Steps to Prepare for Pregnancy

Written By Vita Kazakova

At the December A4M conference, numerous sessions focused on women's health, particularly highlighting how a woman's preconception health significantly impacts her future child's immune system and overall wellbeing. This blog post outlines essential factors to consider when planning for pregnancy.

I was inspired to write this blog by the frequent questions I receive about how to prepare for pregnancy. Here's a comprehensive preconception health checklist:

  1. Nutrition & Metabolic Health. Your diet should be individually balanced with appropriate amounts of protein, fats, and carbohydrates. Remember that there's no universal diet that works for everyone. Optimizing your metabolism and nutrition can reduce diabetes risk for both you and your future child. Important metrics to track include BMI, waist circumference, and laboratory tests for glucose, insulin, and glycated hemoglobin (HbA1c). These measurements will help determine if lifestyle modifications are necessary. Note that regular menstruation doesn't guarantee ovulation, especially in cases of elevated BMI.

  2. Nutrient Deficiencies. Beyond just folate testing, it's crucial to evaluate levels of vitamin B12, vitamin D, iron (including storage - ferritin), and at least omega-3 fatty acids. Testing for deficiencies is a crucial part of pregnancy preparation. As a baseline, these tests should be included in your preconception plan.

    Low levels of vitamin D during pregnancy have been associated with adverse pregnancy outcomes, including preeclampsia, gestational diabetes, and preterm birth [1].

    A sufficient level of omega-3 is important for pregnancy. Omega-3 fatty acids, particularly DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid), play a crucial role during pregnancy, contributing to fetal brain and eye development, and supporting maternal health. This meta-analysis confirms the positive impact of omega-3 on pregnancy outcomes, including a reduced risk of preeclampsia, preterm birth, and low birth weight [3].

    However, a more comprehensive assessment may also involve evaluating vitamin A, vitamin E, zinc, copper, and other essential micronutrients.

    Because, for ezample, excessive intake of vitamin A (i.e., retinol, retinyl palmitate), especially during the first trimester of pregnancy, may have teratogenic effects on the fetus [3].

  3. Thyroid Function Assessment. Proper thyroid function is essential, as it impacts not only fertility and pregnancy progression, but also the future child's health, including cognitive development [4].

    Important tests: TSH, free T3/T4, and thyroid antibodies.

    Keep in mind that both iodine deficiency and excess, as well as selenium deficiency, can be risk factors affecting proper thyroid function and pregnancy.

  4. Hormonal Testing. Many women are aware of the importance of adequate progesterone levels for pregnancy, but it is crucial to test for it at the right time - on the 7th day after ovulation when levels peak. Ovulation test strips can help you determine the right timing. Hormone tests should be conducted on specific days of the cycle, ideally under the guidance of a specialist.

  5. Gynecological Examination. Include a physical exam, infection screening, and discussions about uterine health, egg quality, potential endometriosis, and hormonal status.

  6. Gut and Vaginal Microbiome Health. A healthy microbiome is crucial for conception, pregnancy, and your future child's health [5]. For instance, chronic bacterial vaginosis can cause infertility and affects the microbiome transferred to the baby during vaginal delivery.

  7. Digestive Health. Consider endoscopy if you have gastrointestinal issues. Address chronic conditions like reflux and constipation before pregnancy, as symptoms may worsen during gestation.

  8. Environmental Toxins. If you've been exposed to mycotoxins or heavy metals, allow time for recovery before conception. For example, maternal mercury poisoning has been linked to neuroinflammation in children [6],[7]. Health agencies often recommend that pregnant women choose fish known to have lower mercury levels and limit the intake of those with higher concentrations [8].

    If you have recently been in contact with mycotoxins or heavy metals and are still experiencing symptoms, consult a specialist before attempting pregnancy.

  9. Dental Check-Up. It is best to complete any necessary dental treatments before pregnancy.

    For women over 35, I recommend checking Anti-Müllerian hormone (AMH) levels as an accurate marker of ovarian reserve.

While this preparation might seem overwhelming, remember that specialists can help create your personalized preconception plan. The preparation typically takes 3-9 months. Your future health, pregnancy experience, postpartum recovery, and most importantly, your future child's health significantly depend on your actions today.

Lifestyle factors matter - even for IVF success. Alcohol consumption, excess weight, smoking, and chronic stress can all deplete your body's reserves.

References:

  1. Wei SQ, Qi HP, Luo ZC, Fraser WD. Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2013;26(9):889-899. doi:10.3109/14767058.2013.765845.

  2. Abdelrahman MA, Osama H, Saeed H, Madney YM, Harb HS, Abdelrahim MEA. Impact of n-3 polyunsaturated fatty acid intake in pregnancy on maternal health and birth outcomes: systematic review and meta-analysis from randomized controlled trials. Arch Gynecol Obstet. 2022;305(3):659-673. doi:10.1007/s00404-022-06533-0. PMID: 35348829.

  3. Rothman KJ, Moore LL, Singer MR, Nguyen US, Mannino S, Milunsky A. Teratogenicity of high vitamin A intake. N Engl J Med. 1995;333(21):1369-1373. doi:10.1056/NEJM199511233332101.

  4. Levie D, Korevaar TIM, Bath SC, et al. Thyroid function in early pregnancy, child IQ, and autistic traits: a meta-analysis of individual participant data. J Clin Endocrinol Metab. 2018;103(8):2967-2979. doi:10.1210/jc.2018-00374. PMID: 29757392.

  5. Adamczak AM, Werblińska A, Jamka M, Walkowiak J. Maternal-Foetal/Infant Interactions - Gut Microbiota and Immune Health. Nutrients. 2024; 16(3):450. PMID: 38540103; PMCID: PMC10967760.

  6. Grandjean P, Pichery C, Bellanger M, Budtz-Jørgensen E. Calculation of mercury's effects on neurodevelopment. Environ Health Perspect. 2012;120(12):A452. doi:10.1289/ehp.1206033. PMID: 23211440; PMCID: PMC3548290.

  7. The Pew Charitable Trusts. Polluting the Future: How Toxic Mercury Contaminates Our Water, Food, and Health. Published February 2005. https://www.pewtrusts.org/-/media/legacy/uploadedfiles/wwwpewtrustsorg/reports/global_warming/ctamercury0205pdf.pdf

  8. U.S. Food and Drug Administration. Advice about eating fish. https://www.fda.gov/food/consumers/advice-about-eating-fish

  9. U.S. Food and Drug Administration. Eating Fish: What Pregnant Women and Parents Should Know. Published January 2017. https://www.fda.gov/media/102331/download


Vita Kazakova
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