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Pre-pregnancy advice There are several general
health factors that can reduce the chance of conceiving and/or increase the
risk of miscarriage or damage to the fetus, but which can be avoided or
minimised by simple precautions beforehand. These should be considered by
all couples trying to conceive but equally by couples experiencing
difficulty in conceiving and requiring fertility treatment. We offer the
following information and advice, and there are booklets available giving
more detailed information, listed at the end.
Rubella (German measles) immunity check and
immunisation.
Rubella infection in the first few weeks of
pregnancy can cause abnormalities in the baby. Most women will have been
vaccinated against Rubella in their teens but this does not necessarily
give lifelong immunity. It is therefore important to check a woman's
immunity with a blood test before she tries to conceive. If you are not
immune, vaccination is advisable. The vaccination itself can theoretically
cause damage to an early fetus (though not yet demonstrated). Therefore
you should have it done early in your menstrual cycle (before you could
have conceived) and take contraceptive precautions until a repeat blood
test 8 weeks later to check that vaccination has been effective.
Hepatitis B and C tests.
These virus infections can be passed on to the fetus
by either parent and can occasionally cause serious liver disease. The
viruses can be carried in the secretions of men and women who may be
completely free of symptoms themselves. We advise both partners to have a
blood test to check for hepatitis B and C before commencing infertility
treatment.
Toxoplasmosis.
This is one of a number of uncommon infections which
can be passed from a mother to her unborn baby and can cause severe damage
to the brain, eyes and other organs. It is sometimes carried by cats, dogs
and sheep who pass the parasites that cause the infection in their
motions. If you have a cat which uses a litter tray, it is sensible not to
handle or change soiled cat litter in pregnancy unless you use rubber
gloves and wash thoroughly afterwards. Pregnant women should avoid sheep
during lambing and not handle the new born lambs or afterbirth. No matter
how clean and healthy your pet is wash your hands after handling it and
before preparing food. Remember to use a separate knife and board for
preparing raw meat and poultry to other food. Make sure you cook meat and
poultry throughly and when reheating food ensure it is piping hot all the
way through. Store raw and cooked foods well away from each other, with
raw meat on the lower shelf to prevent juices driping on cooked food.
Please remember the risk of this condition is very low (1 in 50,000
pregnancies in 1989-90) but you can reduce the risk even further by
following this simple advice.
Diet.
It is important that a woman has a healthy
well-balanced diet whilst trying to conceive and during pregnancy.
However, some foods are best avoided in pregnancy and during infertility
treatment. These include soft cheeses, especially those made with
unpasteurised or raw milk, which may carry a small risk of causing
infection with listeria, which can lead to miscarriage; and liver or liver
products (such as patés) which contain too high a level of vitamin A,
which can induce developmental abnormalities in the fetus. It is thus
important to avoid vitamin supplements containing Vitamin A. A booklet
about diet in pregnancy and foods to be avoided is available in the
clinic.
Folic Acid Supplements.
Deficiency of folic acid in a woman's diet increases
her risk of conceiving a child with spina bifida and similar defects.
Women who have had a previous pregnancy affected in this way should take a
5 milligram tablet of folic acid every day during the first 12 weeks of
pregnancy. This minimises the risk but as the baby's spine forms at an
early stage of development it is best to start folic acid 3-4 weeks before
pregnancy, to be sure you have adequate body stores before conceiving.
The risk of this type of abnormality can also be
reduced in women who have not previously had an affected pregnancy.
The dose of folic acid advised under these circumstances is much lower,
only 0.4 milligrams a day, but should be taken over the same period of
time. You should be able to purchase this lower dose of folic acid at any
chemists but the higher dose is only available on prescription. We would
also encourage you to eat foods with a high folic acid content, especially
green leafy vegetables, particularly brussels sprouts and spinach, and
fortified breakfast cereals. An explanatory booklet is available (see
below) if you would like more information.
Diabetes screening.
Some types of diabetes may develop for the first
time during pregnancy and can cause complications for both the mother and
baby. If the potential mother has a family history of diabetes,
particularly the milder type of diabetes which can develop quite late in
life, it may be necessary to arrange a simple test (glucose tolerance
test) to check for this. If you have a parent, grandparent, aunt, uncle,
brother or sister with diabetes, you should discuss this with one of the
doctors in the clinic.
Smoking and alcohol.
Smoking is known to increase the risk of
complications in pregnancy, in particular, poor growth of the baby,
premature delivery and bleeding from the placenta. Alcohol in excessive
amounts can also increase the risks to the baby. In addition, we know from
our own research in Bristol that smoking by either the man or the woman
reduces a couple's chance of success significantly in each cycle of
treatment. We advise all couples to avoid smoking during infertility
treatments and for the woman to avoid smoking and take little alcohol
during pregnancy.
Drugs and medicines.
A number of drugs are known to reduce fertility and
there are others which are best avoided in pregnancy. You will have been
asked about any drug treatments at your initial consultation but it is
important to check with one of the doctors or nurses in the clinic if you
need to take any new drugs or medicines whilst having infertility
treatment. Standard doses of aspirin or paracetamol do not cause any
problems and can be taken if required. It is felt that recretional drugs
such as cocaine are harmful during pregnancy and should be avoided.
X-rays.
Any type of radiation including x-rays can cause
damage to an unborn child, especially in the early stages of pregnancy
whilst the baby is developing. X-rays are best avoided in pregnancy or in
the second half of your monthly cycle if you are trying to conceive. If
you need an x-ray examination you should let the doctor concerned know the
date of your last period, to take the necessary precautions.
Information Booklets Available
"Folic Acid and the Prevention of Neural Tube Defects"
Department of Health, Health Publications Unit, Heywood Stores,
No 2 Site Manchester Road, Heywood, Lancashire OL10 2PZ
"While you are pregnant - safe eating and how to avoid
infection from food and animals"
Department of Health and Central Office of Information. H.M.S.O.
Publications.
See also:
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