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Pre-pregnancy Health Guidelines

Here are some important things to consider – and act upon – before you become pregnant. Make changes to become as healthy as possible before you start trying to conceive.

Take 400 Micrograms of Folic Acid Every Day

If you are of childbearing age, take 400 micrograms (400 mcg or 0.4 mg) of folic acid every day, even if you are not planning to become pregnant. Since many pregnancies are unplanned, this is good advice for all women between 18 and 45. The easiest way to do this is by taking a standard multivitamin daily.

Studies show that folic acid plays an important role in lowering the risk for certain birth defects (called neural tube defects), if it is taken before conception and through the first 3 months of pregnancy.

You can also get your folic acid in:

• Dark green leafy vegetables (spinach, Swiss chard, kale)
• Citrus fruits (strawberries, oranges, and orange juice)
• Whole-grain breads and cereals 
• Legumes (beans, peas) 
• Fortified breakfast cereals

Maintain a Healthy Weight

It is important to try to reach or maintain a healthy weight before you conceive (get pregnant). Underweight women may have a harder time getting pregnant and are more likely to have smaller babies who may have problems during labor and after birth. Women who are overweight may experience high blood pressure or diabetes during pregnancy. Babies born to overweight women may also have a higher risk of certain birth defects. Reaching and maintaining a healthy weight before pregnancy can reduce these risks.

Eat Healthy Foods Every Day

• Eat whole grains, fruits, and vegetables daily.
• Cut down on fats like butter, margarine, sauces, gravies, mayonnaise, salad dressing, sour cream, and baked goods such as pastries, cookies, and crackers.
• Choose lean meats and poultry (chicken or turkey without skin).
• Don’t eat large fish, such as shark, swordfish, tilefish, and king mackerel, because they contain high levels of mercury. The U.S. Food and Drug Administration advises that women of childbearing age, pregnant women, nursing mothers, and young children can safely eat 12 ounces per week of cooked fish. You can eat shellfish, canned fish, smaller ocean fish, or farm-raised fish. 
• Eat less fried food. If you eat out or go to fast food restaurants, try to select healthier options from the menu. 
• For snacks, choose fresh fruit, raw vegetables, yogurt, or popcorn (without butter) instead of high calorie foods like chips, candy, or soda. 
• Drink 8 to 10 glasses of fluid daily. This includes water, milk, and soup. 
• Limit caffeine drinks (coffee, tea and soda). Recent studies have linked caffeine use to an increased risk of miscarriage. Try switching to decaffeinated beverages. If you do use caffeine, limit it to 1 cup of coffee or 2 cups of tea a day. Don’t forget that many regular sodas also contain caffeine. They also contain the amount of sugar equivalent to a candy bar. If you choose soda, consider switching to the caffeine-free and sugar-free varieties.
• Some herbal supplements are not considered safe in pregnancy. Please talk with us about any supplements you are taking.
• DHA (also called omega-3 fatty acids, fish oil) is a necessary structural component of the brain and eye. One to two weekly servings of the fish will help you get the DHA you need to help with the development of your baby's brain. If you do not eat fish, talk to us about whether you should be taking a DHA supplement. 

Be Physically Active on Most Days

If you are not already physically active on a regular basis now, this is a good time to start. You will feel better overall, have more energy, less stress, and sleep better. Try to develop a regular, moderate exercise program that you can continue during pregnancy. It is important to begin slowly and build up gradually. A 5 or 10-minute walk is a good start. Try to set a goal of exercising at least 30 minutes per day on most days. If you have a health condition, please check with us before you begin any exercise program.

If You Smoke, Quit Now

If you smoke, one of the most important things you can do to improve your health is to quit now. Smoking may make it harder for you to get pregnant. And women who smoke are more likely to have problems in pregnancy and childbirth, like premature babies. Once your baby is born, studies show that there is also an increased risk for SIDS (crib death) for babies exposed to secondhand smoke.

Don’t Drink Alcohol or Use Recreational Drugs

Using alcohol or drugs like cocaine or crack during pregnancy can harm your baby. These drugs can cause your new baby to cry a lot or have problems eating, sleeping, or breathing. Later, your baby might have trouble learning. These drugs can also cause serious problems like birth defects or brain damage. They can even cause you to have a miscarriage.

Avoid Toxic Substances or Radiation

If you are around certain chemicals that are found in the home or workplace, it could make it more difficult to become pregnant and may harm your developing baby. To decrease contact with chemicals, make sure you wear rubber gloves and work in a well-ventilated area. You can also try to:

• Follow safety recommendations for use of toxic chemical products (solvents, pesticides, cleaners, paint thinners).
• Avoid contact with products containing lead or mercury (that can be found in certain foods).

Have Regular “Well Woman” Exams

We recommend that women have regular Pap tests, pelvic exams, and breast exams. All sexually active women 24 and younger should also be screened every year for chlamydia (a sexually transmitted disease). If you have any unusual bleeding, pain, sores, or bumps near your vagina, please let us know. It is better to identify any health problems right away when they may be easier to treat.

Get Tested for Sexually Transmitted Diseases

Diseases that are transmitted through sexual contact not only affect your ability to get pregnant, but they also can infect and harm your baby. Some examples of sexually transmitted diseases (STDs) are chlamydia, gonorrhea, genital herpes, HIV (the virus that causes AIDS), hepatitis B and C viruses, and syphilis.

You can have an STD even if you don’t have symptoms. STD symptoms can include sores, bumps, or blisters near your vagina, rectum, or mouth and burning or pain when you urinate. If you have any of these symptoms, you should avoid having sex until you can see us for evaluation and treatment.

Get Vaccinated for Rubella and Chickenpox

Some infections can be prevented by immunization. Before you plan to get pregnant, ask us whether you should be immunized against rubella (German measles), chickenpox (varicella), or hepatitis. If you are not immune, you may want to receive the vaccinations before you get pregnant. Being exposed to these infections during early pregnancy could harm your baby. We recommend that you wait at least one month after being vaccinated before trying to get pregnant.

If you are not sure if you or your family members have been vaccinated against rubella or chickenpox, you can find out by viewing your Preventive Services online through my home page or by contacting my office.

Get Your Pertussis Vaccination

Whooping cough (also called pertussis) is a contagious disease that can spread easily from person to person through coughing. When babies get whooping cough, it can be life-threatening. You can protect your baby by getting a Tdap (tetanus, diphtheria, pertussis) vaccine before you are pregnant, during pregnancy, or after giving birth. Partners and families can be vaccinated at any time, but preferably before the birth of the baby so they don't infect their newborn. It is safe for mothers to get the Tdap vaccine while breastfeeding.

If you are not sure if you and your family members have been properly vaccinated against whooping cough, you can find out by viewing your Preventive Services online through my home page or by contacting my office.

Find Help if Your Partner has Ever Hurt or Threatened You

If you think you're being abused or may be abusing someone else, you can get help by talking to us or:

• Contact the National Domestic Violence Hotline, 1-800-799-7233 or 1-800-787-3224 for hearing/speech impaired.

If someone has hurt you before, it may happen again. Sometimes abuse can start when you become pregnant. Abuse during pregnancy can cause health problems for you and your baby.

• Women who are abused while they are pregnant are not as healthy and often have more anemia, infections, and bleeding. 
• Babies born to abused women have a higher risk of low birth weight, premature birth, and death.

Seek Genetics Counseling to Minimize the Risk of Birth Defects

If you, the father of your baby, or any close family members (children, parents, sisters/brothers, aunts/uncles) have a history of birth defects or inherited conditions, you may have a higher chance of having a baby with such a condition. A genetic counselor can give you more information about the specific risks to your baby and possible tests you may choose to have. Getting your test results before you get pregnant will give you time to consider your options.

Manage Your Chronic Disease(s)

If you have a chronic medical condition, it is important to discuss this with us before getting pregnant. We want to help you successfully manage conditions such as:

•  Diabetes
•  High blood pressure 
•  A seizure disorder 
•  Depression
•  Other kinds of chronic illness

It is best to have these chronic conditions under control before conceiving. If you take any prescription, over-the-counter medications, or herbal remedies on a regular basis, discuss this with us.

Try to Avoid Taking Teratogenic Medications

Teratogenic medications are medications that increase the risk for birth defects if used during pregnancy. Many of these medications are commonly prescribed:

The list of medications above isn’t comprehensive, but it contains some good examples of medications to avoid if you think you might become pregnant.

Some medications can be changed before pregnancy, while others should still be used because the potential benefits outweigh the risk. If you are of childbearing age and think you may be taking a teratogenic medication, please discuss this with us. Please do not stop any medications without talking with us first.

Tips on Getting Pregnant

Keep track of your cycle

For the best chance of success, it’s important to observe and understand your menstrual cycle.

The menstrual cycle is measured in days, starting with Day One as the first day of the menstrual period. Ovulation (releasing an egg) usually occurs at approximately 14 days before you expect your next period. This may not be Day 14 if your cycles are longer than 28 days. If the released egg is not fertilized, then you get your period. Normal cycle lengths can vary from 21 days to 42 days.

The easiest time to get pregnant is around the time of ovulation. Besides counting the days of your cycle, you can also try to predict ovulation using a basal body temperature chart or an ovulation predictor kit. For additional help with predicting your fertile days, try the fertility calculator.

Use a Basal Body Temperature Chart

The basal body temperature (BBT) indicates your body’s temperature while at rest. Hormone changes during your menstrual cycle affect your body temperature. A woman’s basal body temperature increases during ovulation.

To use this chart:

• Keep your thermometer at your bedside.
• Take your temperature for 5 minutes every morning before you get out of bed. Record the number on a chart.
• The day before ovulation, your BBT will rise 0.4 to 0.6° Fahrenheit or more.
•  You should have intercourse every day for 3 days when your temperature reaches this level.

Ovulation Prediction Kit

Ovulation prediction kits help determine when you are about to ovulate. They are sold over the counter at pharmacies. About 12 to 14 days before a menstrual period, the brain releases luteinizing hormone (LH). This is called the “LH surge” and can be detected in your urine. The LH surge happens about 1 to 1½ days before an egg is released. Here are some tips for using the kit successfully:

• Carefully follow the directions that come with the kit. 
• It is best to test your urine in the morning after you have already urinated one time.
• Begin testing on the 10th day of your menstrual cycle unless we recommend that you to start on a different day. 
• Once your urine test shows that the LH surge has occurred, you will be fertile for several days. 
• When you detect the LH surge, you should have intercourse every day for 3 days.

Early Signs of Pregnancy

Do you think you may be pregnant? Some women can tell almost immediately because of certain changes in their body. The most common symptom is a skipped period. Some other early pregnancy symptoms include:

• Going to the bathroom more frequently. You may notice that you even have to get up in the middle of the night, something you never used to do. This is caused by a pregnancy hormone that increases urinary frequency.
• Nausea and/or vomiting. This is typically called "morning sickness." However, nausea and vomiting is not just limited to the mornings. Some women feel nauseated and/or have vomiting at different times of the day, sometimes all day. Please call us if you experience vomiting that is:
  • Severe (with pain or fever)
  • Frequent (more than 2 to 3 times a day)
  • Lasts more than an hour
• Fatigue. Fatigue is also due to a pregnancy hormone. Just hang in there – many women begin to feel better by the second trimester. Try to get extra rest.
• Sore and/or enlarged breasts. The soreness can be like what you feel before your periods, except now it is all the time! This also usually lessens or disappears with time.

If you have any of these symptoms and you have not yet done a pregnancy test, please do one soon. You can stop by our lab for a pregnancy test. No appointment or lab order is needed.

Difficulty Becoming Pregnant

Sometimes getting pregnancy takes time. It may not happen as quickly as you would like. This may depend on many factors, including your age.

Couples under the age of 35 are considered to be infertile if they have not been able to conceive after 12 months of having sexual intercourse at least 2 to 3 times a week without using any form of birth control.

Couples 35 or older that have not conceived after 6 months of having sexual intercourse at least 2 to 3 times a week without using any form of birth control may have a fertility problem.

Infertility Can Affect Men and Women

Infertility in men can be caused by problems with:

• Sperm (volume, count, shape, movement)
• The testicles 
• Prostate gland 
• Varicocele (an abnormally large vein in the scrotum) 
• Chronic illness 
• Medications 
• Hormone levels

Infertility in women can be caused by problems with:

• Egg quality
• Ovulation factors 
• The cervix, uterus, and/or fallopian tubes
• Unhealthy body weight 
• Hormone levels

Egg Quality Declines with Age

Egg quality refers to both the ability of an egg to become successfully fertilized and also the ability of that fertilized egg to develop into a healthy baby. Egg quality is most closely associated with age.

Baby girls are born with a certain number of eggs. As a woman ages, the number of eggs, as well as the quality of the eggs, declines. As a result, a woman over 35 years old has a lower chance of getting pregnant and a higher chance of having a miscarriage or a baby with congenital problems (such as Down syndrome) than a younger woman does.

Both hormone functioning and reproductive anatomy must be within a healthy range for fertilization and fetal growth to occur.

Treatments for Infertility

An infertility workup may consist of:

• A sperm analysis.
• Blood tests. 
• Radiological imaging studies like a hysterosalpingogram (HSG) or ultrasound. An HSG is a dye test that looks at whether the tubes are open and if there are any abnormalities in the uterus. The ultrasound could see if there are any abnormalities in the uterus or ovaries. 
• Outpatient surgery like a hysteroscopy (an exam of the uterus with a small camera) or, less commonly, a laparoscopy (looking inside the belly with a camera).

Treatments for infertility could include: 

•  Stimulating ovulation using pills 
•  Hormone shots or hormone medications 
•  Intrauterine insemination 
•  In vitro fertilization

Your Care with Me

If you’re thinking of getting pregnant:

• Read and follow the health guidelines in this series of articles.
• Start taking folic acid or prenatal multivitamins. They are available in our pharmacy without a prescription or at your neighborhood drugstore.

If you think you might be pregnant:

• You can stop by our lab for a pregnancy test. You don’t need to make an appointment or bring any paperwork.
• You can buy a home pregnancy test kit in our pharmacy or at your neighborhood drugstore.

If you’re having trouble getting pregnant, you may have a fertility problem if you are:

• Younger than 35 and have been trying to get pregnant for 12 months or longer.
• Older than 35 and have been trying to get pregnant for 6 months or longer.

If you are having difficulty getting pregnant, contact me by e-mail or call to discuss whether you should be referred to one of my colleagues who specializes in infertility.

Contacting Me

You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

For nonurgent questions or concerns, you can: 

• Email me using this site. 
• Book an appointment online to see me in person.

For immediate concerns, or you prefer to use the telephone:

• Call our 24/7 Appointment and Advice line at 1-866-454-8855. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you.

If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

Convenient Resources for You

As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.