Guide 1: Pre-Pregnancy Preparations

By Dr TAN Shu Qi, Associate Consultant and Associate Professor Tan Thiam Chye, Visiting Consultant, Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital

Start your pregnancy journey on a healthy note with this comprehensive guide to pre-pregnancy preparations. Get handy tips and recommendations on important topics including proper nutrition, vaccinations, fertility and conception.

1. Nutritional Needs for Pre-Pregnancy

Start off with these positive steps for a healthy diet to make your pregnancy healthy, active and happy:

Stay Healthy

A healthy diet will nourish you and your baby. It should be balanced in calories, carbohydrates, protein and fibre, and provide appropriate and adequate nutrients.

Do: Eat these foods for these beneficial nutrients:

• Dark green vegetables like spinach and asparagus, citrus fruits and juices for folate (or folic acid) which helps in the prevention of neural tube defects.
• Red meat, chicken, fish, egg yolk and green leafy vegetables as sources of iron, which help to form red blood cells and therefore prevent anemia.
• Coldwater deep-sea fish like tuna, salmon and sardines for DHA, an omega-3 fatty acid for healthy development of your baby’s eyes and brain.
• Milk, hard cheese, yoghurt, sardines, beancurd and foods like tauhu or tau kwa for calcium and Vitamin D for strengthening of bones.

Take Folic Acid

Folic acid or folate is a type of vitamin B that reduces the risk of brain and spinal cord defects developing in your baby.

Do: Take a folic acid supplement of at least 400mcg at least three months before trying for pregnancy, and for the first 12 weeks of pregnancy. Some women might require up to 5mg of folic acid. Do speak to your doctor for more advice on the appropriate dosage.

Related: Nutrition During Pregnancy

2. Good Habits to Encourage Pregnancy

Keep in mind these tips when trying to conceive.

Start Young

Fertility declines sharply from 35 years of age. The chances of genetic abnormalities and pregnancy complications also increase.

Do: Start young when you're in your prime if you can!

Quit High-risk Activities

Babies born to smokers tend to have lower birth weight, slower growth, higher risk of asthma and breathing problems. The pregnancy can also be associated with an increased risk of complications. This applies for passive smoking too!

Do: Quit smoking. Encourage your partner and family members to stop smoking as well.

Go for a Pre-conception Check-up

It's important to keep prior medical conditions like diabetes, hypertension, epilepsy, anaemia and others under control to ensure a healthy pregnancy.

Do: Visit a gynaecologist early on to discuss your chance of conception and assess your pregnancy risks, if any. It would be helpful to bring you and your partner's medical and immunisation history during the consultation as well if available.

Related: Pregnancy Dos and Don'ts

3. Pre-Pregnancy Vaccinations

Getting the right vaccinations before you conceive is crucial to protecting you and your baby during pregnancy. Make sure you're protected against these three vaccine-preventable illnesses at least three months before you conceive:

Rubella (German measles)

This contagious virus can be passed on to your baby. Your baby may be at risk of heart damage and hearing loss. pregnancy. The pregnancy will also be a higher risk of miscarriage or stillbirth.

Chicken Pox

Although this extremely infectious disease is uncommon in pregnancy and does not cause serious harm to you, your baby may be affected by skin blisters, scarring and organ damage.

Hepatitis B

An infection can be acute or chronic. If you're a chronic carrier, you can pass hepatitis B to your baby, which puts them at risk of liver-related diseases like cirrhosis or liver cancer later in life. Tell your doctor about your medical history before conceiving.

Related: More About Pre-Pregnancy Vaccination

4. Am I Pregnant?

Use these pointers to find out if you're carrying a baby:

How do pregnancy test kits work?

If you're pregnant, your body will produce a hormone called human chorionic gonadotrophin (hCG). This hormone will be present in your blood and urine. The pregnancy test kit will detect the presence of hCG in your urine and be able to tell you if you're pregnant if you're between the fourth and fifth week of your pregnancy.

How accurate are pregnancy test kits?

Pregnancy tests are rarely wrong. In fact, they are more than 99 percent accurate. However, if you do the test too early, your body may not have enough hCG and your test will come back negative. Repeat the test again a few days later to be sure.

There are instances where the hCG levels are raised temporarily and drop to zero. Your test kit may give you a false positive at first. Ovarian tumours may also secrete hCG and create an inaccurate result. To be certain, check in with a gynaecologist after you perform a kit test.

When should I do the pregnancy test?

You can test any time of the day but your first morning urine will be the most concentrated with pregnancy hormones. Testing a few days after your missed period is recommended for the greatest accuracy, although you may test positive as early as six days after ovulation.

Related: More About Pregnancy Test Kits

5. Commonly Asked Questions About Pre-Pregnancy

The overload of information on how to conceive may confuse you! Here's a handy list of frequently asked questions and answers to help you conceive:

When should I seek medical attention if I'm unable to conceive?

80% of couples will conceive within 12 months of active trying. If you are not pregnant after one year of regular sexual intercourse (defined as two to three times a week), it would be a good time to seek medical attention. If you have certain risk factors for subfertility (e.g. older above the age of 35 years old, irregular periods, history of gynaecological problems such as pelvic inflammatory disease or endometriosis), it would be a good idea to seek a gynaecological opinion earlier after 6 months of active trying if you have not yet been successful with conception. 

Why can't I conceive?

Always remember that not being able to get pregnant is not the fault of your partner or you. There are many different reasons for not being able to conceive, such as male and female subfertility or sexual dysfunction.

Female subfertility happens when the sperm is unable to reach and fertilise the egg. It could be due to your ovaries not being able to produce an egg, Fallopian tube blockage or abnormalities in your womb. Male subfertility, on the other hand, includes low sperm count, abnormal sperm shape, problems in the testicles and testes ducts and others.

Don't forget that you and your partner are not alone. Twenty percent of subfertile couples will not be able to find the cause of their subfertility.

What can I do to get pregnant?

Various tests can be carried out to investigate underlying causes for subfertility. There are also treatments depending on the cause of subfertility, such as medications to induce ovulation and assisted reproductive techniques such as intrauterine insemination and in-vitro fertilisation. These treatments will only be suggested after counselling and investigations by your doctors.

How do I know if an obstetrician is right for me?

Word-of-mouth recommendations by friends or relatives may be useful but what works for one mum may not work for another! One good way to start thinking about this is if you prefer to be taken care of by an obstetrician in a restructured maternity hospital or in a private maternity hospital.

What foods should I avoid when trying to conceive?

Practicing healthy, pregnancy-safety eating habits when trying to conceive can help you have a healthy pregnancy once you conceive, too. Here's what to avoid:

• Raw sushi or sashimi and unprocessed dairy products: these may result in gastrointestinal infections or listeria infection, which can affect your pregnancy and baby
• Fattening and sugary foods: these may lead to excessive weight gain in pregnancy which are associated with a greater risk of pregnancy complications such as gestational diabetes or hypertension in pregnancy. Being overweight before conceiving may also increase the risk of these pregnancy complications
  
• Certain types of fish: shark, king mackerel and swordfish can contain high amounts of mercury, which can be dangerous in pregnancy when consumed in high doses
  

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Read these next:

• Pregnancy sexual positions
• Pregnancy and pre-pregnancy preparation
• Before the first antenatal visit​​

Sources:

The New Art and Science of Pregnancy and Childbirth 2008, World Scientific

Healthy Start for your Pregnancy 2012, Health Promotion Board Singapore