Whether it will be your first pregnancy or a subsequent pregnancy, a lot of questions can arise when planning to have a baby. 

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Having a visit with your healthcare provider ahead of time is a great way to be sure you are not missing out on any important steps of preparing yourself to carry and care for your future child. Your provider will have some questions for you, like what medicines and supplements you are taking, what your past medical and obstetric history involves, and the details of your menstrual cycle. You should prepare some questions for your provider as well.  

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We asked our Medical Director and OBGYN, Dr. Liz Swenson, for responses to some of the most common pregnancy planning questions. 

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1. What can I do to optimize my health before I am pregnant? 

Here are some guidelines from the American College of Obstetricians and Gynecologists, ACOG.

• Be sure you are up-to-date on your vaccinations, including a yearly flu and COVID shot.
• Try to maintain a habit of regular exercise.
• Be at a healthy weight, and eat a diet balanced in whole grains, protein, veggies, fruits, and dairy (plant-based is ok). 
• Start limiting caffeine intake, as you should consume 200 mg or less per day during pregnancy.  
• Stop drinking alcohol once you are pregnant. 
• Avoid use of other drugs and tobacco products. 
• Meet with your provider to review your medical conditions and prescription medications to see if changes or tests are recommended.

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2. Should I be taking a prenatal vitamin? If so, when should I start, and which one should I take?

Prenatal vitamins are ideally started before you get pregnant. The ingredient folic acid, in particular, is important in the early stages of pregnancy due to its role in preventing problems with spinal cord formation (called neural tube defects). In general, most over-the-counter prenatal vitamins will have adequate levels of critical vitamins and nutrients. Your obstetric provider may have a recommendation, or they may leave it up to you. Try to keep it simple by choosing a familiar brand that gives a dose of one pill a day with at least 0.4mg of folic acid. If you have problems swallowing pills, there are brands available as chewable gummies, too.

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3. I am currently taking a birth control pill - how long do I need to be off this before getting pregnant? 

There is no specific amount of time needed off a birth control pill or other hormonal contraception before getting pregnant. It’s safe to start trying right away. It can take a month or two for periods to become regular again once you stop taking the contraceptive, but you may still get pregnant during that time.

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4. What if my periods are not regular? 

This depends on how irregular your periods are. If they are just a few days off and still coming every 24-38 days, you may want to use an ovulation predictor kit (available over-the-counter) to help track your most fertile days. If you are skipping months, not getting positive results with the ovulation tests, or getting a period more than once a month, it would be best to set up an appointment with a fertility provider or OBGYN to get evaluated. 

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5. How do I track my cycles and know when I am fertile?

In general, it’s recommended to have sex every 1-2 days during the week of ovulation. As mentioned above, home ovulation predictor kits can be used in addition to temperature tracking (called basal body temperature tracking). Both methods allow you to detect a spike in a hormone (LH) that occurs 24-36 hours prior to ovulation. Timing intercourse the day of the positive result and again the next day will help the sperm be in the right place at the optimal time.   

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6. How will I know if I am pregnant, and how can I test?

Home urine pregnancy tests are widely available and quite accurate at detecting an early pregnancy. Ideally, wait to see if you miss your period, then do a test. This can help ensure the level of pregnancy hormone (hCG) is in the detectable range. For some, these tests could detect a pregnancy sooner, even as early as a week after ovulation. If you choose to test early and it’s negative, be sure to test again if you end up with a late period.  

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7. How long should I try to get pregnant before getting help? 

For those under 35 years old, it is recommended to try for a year before getting help, as the average time to get pregnant ranges from 9-12 months. If you are 35-39 years old, you can get help after trying for 6 months. And, if you are 40 years or older, getting an immediate consultation is recommended as you may need to enact a plan quickly. For any age, if you are not getting a period every month or are having other abnormal bleeding, we recommend seeing your provider as soon as possible for further evaluation.

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8. Do I need any tests before trying to get pregnant?

Making sure you are up-to-date on your screening tests is recommended prior to pregnancy. This includes an HPV test to check for cervical cancer, tests for sexually transmitted infections, and a mammogram (as recommended based on your age and family medical history). If you have other health conditions, lab tests are helpful to see if they are well managed. For example, you should have good control of diabetes, thyroid disease, anemia, and high blood pressure before getting pregnant, as these conditions can increase health risks to both the pregnancy and the mother. 

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Everyone has the option for carrier screening before getting pregnant, which can help identify the likelihood that particular genetic conditions are inherited. Also, if you have a known family history of a certain genetic condition (i.e., Fragile X syndrome), you have the opportunity to test for this (and discuss possible pregnancy management approaches) prior to getting pregnant.  

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Carrier screening is done as a blood test ordered by your OBGYN or a genetic counselor that checks for a panel of genetic conditions, including cystic fibrosis and Fragile X syndrome. Usually, you are tested first and if you are found to be a carrier of any of the conditions, your partner is then tested. If both you and your partner carry the gene, or if a gene is dominant (meaning that one carrier is enough to pass it down), there is a significant chance of having an affected child. In these cases, couples have the option of doing in vitro fertilization (IVF) and testing embryos before use, or opting for other approaches to pregnancy (e.g., donor sperm, eggs, or embryos). 

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9. Are there testing options I can plan for during pregnancy?

Prenatal screening tests are available for everyone to check for abnormal chromosomes during the first and second trimesters of the pregnancy.

• Non invasive prenatal test (NIPT) evaluates fetal DNA circulating in the maternal blood (>10 weeks)
• First trimester combined test - involves a maternal blood test for specific markers and an ultrasound of the fetal neck thickness (NT) (11-14 weeks)
• Quad screen combines a maternal blood test for specific markers in the first and second trimesters 
• An anatomy ultrasound is done between 18-22 weeks to look for fetal size, placental location, anatomical abnormalities, and markers for genetic conditions.

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Diagnostic testing may also be recommended if you have a positive screening test, have other medical indications, or are considered higher risk for a chromosomal abnormality. They are invasive (done with a needle ) so carry a small risk for miscarriage. These diagnostic tests may also be an option if you are concerned about a specific genetic condition. 

• Chorionic villus sampling - tests cells from the placenta to grow the pregnancy chromosomes (10-13 weeks)
• Amniocentesis - tests cells from the amniotic fluid to grow the pregnancy chromosomes (15-20 weeks)

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10. What happens if I am over 35 years old during the pregnancy?

Similar to being pregnant before age 35, you will have the choice of prenatal screening tests for abnormal chromosomes during the first and second trimesters of the pregnancy. Those 35 and over also have the option to get a diagnostic test (like an amniocentesis) performed in addition to, or instead of, a screening test as the overall risk of a chromosome abnormality affecting the pregnancy is increased. You also may be more likely to need low-dose aspirin to prevent complications during the pregnancy. In some situations, you may need additional ultrasounds or monitoring to check the growth and well-being of your pregnancy. Your obstetric provider will guide you through this.

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