Planning for Pregnancy

Intro: We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): Well, hello and welcome to the show. You're listening to Weekly Dose of Wellness. It is brought to you by MemorialCare Health System. I'm Deborah Howell. Today's guest is Dr. Heidi Cough, a caring physician who is board-certified in obstetrics and gynecology and who is affiliated with Saddleback Memorial. Dr. Cough's interests include general obstetrics, minimally invasive gynecologic surgery, contraception, health maintenance, and adolescent medicine. Dr. Cough pursued obstetrics and gynecology so that she could establish relationships with her patients and continue to follow them through many, many life changes. Welcome to you, Dr. Cough.

Heidi Cough, MD: Thank you very much. Thanks for having me.

Deborah Howell (Host): Ladies, ladies, ladies, what you do before pregnancy is just as important as what you do during pregnancy. To prepare for the best pregnancy possible, preconception planning is essential. So, doctor, what is preconception planning?

Heidi Cough, MD: Well, preconception planning is where women prepare their body and their environment for the most important time of their life. What we're trying to do is optimize any health conditions that a woman may have, identify any hazards in her environment that could be detrimental to pregnancy, and then institute interventions before the pregnancy so as to avoid problems.

Deborah Howell (Host): What are some of the hazards you're talking about?

Heidi Cough, MD: Well, some potential hazards in the home environment could be things just as simple as what we use for cleaning on surfaces of the countertops or using Windex to spray on the windows. So it's important when women are cleaning the home to make sure that they're in a well ventilated area, have all the windows open. Additionally, there's, if women have any cats at home, they shouldn't be changing the cat litter boxes because there's a parasite called toxoplasmosis in the cat litter box that could potentially cause miscarriages. So there's some of these potential things that women need to be paying attention to so that they don't have problems during their pregnancy.

Deborah Howell (Host): Okay, well, yes, well warned is forearmed, right?

Heidi Cough, MD: That's correct.

Deborah Howell (Host): How far in advance should couples plan?

Heidi Cough, MD: I recommend that couples plan at least 30 days in advance because women should be taking a prenatal vitamin starting a month before they even stop their birth control to make sure that they're building up helpful vitamins and minerals in their body before they start trying to conceive. What women don't want to do is wait until they have their positive pregnancy test to start instituting these interventions, because once a pregnancy test is positive, a woman has already been pregnant and the baby's already been developing for two to three weeks. And so if they wait until that time to start making sure that their body and their environment is healthy, the baby's already been developing, so it might be too late to make some of these changes.

Deborah Howell (Host): Okay. So vitamins are one thing. What other health and diet considerations should moms-to-be take into account? What foods should she avoid, for example?

Heidi Cough, MD: Well, for example, on foods to avoid, most women know that they shouldn't be smoking or drinking alcohol. Other things to be paying attention to are limiting caffeine intake to less than 200 milligrams a day.

Deborah Howell (Host): What is 200 milligrams for the average person?

Heidi Cough, MD: So as an example, the average cup of home brewed cup of coffee has about 135 milligrams of caffeine in it, so it is safe to still if women need to have a cup of coffee. It's best to try to avoid it if possible, but some women just need their get-go in the morning, so that one cup is going to be okay.

Deborah Howell (Host): I was just thinking that's a cup and a third. But I drink green tea, so what would that be, how much green tea?

Heidi Cough, MD: Green tea has about 30 milligrams of caffeine in it. So that has very, very minimal tea and Coca-Cola have very little caffeine in them compared to what a cup of coffee has. So, although we don't want to push it to the limit, it is safe to have some of those beverages, so you don't have to deprive yourself during the months that you're trying to get pregnant.

Deborah Howell (Host): Excellent, okay.

Heidi Cough, MD: Other types of foods that we're talking about are making sure that any meats are cooked all the way through, nothing should be eaten that's raw or undercooked. So red meats as well as fish. Anything that's a dairy product has to be pasteurized so that all the bacteria is killed off. So that's milk and then soft cheeses. And then women want to avoid eating any fish that has high mercury in it. So it's like shark and swordfish and king mackerel, they're not commonly consumed fish.

Deborah Howell (Host): Tuna?

Heidi Cough, MD: Actually tuna is okay. Tuna isn't one of the fish that has a high level of mercury in it, so it is safe to eat and it's recommended that women have two servings of fish in a week because it has healthy DHA or omega-3 fatty acids in them, and those help with the brain and eye development of the baby. So if women want to consume tuna, white fish like halibut, salmon, shrimp, those are all safe to consume.

Deborah Howell (Host): But no sushi, ladies, for nine months, sorry. I know, that's, that for me would be like the hugest thing, you know, because everybody…

Heidi Cough, MD: I think there are a lot of women it's the, they ask about the caffeine for them. But so try to reassure them that the cup of coffee is okay, but a lot of women need more than one cup of coffee to get through the day, so we try to limit them.

Deborah Howell (Host): Understandable. Maybe coffee in the morning and then a little cup of tea later in the afternoon.

Heidi Cough, MD: Yes, exactly. Just something a little extra in the afternoon.

Deborah Howell (Host): Okay, so what exams and lab tests should moms-to-be complete before conception and immunizations as well?

Heidi Cough, MD: Sure. So a woman should have a complete physical examination that's been done within the year. And that would include doing a pap smear, if it's indicated for her. It's also really important that women are up to date with their dental care, interestingly, because oral caries and periodontal disease have been associated with a higher chance of having pre-term labor. And so if a woman can get her dental cleaning done and out of the way, and you know, they always want to do an X-ray, just get that stuff done before your pregnancy, so you make sure that that's all up to date. For vaccinations, if women have received their childhood vaccinations when they were younger, they should be up to date. A couple ones in particular that would have to be given at least 30 days before a pregnancy are the live vaccines and those are the ones for rubella or varicella, which is chickenpox. And some women aren't sure if they had chickenpox, but they might have been exposed to it as a child, never had any lesions but do have immunity to it. So we can do blood testing to check for immunity against varicella and rubella if a woman is not sure if she was vaccinated.

Deborah Howell (Host): So clearly you want to do all that beforehand.

Heidi Cough, MD: Yes, because those vaccines have to be given 30 days before a pregnancy. So you don't want to wait until you're pregnant to find out that you're not immune. These are things that you want to plan before the pregnancy.

Deborah Howell (Host): Good, good, good. Especially measles now, we've had a little outbreak of that and you know, so we got to take care of these things before.

Heidi Cough, MD: It is, yeah, yes, it's very important to make sure that those vaccinations are up to date. You don't want to risk anything during this important time in your life.

Deborah Howell (Host): All right, that's for moms-to-be. Now what tips and considerations can dad do to help give the baby the best start possible?

Heidi Cough, MD: Well, men want to make sure they're healthy just as the women do, to help improve mostly for their fertility. Men should also have a physical exam, they should have a normal body mass, like a normal weight, to make them a normal body mass index, so they should make sure that they're exercising and eating nutritiously. And also, as I told the women to avoid tobacco and alcohol, men should too during the months that they're trying to get pregnant because excess tobacco and alcohol has been linked with lower fertility rates. And also to help men's fertility, they should avoid hot environments like saunas, hot tubs, or laptops on the laps because all of that can lower their fertility rate.

Deborah Howell (Host): My brother-in-law was a pilot and he used to fly fighter jets and those cockpits got so warm and they couldn't figure out why they couldn't conceive. And as soon as he got out of the cockpit, of course boom the baby started to fly. So those warm environments are really important to avoid.

Heidi Cough, MD: It really makes a difference and men's fertility kind of renews itself about every month, so if something has happened to damage their fertility, if they wait a month a lot of those damages will reverse themselves and they'll go back to normal fertility. So it's fortunate for men in that regard.

Deborah Howell (Host): That is terrific news. I hadn't heard that. That's very fast.

Heidi Cough, MD: Yeah. Whereas women are born with all the eggs they'll ever have in their life, and they age with the women. We don't get them renewed. So.

Deborah Howell (Host): Well, that's a bad system. We need to change that.

Heidi Cough, MD: I wish we could, a lot of women wish that we could.

Deborah Howell (Host): Where can couples go to learn more?

Heidi Cough, MD: They can start by going to startingmyfamily.com or they can sign up to attend a free preconception planning event with their spouse. It's taught by an OBGYN and it includes a one-on-one question and answer session with a hospital tour. Or finally they can contact their OBGYN to schedule a preconception planning visit.

Deborah Howell (Host): Okay, all very good advice. It's such a good time to have a baby. I mean, when I look at the hospital facilities and how they've changed and how they now nurture both the husband and the wife, it's just, it's a lovely thing.

Heidi Cough, MD: It is always a wonderful thing.

Deborah Howell (Host): Well thank you so much Dr. Cough. It's been great to have you on the program today to talk to us about what we need to know about giving our families the best start possible. We really appreciate your time today.

Heidi Cough, MD: You're welcome. And thank you for having me.

Deborah Howell (Host): And everybody, if you'd like to listen to a podcast or for more information, what you can do is visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness, brought to you by MemorialCare Health System. Have a fantastic and healthy day.