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Pre-Pregnancy Checklist: 10 steps to take BEFORE you start trying to conceive

Pre-Pregnancy Checklist: 10 steps to take BEFORE you start trying to conceive

If If you and your partner have decided that it’s time to start trying to have a baby, congratulations! This is an exciting time for you and your growing family. Before you embark on this journey, there are a few things I encourage women to consider. The preconception period (the time leading up to becoming pregnant) is a very important time to examine your health status and fertility and make supportive healthy changes to your diet and lifestyle. Why? Beyond supporting a healthy, comfortable pregnancy, the preconception environment in your body sets the foundation for your child’s health.


Think of your body as a garden. When you go to plant a seed, you want to ensure that the soil is rich, nutrient dense, positioned in the sunlight, and free of any pests or harmful bugs in order to ensure your seeds have the best environment possible to grow and thrive. Plenty of research demonstrates that the prenatal environment plays a role in a child’s future health. For example, the foods we eat, the medications we use, parental health status, and our environmental exposures to contaminants are linked to infant conditions such as eczema, allergies, asthma, and diabetes, among others.


For this reason, I strongly suggest that women (and their partners) spend at least 3 months focusing their attention on nurturing the soil, preparing their bodies, before they start trying to conceive. I would ideally recommend 6 months at minimum for women who are either managing their own health conditions, have a history of hormone imbalances, or who have been on hormonal birth control for many years and are unfamiliar of their own menstrual cycle.


This article is for women who want to be proactive and prepare their bodies for pregnancy. As a Naturopathic Physician, I’m committed to supporting women in all aspects of their health including their nutrition, hormone health, sleep, emotional wellbeing, stress resilience, and in developing their own innate body wisdom. I want to ensure that your pregnancy is not simply free of complications, but that your pregnancy is optimally healthy, feels empowering and affirming, and you feel confident and full of vitality.


I created this checklist so you know what health professionals you should check in with, what testing to ask for, what supplements to take, what foods you should be eating, and what lifestyle factors you should be considering. It combines a medical approach (i.e. what the Society of Obstetrics and Gynecologists of Canada recommend) and a holistic naturopathic approach described above, so you get the best of both worlds.


Pre-Pregnancy Checklist


1. Start taking a prenatal multivitamin with folic acid.


Most women are already aware that they need to start taking folic acid, but do you know why? Folic acid, also known as folate, or vitamin B9, is a critical vitamin required for the development of your baby’s neural tube. The neural tube is a structure developed very early in pregnancy that later becomes the brain and spinal cord. Folic acid deficiencies are associated with neural tube defects and other abnormalities that can affect the health of your baby. For this reason, folic acid supplementation is strongly recommended for all women of childbearing age.


Natural folate can be found in a variety of food sources. For example, dark leafy green vegetables, broccoli, oranges, bananas, dried chickpeas and legumes. In Canada, many foods are fortified with folic acid, such as white flour, enriched pasta and cornmeal products. Increasing the foods sources of folate in the diet, particularly from the green leafy vegetables, is highly recommended. Even if you eat lots of greens, you should still take a multivitamin with folic acid to ensure you have maximal protection from neural tube defects.


How much folate should you be taking? For most women, 0.4mg of folic acid is the minimal recommended dose. The Society of Obstetricians and Gynaecologists of Canada (SOGC) recommend being on a multivitamin with folic acid for at least 3 months in the preconception period before trying to conceive. Certain women who are at moderate or high risk of neural tube defects may require higher doses. For example, women (or their male partners) with a personal history of neural tube defects, or women with a previous pregnancy with a neural tube defect, may need 1.0-4.0mg of folic acid per day in addition to a folate-rich diet. Speak to your medical doctor or Naturopathic doctor to better understand if this pertains to you.


I strongly recommend you obtain your folic acid/folate requirements as part of a good quality, professional line prenatal multivitamin. Folic acid is the synthetic form of folate; it is only found in supplements. Some supplements contain folate in the form called “methylfolate” or “5-methyltetrahydrofolate”, which are the most biologically active forms of folate.


Folate is ideally delivered with vitamin B12, which is a part of a multivitamin. Other vitamins and minerals in a prenatal multivitamin help optimize your health prior to your pregnancy (more on this later in the naturopathic assessment section).


2. Schedule a general health check up and/or physical exam with your family doctor.


Schedule an appointment with your family doctor and inform them that you are planning to conceive in the near future and want to review your health and do any recommended blood testing. Your doctor should review the following with you:


  • Pap exam. If it has been 3 years or more since your last PAP exam, schedule this visit. While Pap’s can be done during pregnancy, in the event that any further investigation or treatment is required based on your results, it’s best to take care of that before getting pregnant.
  • Review your medications. There are many medications that cannot be taken during pregnancy or are not recommended in the preconception time. Very few medications are known to be safe during pregnancy. Review your medications with your doctor and discuss weaning off where appropriate, or making switches to safer options for your pregnancy. By the same token, you should speak to a Naturopathic Physician to review your supplement protocol to ensure they are safe to take during the preconception period.
  • Review your immunization history. Certain viruses, if caught during pregnancy, can have harmful outcomes for the baby. Family doctors can do a blood test to screen whether or not you are immune to these viruses. If you’re not, I recommend that you discuss your options for vaccination with your doctor. Doing this in the preconception period is important because “in general, live or attenuated virus vaccines should not be administered during pregnancy as there is a, largely theoretical, risk to the fetus” (Journal of Obstetrics and Gynaecology Canada, 2009). Women who receive these vaccines are advised to wait at least 4 weeks before trying to conceive.
  • Blood work and screening. As mentioned above, standard prenatal blood testing generally consists of screening for your immunity to various viruses that can be harmful in pregnancy (Rubella, hepatitis B and C, and HIV) in addition to screening your blood type. I additionally recommend that you ask your doctor for a full health assessment, if you haven’t had any blood testing done in 1 or more years. Kindly ask if your doctor would screen your blood sugar, cholesterol, thyroid, vitamin B12, iron, vitamin D, and electrolytes, and if there is anything else they would recommend for you specifically. In British Columbia (where I practice), family doctors are sometimes limited in what tests they are able to offer you in a given appointment. Try not to get frustrated if they deny your requests for certain tests. Speak with your Naturopathic Doctor about private testing where needed; ND’s are able to send for almost all of the same tests that family doctors do. More on this in the next section.


3. Have a full Health and Wellness Assessment with a Naturopathic Physician.

Adding a Naturopathic Physician to your prenatal health team is an excellent way round out the care you receive. Many women come to be because they have many questions about their hormones, health and bodies that their family doctor didn’t have time to answer during their short visit. As an ND, I get to spend a full hour with women in their initial visit assessment, and 30 minutes in our follow up meetings. This provides ample time for us to delve into the nuances of interpreting your blood work in great detail, examining your diet and nutrient status, closely monitoring your menstrual cycle and hormones, and thoroughly discussing and supporting other aspects of your health including your sleep, stress, digestion and emotional wellness. All of these factors play a role in your ability to get pregnant and have a healthy baby. Here are the areas that I examine and how it pertains to your pregnancy and future child:


  • Review of your medical history. Women with a history of hormone imbalances, irregular periods, hypothyroidism, PCOS, diabetes, among other notable conditions require special attention in supporting their fertility and pregnancy. For this reason, we do a thorough review of your personal and family medical history so we can identify and address any possible barriers to a healthy pregnancy.
  • Targeted blood testing. I review my patient’s blood work history to ensure that their values are not simply “normal”, but rather, that they are optimal. In some cases, we will do more thorough thyroid testing or hormone testing.
  • Dietary analysis. I analyze the diet my each patient to ensure they are getting the nutrients they need for a healthy pregnancy and baby.
  • Nutrient status. Many women have at least one nutrient deficiency that requires correcting to ensure a healthy pregnancy. For example, iron deficiency is incredibly common and sadly under-treated. We will examine this closely so that we can correct any deficiencies prior to conception.
  • Hormone status and menstrual cycle assessment. Healthy hormones help lead to healthy pregnancies. I evaluate the menstrual cycle over at least 3 months to ensure that ovulation is healthy and progesterone levels are sufficient for fertilization and implantation.
  • Fertility testing. Some women, particularly those over the age of 35, desire blood testing to understand their fertility status and their family planning options. We use blood tests along with menstrual cycle history and health history to evaluation this. I also treat women who are undergoing Assisted Reproductive Technology through their fertility clinic.
  • Digestion, sleep, stress and emotional health. These factors play important roles in your ability to absorb nutrients and make hormones, your ovulation and menstrual cycle.
  • Environmental toxin exposures. Certain chemicals can impact fertility. For this reason, I delve into home and environmental factors to screen for any concerning exposure. See section #9, below for more information.
  • Physical exam and body composition testing. A baseline physical exam is performed alongside muscle and fat mass testing to examine body composition as it pertains to fertility and hormones.
  • Treatments using natural medicine, herbs, supplements and acupuncture where needed to help optimize health and fertility.


4. Book an appointment with your dentist.


The shift in your hormones during pregnancy affects your oral health and risk of gum disease. Certain oral conditions such as peridontitis have been associated with adverse pregnancy outcomes, such as having a preterm birth or a low birth weight baby. If it’s been over 6 months since your last dental visit and cleaning, book in for an appointment.


5. Reflect on your diet and optimize your food choices for fertility.


Beyond simply eating more folate-rich vegetables, your diet deserves attention during this critical preconception time. Ideally, move towards eating “Mediterranean-style Diet” with high amounts of vegetables, plant-based protein, whole grains, extra-virgin olive oil and healthy fats, fish and legumes, with minimal dairy and meat and no processed foods or added sugar.


For more detailed information, check out my article on the Fertility Diet for more information about what foods to eat, and which to avoid, for the 3+ months before you conceive. If you have Polycystic Ovarian Syndrome, this article on the treating PCOS naturally is best for you. For women with endometriosis, this article is a good starting point for best dietary patterns for hormone health and fertility. Speak with your ND about the specific foods and nutrients that you should focus on for your unique body.


6. Reflect on your lifestyle and habits.


This is a lovely time to sit down and reflect on the habits that are supporting you, versus the habits that are not serving you.

How frequently do you exercise and move your body, and how does it make you feel? I recommend at least 1 hour of movement per day, whether that’s walking, working out, hiking or yoga (or other favourite activities you may have).

How frequently do you have a glass of wine (or 3) with dinner? Having 2 drinks or more per day appears to increase the risk of infertility in women. Consider limiting your intake to one glass of red wine every other day (or less), or sipping one or two glasses at social gatherings, only.


How many cups of coffee do you have per day, and do you need it? Studies on fertility and caffeine are conflicting, but it appears that more than 2 servings of caffeine per day (i.e. 2 cups of drip coffee) increase the risk of miscarriage. Limit your caffeine intake to 1 cup per day, or ideally wean down to Swiss water decaf options.


Are you using recreational drugs, and is that serving you at this time? Marijuana and other recreational drugs may have an impact on your ability to get pregnant. Marijuana data on fertility is limited and may be confined to heavy use.


7. Reflect on your stressors and coping strategies.


What are the major stressors you face on a daily or weekly basis and how do you respond to them? I always ask my patients how stress manifests in their body. Many of us have physical symptoms that arise like the warning light on your dashboard to tell you that something’s not right. For some that may be upper back tension, for others its sleep disturbances or an irritable mood.


The stressors you manage and how you manage them is important and can have implications for your hormones and fertility. High stress and sleepless nights can cause anovulation, meaning your body doesn’t ovulate for one cycle or more.

While we can’t always modify the stressors in our life, what we do have control over is how we respond to those stressors. What tools or habits do you turn to when you’re stressed? Is it exercise? Talking it out with friends? Drinking half a bottle of wine? As mentioned above, reflect on what habits serve you, and which don’t.


I highly recommend bring a Registered Clinical Counsellor on board as part of your healthcare team to support you in examining your perception of stress. A mindfulness meditation practice using an app such as Headspace is an excellent, research-validated tool to help improve your stress resilience. There are a multitude of wonderful adaptogenic herbs that help to improve your stress resilience, and some that have the added bonus of supportive hormones and ovulation. Speak to your ND about whether any of these herbs would be appropriate for you at this time.


8. Start tracking your menstrual cycle and ovulation signs.


If you are still taking hormonal contraceptives, I recommend coming off them at least 3 months prior to when you ideally plan to get pregnant. If you have a history of irregular or painful periods, I recommend coming off them 6-12 months before you plan to get pregnant. Irregular periods (less than 21 day long cycle or more than 35 day cycle) indicate a hormone imbalance that should be addressed before you conceive.

Once you’re off contraceptives, I highly recommend tracking your menstrual cycle on an app to get to know your hormones and ovulation. Use an app such as Natural Cycles or Kindara to monitor the frequency of your periods.


I additionally recommend you start tracking your ovulation and fertility window. Typically, ovulation occurs in the middle of the menstrual cycle (ex. day 14 of a 28 day cycle). Day 1 of your cycle starts on the first day of your period. Some of the signs that you have ovulated include:


  • Changes in your Basal Body Temperature (BBT). Tracking your BBT is a great way to get to know your body and changes in your hormones throughout the month. After ovulation, your core temperature shifts upwards slightly, and this can be observed when you track your temperatures upon waking before getting out of bed. Use an app like Natural Cycles, which uses this information to predict your ovulation days in the future months, which is useful when trying to conceive.
  • Changes in your cervical mucus. The quality and consistently of cervical mucus changes throughout the month as your hormones shift. During your peak fertile days, you’ll notice clear, slippery mucus that looks like egg white.
  • Ovulation Prediction Kits. These are little strips that you pee on that will change colour at ovulation time.


Use one of more of these methods to start tracking when you ovulate. Track for 3 months and discuss this with your Naturopathic Physician. Ovulation that is too early or too late in the cycle (or if you’re not ovulating at all) indicates that more investigation should be done to identify the cause.


9. Detoxify your home and skincare products.


Sadly, we are exposed to hundreds if not thousands of chemicals on a daily basis. Some of these chemicals have known adverse effects on fertility. The EARTH study (2018) examined the effect of environmental exposures on sub-fertile couples visiting a fertility clinic. I will briefly list some of the findings here:


Phthalates and parabens. Women with higher levels of phthalates (as determined in urine samples) were associated with reduced egg yields, lower chances of pregnancy, an increased risk of pregnancy loss and lower likelihood of live birth outcomes after In-Vitro Fertilization (IVF). In men, higher phthalates levels were associated with decreased semen quality. Phthalates and parabens are commonly found in many skin care products, lotions, and perfumes/colognes.


Pesticides. High pesticide residue fruit and vegetable intake was associated with lower total perm and lower morphologically normal sperm in men.


Bisphenol A (BPA). BPA is found in plastic bottles, CD’s/DVD’s, PC#7 plastics, food containers and on the inner lining of canned goods. Increased BPA exposure was associated with decreased probability of implantation, clinical pregnancy and live birth.


Mercury. Sources of mercury come from seafood consumption and coal burning power plants. One study showed that higher mercury levels were seen in men with abnormal sperm and women with “unexplained infertility”.


Here are a few starting points for detoxing your home:


  • Audit your skincare products, shampoo, and makeup and switch to natural options and brands.
  • Examine your soaps, laundry detergents and cleaning products and switch to natural options.
  • Check out the Environmental Working Group website for safety ratings of various products and brands.
  • Choose organic. Read the fertility diet article for more information.
  • Quality seafood.  Avoid large fish that may contain mercury, such as tuna, barracuda, marlin, sea bass, and swordfish.
  • Get rid of plastic. Replace plastic water bottles and food storage containers with glass or metal options.


10. Request that your partner goes in for his/her own health check up, too.


The journey into pregnancy and beyond involves the two of you. Even if you’re the one who will be carrying the baby, your partner has a role in this process, too! Whether or not you have a male partner, the collective shift in your home towards healthy eating and habits works better for everyone if it’s a family endeavour. Your partner would benefit from taking this opportunity to do their own health check in with their medical doctor and naturopathic doctor. I’m always thrilled to welcome my patient’s partners into the clinic for their own personal health assessments.


I hope this article provides some guidance and direction for you as you navigate this exciting time in your life! Connect with me on Instagram @dr.kathleenmahannah for more information about hormone health and fertility. To connect with me in person, follow this link.


Yours in Health,


Dr. Kathleen

References:


Oral Health and Pregnancy. Government of Canada. Obtained online from https://www.canada.ca/en/public-health/services/pregnancy/oral-health-pregnancy.html

Gruslin, A. et al (2009) Immunization in pregnancy. Journal of Obstetrics and Gynecology Canada, 2009, 31(11):1085-92. Obtained online from https://www.jogc.com/article/S1701-2163(16)34354-7/abstract

Wilson, D. et al (2015) Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid-sensitive congenital anomalies. SOGC Clinical Practice Guideline, May 2015 (No. 324)

Mueller et al. (1990) Recreational drug use and the risk of primary infertility. Epidemiology, 1(3): 195-200.

Messerlian et al. (2018) The Environmental and Reproductive Health (EARTH) Study: a prospective preconception cohort. Human Reproduction Open 2018; 1-11.

Choy et al. (2002) Infertility, blood mercury concentrations and dietary seafood consumption: a case-control study. BJOG, 109(10):1121-5.

All content found on this website was created for informational and general educational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your primary care provider or other qualified health professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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