The Becher's Brook Surgery

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Preconception and Early Pregnancy Advice

It is apparent from scientific research, that there are benefits to both Mother and Baby, of some steps that can be taken before conception occurs.

Briefly, they are to lead a healthy active lifestyle, stop smoking and alcohol, to take folic acid supplements, and make sure you have been vaccinated against Rubella.

The following information has been adapted by me, from the advice given in the infertility clinic, run from The Queen's Medical Centre, attached to the University Hospital in Nottingham.

This is not the only source of information, but it seems to be both up-to-date, and comprehensive. If you or your partner would like further information, then please arrange to come and see a Dr (usual appointment arrangements). It may help the Dr if you have any specific queries, to let us know by writing in advance, and these can perhaps be dealt with more efficiently by letter, or telephone call.

The Royal College of Obstetricians and Gynaecologists are the official gold standard for advice, but clearly only to be contacted if other information is not readily available though your usual GP.

There is a comprehensive review of why Folic Acid is beneficial, should you wish to review this, and is available to be printed if you contact the surgery.

Dr Peter Windross, April 2004

Preconception and Early Pregnancy Advice

A healthy diet and lifestyle during the months leading up to conception and throughout pregnancy is recommended to aid the chances of conception and maintenance of a healthy pregnancy. It has been found that pre-pregnancy preparation has reduced the incidence of congenital malformation, pre-term birth, and intra-uterine growth retardation.

Although most of the information given here is applicable to pregnancy it is advisable to consider this information for the time when trying to conceive, as a good diet will ensure that should a pregnancy occur, your body would have a good store of nutrients for a baby to utilise.

Importantly, in early pregnancy at a time before the pregnancy test becomes positive, the embryo is undergoing many developmental changes; hence it is recommended that you do not expose yourself to any undue risks of infection that could affect that development. These infections include Toxoplasmosis, Listeriosis and Salmonella.

An unborn baby is most susceptible to nutritional deficiencies and infections during the first trimester (i.e. the first three months) of pregnancy when the development is greatest.

Therefore this information is designed to give guidance on maintaining a safe and healthy lifestyle, that you can follow during treatment and beyond.

The following document is in five sections:

Diet and Nutrition

Once pregnant, the amount of food eaten does not have to increase much. It is not true that you are eating for 2! You need to increase the amount of calories in your diet usually only in the last three months of pregnancy by about 200 calories, which is equivalent to two slices of wholemeal bread with butter!

However, although the amount you eat doesn't increase dramatically you may need to look at the balance of your diet to ensure it contains all the components needed for a healthy pregnancy. Poor nutrition can be linked to congenital abnormalities, neural tube defects and low birth weight babies.

Essential food groups

Bread and Cereals: Daily requirement 4 - 6 portions

This group of foods is necessary to provide essential energy. This group of foods includes rice, pasta and breakfast cereals. As these types of food are filling and provide required energy, they are generally regarded to be the foundation of a healthy diet. Also, when eating wholemeal varieties of pasta, bread and rice, they provide added fibre, which can help constipation, which is a common complaint in pregnancy. Also, carbohydrates are a good source of the B vitamins and foods such as breakfast cereals now contain added vitamins.

Fruit and Vegetables: Daily requirement 4 - 5 portions
Fruit and vegetables are good sources of fibre and vitamin C. Green leafy vegetables provide natural folic acid, the vitamin that protects babies from neural tube defects. Ensure that one daily portion is a citrus fruit such as an orange, or a glass of fresh orange juice as this will ensure that you are getting sufficient vitamin C.
Meat and Fish: Daily requirement 2 - 3 portions
This food group provides a good source of protein, which is required for the tissue building that will be taking place as a baby develops. This food group includes meat, poultry, fish, eggs, nuts and pulses. An important food source in this category is oily fish such as kippers, mackerel, salmon, sardines, pilchards and tuna. These foods are an excellent source of omega-3 fatty acids which are needed for the development of a baby's brain, nervous system and eyes. Fish liver oil supplementations are a source of omega-3 fatty acids, but these are not recommended in pregnancy as they contain high levels of vitamin A which is teratogenic (which is the medical 'posh-word' meaning it is known to be harmful to an unborn baby).
Dairy Products: Daily requirement 3 portions
This food group is high in calcium and protein and can be used as an alternative source of protein for women who don't have a sufficient intake of meat and fish products. This group of foods is necessary to aid the bone and tissue growth of a developing baby. This food group includes milk, cheese and yoghurt. If you are trying to cut down calorific intake then the low fat options of these foods can be used as they still contain the necessary calcium and protein of the full fat equivalent.
Fats and Oils
To prevent unnecessary weight gain, carbohydrates should provide the majority of your energy requirements (this is pregnancy specific, as the low-carbohydrate options like the 'Atkin's Regime' are not recommended during pregnancy). However, some unsaturated fats are required to provide a balanced diet to aid the development of your baby's brain and vision. It will probably be unnecessary to add fat to your diet because a sufficient amount will already be present in oily fish, nuts, dairy produce and margarine spreads.
Vitamins and Minerals
Calcium - Vitamin D

Calcium is required to aid development of babies bones and teeth. It is found mainly in dairy produce, with a daily requirement being equivalent to a pint of milk. If you do not eat any dairy produce, calcium can also be found in fortified soya milk, tofu, spinach, canned fish, oranges and white bread.

There is research that has found that bone density diminishes in the first three months of pregnancy to enable uptake of calcium by the developing baby. Therefore, it would be advisable to ensure calcium intake is sufficient while trying for a baby, to build up your calcium reserves in preparation. In pregnancy calcium intake is naturally increased by your body from the gut, by making the normal processes more efficient by 60-70%! so as long as you are taking the recommended amount of calcium, further increase is not required.

Calcium absorption is improved with the presence of vitamin D in the diet. The main source of vitamin D is usually from exposure to sunlight, so alternative, dietary sources of vitamin D should be considered, such as: oily fish, eggs, and milk. Some women who for cultural reasons keep themselves covered up and do not expose themselves to sunlight may be lacking in vitamin D, and in these ladies a supplementation, under the guidance of their GP, may be necessary.

Iron

Iron is required for the formation of red blood cells both for yourself, as the blood volume expands dramatically in pregnancy, and for a developing baby. However, as with calcium, the amount taken in does not need to dramatically increase, as the body becomes more able to absorb iron from the diet. Food rich in iron includes red meat, kidney, lentils, wholemeal bread, cereals and dark green vegetables. The iron found in meat is a different form to that found in vegetables and grains.

Iron from grains and vegetables is less easily absorbed and requires the presence of vitamin C to aid absorption. Therefore, if you are vegetarian or you only eat limited amounts of meat and depend upon vegetable sources of iron, then it is important to have a good intake of vitamin C with meals. In addition, polyphenol antioxidants (Tannins) which are found in tea can inhibit the absorption of iron which is from vegetable sources, therefore it is not advisable to drink tea with a meal if you are vegetarian and rely on iron from vegetable sources.

B Vitamins and Folic Acid

B vitamins are required for the growth and development of unborn babies. Women who lack vitamin B in their diet are more likely to have a low birth weight baby. Foods that contain vitamin B include bread, cereals, eggs, milk, pulses, green vegetables, meat and fish. Vitamin B12 is only found in meat or dairy produce, therefore if you have a vegan diet where you have none of these products in your diet, it would be advisable, under the guidance of your midwife or GP, to have supplementation. Folic acid is an important B vitamin as it has been conclusively shown that a lack of folic acid in your diet can cause neural tube defects in an unborn baby. Hence the government advises that folic acid supplements should be taken pre-conceptually. In addition, it is recommended to have a dietary intake of folic acid. This can be found in green vegetables, especially broccoli and spinach, fortified breads and cereals, Marmite, oranges, bananas and avocados.

Vitamin A

Vitamin A in large quantities can cause congenital defects in children. Therefore food sources that are high in vitamin A are not recommended in pregnancy. Foods such as animal liver products e.g. paté should be avoided as should supplements such as fish liver oil. However, it is not wise to eradicate vitamin A completely from your diet, as some vitamin A is required for a healthy pregnancy. The carotene form of vitamin A that is found in vegetable sources is not harmful in pregnancy and can therefore be used as a safe alternative source of vitamin A.

Food safety

Toxoplasmosis

Toxoplasmosis is an infection caught by humans from the parasite Toxoplasma Gondii. The infection is usually harmless and about three out of ten people will already have contracted the infection, probably without realising. Once someone has had Toxoplasmosis, they are immune for life. Toxoplasmosis however, can cause harm to an unborn baby, should the mother contract the infection whilst she is pregnant. The Toxoplasmosis parasite lives in cat faeces, soil contaminated by faeces, goat's milk and raw meat. You can contract Toxoplasmosis by consuming anything that is infected with the parasite. So, steps you can take to avoid contamination with Toxoplasmosis:

If you are at any stage worried that you may have contracted this infection, there is a blood test that can be performed by your midwife or GP to establish if you are infected. If you have the infection then you can be given a course of antibiotics that can reduce the risk of infection crossing to your unborn baby.

Listeriosis

This illness is caused by a bacteria found in some foods. Listeriosis contracted whilst pregnant may cause miscarriage, stillbirth or severe illness in new born babies.

Although it occurs only very rarely, it is advisable to avoid foods that may contain these bacteria.

The foods to avoid are:

Cooked chilled foods need to be thoroughly reheated or avoided completely. Meat and poultry need to be thoroughly cooked.

Salmonella

Although this bacteria does not pass from mother to baby, it does cause severe diarrhoea in an adult, hence it should be avoided if possible in pregnancy. Therefore to reduce the risk of infection:

General Food Handling

As well as avoiding high-risk foodstuffs, general food hygiene is also essential for reducing infection:

Lifestyle

Exercise

It is safe to continue a number of sporting activities once pregnancy is achieved, if you are normally fit and active. It is not advisable to take up rigorous activity once becoming pregnant. Sports and exercise that are safe in early pregnancy include swimming, yoga, walking and toning exercises (except ones that may put strain on your back, e.g. sit-ups).

High impact activities should be avoided; these include horse riding, skiing, jogging and aerobics. This is because this type of exercise puts strain on joints and ligaments, which have already softened due to pregnancy hormones. In addition, if you have undergone superovulation induction, i.e. follicle stimulation for IVF or ICSI treatment, then your ovaries will be slightly enlarged and will be more susceptible to torsion (twisting) should strenuous activity be undertaken. Also, because pregnancy has been achieved by assisted conception, we advise that sexual intercourse should be avoided until after your six week scan. This does not apply to 'normally' conceived pregnancies…for you: Sex is fine, and can continue as before!

Travel

Following treatment it is safe to drive and travel by plane. You are able to fly until the sixth month of pregnancy. You are, however, at an increased risk of having a deep vein thrombosis on long plane journeys so it is advisable to consult your GP prior to any long journey. If you are going somewhere that requires vaccinations then check whether it is safe for you to have these injections. For example, Typhoid Fever vaccination is not recommended during pregnancy, but Chloroquine, a drug given for malaria, can be given if you are going to an endemic area.

Smoking

Smoking should ideally be stopped completely, or at the very least cut down prior to treatment. Smoking displaces oxygen from the blood cells, and nicotine causes blood vessels to constrict, hence uterine blood flow is decreased and the supply of oxygen and nutrients to a baby are reduced, This can cause a higher chance of miscarriage, higher chance of premature labour, and lower birth weight babies. (Some Mothers like the sound of lower birth weight babies, as this will make labour easier… this is a myth. Labour is not much different, they are more likely to be premature, have lung disease from birth, end up on the intensive care unit, and have lower intelligence in adult life!) Smoking has also been proven to cause reduced fertility in both men and women.

Alcohol

The consumption of alcohol around the time of conception and during pregnancy is associated with low birth weight and foetal alcohol syndrome. Alcohol also affects the level of maternal nutrients because it increases excretion of zinc, vitamin B, vitamin A and folic acid. There is no safe level of alcohol intake during pregnancy, but moderate drinking of 1 - 2 drinks per week has not yet been proven to cause harm. The best advice is to avoid alcohol completely if trying for a baby. However, should you want an occasional drink, the Department of Health advises no more than two drinks daily and preferably to have no more than seven units per week. A unit being a small glass of wine, half pint of beer or a pub measure of a spirit.

Common problems in pregnancy

Morning Sickness

This can be more common if you are expecting twins or triplets. Unlike its name, it can occur at any time of the day. It is usually worse when you become hungry, therefore avoid this by eating little and often. Avoid fatty foods and try carbohydrate foods such as breakfast cereals, biscuits, crackers and cheese and also fruit and milky drinks. Have dry biscuits by the bedside and eat one before getting up in the morning. Try to avoid strong smells, such as smoke and perfumes, that may trigger feelings of sickness. Ginger can be helpful to aid nausea, so foods containing ginger, such as ginger biscuits, may help.

Constipation

To help prevent constipation try to include extra fibre in your diet, by using wholemeal alternative of pasta, rice and bread and it is important to increase your intake of fruit and vegetables. It strongly advisable to increase your fluid intake (so that when you pee, the urine is a pale watery colour) - this should be from water, fruit juices or squash. If you are suffering from nausea, you can drink a surprising amount from merely taking a sip every two minutes throughout the day (try getting into the habit of carrying round a bottle of water). Try to avoid too much tea or coffee as these can have a diuretic (making you wee more) effect and actually reduce the amount of fluid in your system.

Feeling Faint

This can be caused by hormonal changes, not eating properly, or due to the fact that the uterus requires a larger blood supply. To try to avoid feeling faint, eat regularly and get up gradually from a sitting or lying position. If feeling faint, sit or lie down until the feeling passes.

Swollen, Tender Breasts

This again is usually due to hormonal changes as increased breast tissue is laid down in preparation for breast feeding. A good supportive maternity bra will be necessary to give support and comfort. If playing sports, a good sports bra is essential (lessbounce.com are helpful).

Vaginal Discharge

Vaginal discharge will increase due to hormonal influence in pregnancy, which is perfectly normal. However, should this discharge change colour from white, and the vagina becomes sore or itchy, there may be some infection present. This can easily be treated and a visit to the GP may be necessary.

Urine Infections

These are very common, and need treatment if you get any symptoms.

Useful contacts

Women's Nutritional Advisory Service
PO Box 268, Lewes, East Sussex BN7 2QN
Tel: 01273 487 366
http://www.wnas.org.uk/
Twins and Multiple Birth Association (TAMBA)
Harnott House, 309 Chester Road, Little Sutton, Ellesmere Port CH66 1QQ
Helpline: 01732 868000
http://www.tamba.org.uk/
National Childbirth Trust (NCT)
Alexandra House, Oldham Terrace, Acton, London
Helpline: 020 8992 8637
http://www.nct-online.org/
Action on Smoking and Health (ASH)
Devon House, 12-15 Dartmouth Street, London SW1H 9BL
Tel: 020 7233 1800
http://www.ash.org.uk/
Centre for Pregnancy Nutrition
University of Sheffield, Department of Obstetrics & Gynaecology, Clinical Services Centre, Northern General Hospital, Sheffield S5 7AU.
Tel: 0114 242 4084
http://www.shef.ac.uk/pregnancy_nutrition/
Toxoplasmosis Trust
61 Collier Street, London N1 9EB
Tel: 020 7713 0599
http://www.tommys.org/problems/toxo.htm
Foresight (Advice on preconceptual care)
28 The Paddock, Godalming, Surrey GU7 1XD
Tel: 01483 427 839
http://www.foresight.gov.uk/
Royal College of Obstetricians and Gynaecologists
27 Sussex Place, Regent's Park, London NW1 4RG, UK
General enquiries +44 (0)20 7772 6200
+44 (0)20 7723 0575
http://www.rcog.org.uk/

This is one of a number of Patient Information Leaflets available from the Becher's Brook Surgery.