly due to a build up of plaque). Pregnant women may find that their gums become swollen and bleed more easily. 
• It is now known that pregnant women with gum disease are seven times more likely to have a preterm or small baby. There is still debate about why this occurs. Possible factors include: 
  • The spread of bacteria from inflamed gums into the blood stream to the placenta, which can induce labour; and/or
  • The higher than normal level of prostaglandin (a hormone known to also induce labour) in the blood of women with gum disease.
• Dentists are often reluctant to carry out certain procedures during pregnancy if they involve X-rays or anaesthetics. It's especially important to visit your dentist during pre-conception for:
  • A complete check up and examination;
  • A set of X-rays - if clinically indicated;
  • A scale and clean by a hygienist,
  • Education about what to expect, and preventative measures during pregnancy. This will include gum health and measures to take if you develop frequent vomiting.

HEAVY METALS AND CHEMICALS

• Repeated exposure to heavy metals such as lead and mercury is associated with an increased risk of miscarriages and birth defects. Women need to consider precautions to limit their exposure at work and at home.
• Women working in industries where they may be exposed to chemical hazards should discuss potential risks with their doctor or Occupational Health and Safety (OHS) representative.
• If using any chemical products e.g. household cleaners, pesticides, fungicides, paints, varnishes, thinners, remember to always wear protective clothing e.g. gloves and mask and use only as directed.
• Consider switching to alternative cleaning products or experiment with baking soda and water or white vinegar, or source cleaning products that are free of harsh chemicals and toxins.

LEAD and HOME RENOVATIONS

• During pregnancy, lead in the mother’s blood crosses the placenta freely to the foetus. High lead levels are toxic to the developing baby's brain and result in developmental problems. In houses built pre-1970 large amounts of lead may be  found in paint, dust, oils, building products, walls, ceiling cavities and carpets.
•  If you need to do renovations, arrange to move out until the work is completed and all the dust has settled.

ORGANIC LIVING

• If your philosophy is organic then the impending arrival of a new baby is a good time to reflect on providing an environment that is not only peaceful, calm and loving but also one that is toxin free. Look closely at the materials and practices in your home and consider what is the best for your baby. We have examined the issue of toxins in the home and will provide reliable information and links relating to a range of concerns for families who are planning an organic pregnancy.

GENETIC COUNSELLING

• Consider seeking the advice of your family doctor and, where appropriate, a referral to a genetic counsellor under the following circumstances: 
  • If there is a family history of certain genetic conditions or birth defects such as Downs Syndrome, cleft lip and palate, thalassaemia, cystic fibrosis;
  •  You are aged over 35 years of age and planning pregnancy.
•  Genetic Counsellors provide information and counselling regarding:
  • The risk of a planned baby developing a medical condition;
  • Medical information about genetic disorders and birth defects, and prenatal investigations.