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Pregnancy Checklist

Pregnancy is a wonderful journey, it is important to be prepared for it by being physically and mentally sound. Well-informed decisions and planning before conception significantly reduce the health risks for the mother as well as baby. Pre-pregnancy planning can be an exciting experience.

However, it can also be stressful especially if it is your first pregnancy. It is important to learn the basics and for that, the following is a checklist that should be followed to ensure a safe pregnancy.

Take folic acid daily to prevent neural tube defects in your baby.

According to the American College of Obstetrics and Gynaecology (ACOG), it is recommended for all women of childbearing age whether they are actively trying for a baby or not [1]. Standard OTC prenatal vitamins can do the deed.

Make an appointment with your doctor for a thorough evaluation of the state of your health.

It is important to be aware of any pre-existing medical conditions so that precautions can be taken accordingly. Though you are going to have plenty of appointments during your pregnancy do not underestimate the importance of a pre-pregnancy visit. There can be issues that may possibly make conception hard or cause a risky pregnancy. Getting them treated is crucial. Genetic diseases like sickle cell anaemia, thalassemia etc. run in families and getting screened for them should be prioritised [2]. Also, a number of usually existing chronic disorders can be deteriorating for the health of unborn baby including: hypertension, diabetes, depression, seizure disorders etc. If you are using any medications, talk to your doctor about their safety and continuation during pregnancy.

Watch your diet, stick to a nutritious and balanced one.

Eating a variety of healthy food items, rich in all essential nutrients is very important, even more so during pregnancy. Add all sorts of healthy options to your diet including fruits, vegetables and whole grains. Avoid unhealthy options such as fatty, fried and junk food. To provide for your protein needs, add lean meat, chicken and turkey to your diet. Avoid having large sea fish such as swordfish, shark, king mackerel etc. as they have been known to contain high levels of mercury which may make conception hard. Even occupational exposure to mercury can adversely affect fertility [3]. In between meals, stick to healthy snacks such as yoghurt, fresh fruit, raw vegetables, corn etc. Drink plenty of water and limit the use caffeinated drinks including tea, coffee and soda. Maintaining a healthy diet even before you conceive lowers the chances of getting gestational diabetes.

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Stick to a consistent and easily manageable exercise plan.
Some women may think resting and a lot of it is the right thing to do as soon as you they pregnant which is utterly incorrect. Right type of activity and moderate exercise regimen can ensure a healthy pregnancy as well as a healthy baby. It is important to devise a rational exercise plan which you can easily stick to and continue throughout the pregnancy. It is recommended to devote at least 30 minutes of your day to moderate exercise [4]. However, it is best to consult your doctor to find out what works best for you. Avoid hot showers, hot sauna or any other activity that exposes you to extreme heat as that may cause birth defects [5].

Devise a plan to maintain a healthy weight during pregnancy.
Maintaining a healthy weight before and after conception is crucial for mother and baby’s health. If you are underweight or overweight, try to achieve your healthy weight before you conceive. Your weight should fall within normal BMI range. There are plenty of online calculators available that can help you calculate your BMI. The normal range for Body Mass Index (BMI) is between 20-24 kg/m2. There can be certain complications for both underweight and overweight women, for example, it may be harder for underweight women to conceive. They are also more likely to have babies with low birth weight. On the other hand, overweight women are at a great risk to experience hypertension and diabetes during
pregnancy. [6]

Consult your doctor regarding pre-pregnancy immunization.
A number of infections that can threaten the pregnancy can be prevented by pre-pregnancy immunization. Do not forget to ask your doctor whether you need to be vaccinated against certain conditions such as Chickenpox and Rubella. If you are not immunized against these diseases already, you may be given vaccination for these conditions. You should at least wait for one month before trying to conceive after you get vaccinated. Getting a flu vaccine during pregnancy is also very important since pregnant women are at a greater risk to experience respiratory complications caused by influenza. [7]

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Avoid exposure to hazardous substances.
Exposure to a number of substances found at home and workplace can harm the developing baby. These substances include everyday chemicals such as pesticides, paint thinners, floor cleaners etc. as well as radiation and heavy metals. Try to avoid these chemicals by taking precautionary measures. Wear a mask and gloves where these chemicals are being used and try to work in a well ventilated area. Avoid any unnecessary exposure to any sort of chemicals. Avoid getting your hair dyed and nails done during pregnancy. [8]

● Quit smoking, it is very important for your baby!
Smoking can reduce fertility which can make it harder for you to conceive. Not just that, it can also negatively affect the health of you and your baby. Stop smoking even if you are not pregnant yet and have only started trying. Smoking adversely affects the quality of eggs that ultimately causes fetal abnormalities. Women who smoke are also more likely to experience complications during pregnancy and childbirth, go into premature labor and have babies that may end up having health issues throughout their lives. If you are having a hard time quitting smoking, your physician can help you by suggesting a tobacco cessation program. [9]

Seek treatment for substance abuse, if applicable.
If you are an alcoholic, you should enrol yourself in a rehabilitation program before you even think of getting pregnant. Alcohol consumption during pregnancy can cause Fetal Alcohol Syndrome [10] which is a collection of severely debilitating conditions in the baby including cognitive problems. Likewise, if your partner is a regular smoker of marijuana, it may decrease the chance for you to get pregnant. Use of any other drug such as cocaine, meth, or crack can cause irreversible harm to the health of your baby.

Be aware of any history of birth defects in your family.
If there are certain birth defects that run in your family, including you and your husband as well as close relatives, there is a greater risk for your baby to experience the same problems. There are advanced genetic screening tests available that can predict the risk of you having a baby with birth defects.

Signs of Ovulation:

To successfully conceive soon after you start trying, it is very important to know your most fertile days and have as much sex as possible during those days. Your most fertile days are when you are about to ovulate and 24 hours after ovulation. It is important to stay vigilant and closely monitor signs of ovulation. A number of signs and symptoms can help you determine your ovulation day.

Primary or common signs of ovulation:

● Changes in vaginal discharge: During ovulation, cervical fluid alters in consistency and color and resembles egg white i-e it appears clear and sticky in contrast to white and starch like.

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● Changes in cervical position and firmness: The cervix undergoes a number of changes during pregnancy. During ovulation, the cervix appears soft, elevated, open and moist to facilitate migration of sperms.

● Change in Basal Body temperature: Although not very effective to help you conceive, basal body temperature can be an aid in determining your day of ovulation. There is a decline in body temperature just before ovulation, followed by a sharp increase right after it.

Secondary symptoms of ovulation:

Other than the major signs stated above, these secondary or minor symptoms can help you pinpoint the day of ovulation as well.
● Abdominal bloating
● Abdominal discomfort
● Rarely, light spotting
● Higher sex drive
● Heightened sensations i-e smell, taste, vision, touch
● Breast tenderness

Initially, it can be harder to notice these signs but with experience, it becomes much easier to spot them. Additionally, aids are available that can help you determine your day of ovulation such as:
● Ovulation kits and fertility monitors
● Handy mobile phone apps such as Flo
● Home urine tests for ovulation
● Online ovulation calculators such as sahl calculator

References:

[1] https://www.acog.org/
[2] https://www.bmj.com/content/320/7231/337.full
[3] https://oem.bmj.com/content/51/1/28.short
[4] https://bjsm.bmj.com/content/37/1/6.short
[5] https://jamanetwork.com/journals/jamapsychiatry/fullarticle/399269
[6] https://link.springer.com/article/10.1007/s10654-009-9375-2
[7] https://www.sciencedirect.com/science/article/pii/S0264410X03003505
[8] https://www.jstage.jst.go.jp/article/indhealth/47/5/47_5_459/_article/-char/ja/
[9] https://academic.oup.com/ntr/article/6/Suppl_2/S125/1013941
[10] https://www.nejm.org/doi/pdf/10.1056/NEJM197805112981906

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