What to Expect Before You're Expecting

INTRODUCTION

What Can You Expect Before You’re Expecting

(And why does it matter, anyway?)

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Pregnancy, as you probably know, is 9 months long (or 38 weeks from conception, if you’re really serious about keeping count). And if you’ve ever been pregnant before, you probably think that’s plenty long enough. Maybe even a little too long, especially once your belly’s the size of a prize-winning watermelon and your breasts have worked their way through the cup alphabet . . . twice. But is 9 months really long enough? Does that time-honored baby-making timetable really stand up to the latest science?

According to experts, no. From the CDC to the American College of Obstetricians and Gynecologists, the March of Dimes, American College of Nurse Midwives, the American Academy of Pediatrics, and the American Academy of Family Physicians—that traditional 9-month timeline has been bumped by this recommendation: It’s time to add more months to pregnancy.

That’s right, more months. At least 3 more, in fact, for a full 12. But before you panic (3 extra months of not seeing my feet? Of passing on the sushi? Of waiting to hold that bundle of joy?), here’s what you need to know: Those extra months aren’t meant to be spent being pregnant, but getting ready to be pregnant.

The truth is, a healthy pregnancy begins before sperm and egg meet up. Before the home pregnancy test announces the good news. Before the queasies kick in and your waistline checks out. Even before you ditch your diaphragm or peel off your patch. A healthy pregnancy begins before you’re expecting—which is why, if you’re planning to get pregnant, you might want to start planning (and prepping) ahead.

And here’s how. What to Expect Before You’re Expecting—a complete, start-to-cuddly-finish guide to getting pregnant—is everything you need to know to get your body and your partner’s body into the best baby-making shape possible before you start trying to conceive. What baby-friendly foods to order up often, and which fertility-busting foods—and drinks—to keep off the menu. (Hint: Get your sushi while you can, but can the fresh tuna.) How to get your weight where it needs to be for maximum fertility and optimum pregnancy health (packing on too many pounds—or too few—can compromise conception and complicate pregnancy). Which medications need to be shelved (including some surprises, like antihistamines), when to toss your birth control, why your partner should put hot tubs (and spinning classes) on ice, why kicking your smoking habit now can give fertility a boost (while protecting your future baby’s health).

Once you’ve prepped for pregnancy, it’s time to get pregnant. Sounds like the easy (and fun) part—and usually it is. But a little conception know-how can help you fast-track your fertility and make those baby dreams come true sooner. You’ll find out how to pinpoint ovulation, when to schedule in sex, how sex toys and lubes fit in, why wet isn’t wild when it comes to baby-making sex, how to keep on-demand sex spicy—plus the lowdown on sex positions and conception. Have you heard a few conception tales already, or read them on the internet? Fertility fiction and fact are sorted out here, too.

What if you encounter a bump on the way to baby? Fertility challenges—and how to overcome them—are covered, as well as the latest in fertility treatments. You’ll also find out when to let nature take its course, and when to seek help.

Whether you’ve begun your conception campaign already, or you’re just starting to think about getting pregnant, it’s never too late—or too early—to start optimizing your preconception profile. So put time on your side, and add a few months to your baby-making calendar. More pregnancy, it turns out, is more.

May all your greatest expectations come true!

PART 1

Getting Ready to Get Pregnant

CHAPTER 1

Prepping Before You’re Expecting

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Are you gearing up for a pregnancy? Preparing for baby making isn’t only about tossing your birth control (though you’ll need to do that), charting your ovulation (you’ll probably want to do that), and heading to bed (you’ll be happy to do that). It’s also about getting your body—and your partner’s body—into tip-top baby-making shape. From the drinks you and your partner-in-procreation sip to the medications you take, from the habits you’re best off kicking to the supplements you’re best off popping (and not popping)—taking charge of your preconception prep will start you off on the right foot, making conception easier (hopefully) and pregnancy safer and more comfortable (ditto). So before you dive into bed to make that baby, dive into this chapter to find out what steps you should consider taking first.

Your Health Prep

It stands to reason that your overall health has a lot to do with your overall fertility. After all, it takes a healthy body (make that 2 healthy bodies) to make a healthy baby. Which means there’s no better time than now—when that baby-to-be is just a gleam in your hopeful eyes—to make sure that you and your partner are healthy overall. Just about every aspect of your health—from the medications you take to the immunizations you should have to the chronic conditions that need controlling and the dental work that needs doing—can have an impact on your fertility and on your healthy pregnancy to come. So check it all out, starting with those checkups.

Preconception Checkups

“I’m young and in good health, and my periods are regular. Do I really need to see a doctor before I start trying to get pregnant?”

The best prenatal care starts long before conception—and it doesn’t stop at your reproductive parts. So now’s a great time to schedule that full-body tune-up. Even if you’ve never had a sick day, it’s easier to tackle health issues before baby’s on board than to play catch-up after your body is already baby building (and this preconception prep is even more essential if you’re overweight or underweight or living with a chronic condition). To make sure all systems are go, make an appointment with your gynecologist (who, by the way, doesn’t have to be your eventual prenatal care practitioner)—and believe it or not, with your dentist, too—for complete pre-prenatal checkups.

See your gynecologist. Your preconception checkup will include a lot of the same tests and screenings you get at your regular annual—plus a lot of prepregnancy-specific ones. Here’s what you can expect:

■ A Pap test and all the standards of your annual visit, such as a pelvic, breast, and abdominal exam. Get ready to stick out your arm for a blood pressure reading, too.

■ A screening for, or a followup of, any gynecological conditions that might interfere with fertility or pregnancy, such as irregular periods, polycystic ovarian syndrome (PCOS), uterine fibroids, cysts, or benign tumors, endometriosis, pelvic inflammatory disease (PID), or recurrent urinary tract infections. Now—before you get started on baby making—is the time to get any gynecological conditions diagnosed and treated, because certain ones may prevent you from getting pregnant in the first place, and others can complicate pregnancy.

■ A weight check. Because your prepregnancy weight has a lot more to do with your fertility, your future pregnancy health, and even your yet-to-be conceived baby’s future health than you might think, you’ll be stepping right up to the scale for a baseline weight check. If that bottom line isn’t where it should be (close to the ideal weight for your size and body type), your doctor can help you set some goals to get your weight conception-ready. See Chapter 2 for more on your weight and fertility.

■ A urine test to screen for a urinary tract infection and kidney disease.

■ A blood test. Nobody’s favorite part of the checkup, but a blood draw is typically standard at a preconception visit to get a read on your current state of health. You’ll likely need many of the following tests once you get pregnant anyway, so you might as well get a head start on them now—they may not need to be repeated if you conceive within a few months of this workup:

◆ Hemoglobin or hematocrit to use as a baseline during pregnancy and to test for anemia (many women have lower iron stores than they think, thanks to that monthly flow).

◆ Vitamin D level. Your doctor may test for vitamin D deficiency (some women are deficient) and recommend supplementation as needed.

◆ Rh factor, to see if you are positive or negative. If you are Rh-positive, you don’t have to give Rh factor another thought. If you are negative, your partner should be tested to see if he is positive. If he’s positive, then any baby you conceive has a chance of being Rh-positive, and you may end up developing antibodies to your baby’s blood during pregnancy (not a problem in a first pregnancy, but it can result in an Rh-incompatability in a subsequent pregnancy). That’s important information to have, since Rh-incompatibility can be easily prevented.

◆ Rubella titer, to check for immunity to rubella, and a varicella titer, to check for immunity to varicella (chicken pox); see immunizations for more on the important immunizations you should have before becoming pregnant. If you’re not up to date on any of those vaccines, you should get them now.

◆ Tuberculosis (if you’re at high risk for TB)

◆ Hepatitis B

◆ Cytomegalovirus antibody titers, to determine if you’re immune to CMV (this test isn’t routinely recommended, but you can ask for it). If you have recently had a CMV infection, it’s generally recommended that you wait 6 months—when antibodies appear in the blood—before trying to conceive, since exposure to the virus could be dangerous to a baby-to-be.

◆ Toxoplasmosis titer, if you have a cat, regularly eat raw or rare meat, or garden without gloves. If you turn out to be immune (because you’ve been infected in the past), you won’t have to worry about becoming infected during pregnancy and passing it on to your baby.

◆ Thyroid function. Because thyroid function can affect both fertility and pregnancy, preconception screening is recommended if you have a family or personal history of thyroid condition or have symptoms of or risk factors for a thyroid disorder. Some doctors do routine preconception screening for thyroid function.

◆ Sexually transmitted disease (STD)

■ A medication review. Whether it’s over-the-counter or prescription, you and your doctor will discuss all the medications you take—including those you pop only occasionally. Depending on the medication (some are safe during pregnancy, others may not be), a change may be in the cards. You’ll also review any vitamin and herbal supplements you take to see if they’re preconception and pregnancy safe.

■ A discussion about:

◆ When to stop your birth control (your doctor will let you know how long you should ideally wait, if at all, before you can start trying to conceive; see stopping birth control for more)

◆ How to make sense of your cycle and figure out when you’re most fertile (see Chapter 6 for more)

◆ What to eat and not eat while you’re trying to conceive (see Chapter 3)

◆ Whether you should consider any lifestyle changes now that you’re about to start TTC (see your lifestyle prep)

◆ Whether you should consider genetic screening and/or counseling (see genetic screening)

◆ How your age might affect your fertility and impact pregnancy (see getting pregnant after 35)

◆ Any medical problems that should be treated before conception or will need to be monitored during pregnancy. Two examples: If you need allergy shots (or other allergy prevention treatment), the doctor will advise you to take care of them now (you’ll be able to continue to get allergy shots during pregnancy if you start allergy desensitization before you conceive). If you were a PKU baby you’ll need to protect your own future baby by beginning a phenylalanine-free diet 3 months before you conceive, and continuing it throughout pregnancy.

◆ Recent travel. If you or your partner live in or have recently traveled to an area where Zika virus is prevalent, your practitioner will counsel you about the best conception plan, including whether you should wait before trying to conceive (see the box Zika and TTC for more).

■ A family history check. When you’re starting or building on a family, your family tree matters—which is why your doctor will want to check it out. For instance, if there’s a family history of breast cancer, you’re at high genetic risk, and you’re over age 30, the doctor may suggest getting a baseline mammogram for a clear picture of what your breast tissue looks like before all the hormonal changes of pregnancy and breastfeeding begin. Your doctor will also ask about your family history of medical conditions (such as type 2 diabetes, celiac or thyroid disease, or hypertension) and pregnancy conditions (such as preeclampsia) that might affect your pregnancy. See the box shaking your family health tree for more.

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