Until recently, that part of the baby-making equation had been largely absent from the discussion. Increasingly, though, maternal health and prenatal-care experts are urging women to improve their health before conceiving.
The hope is that measures taken to bolster a woman's health prior to conception -- whether it's reaching an optimal weight, controlling a chronic disease or boosting overall nutritional health -- will improve the odds of having an uncomplicated pregnancy and a healthy baby.
Dr. Lorey H. Pollack, director of obstetrics and gynecology at
Pollack blames the medical profession and the media for failing to get the word out.
But recommendations compiled by experts at the U.S. Centers for Disease Control and Prevention as well as more than 35 government, public and private partners may help to draw attention to the importance of preconception care.
Dr. Hani K. Atrash, associate director for program development at the CDC's National Center on Birth Defects and Developmental Disabilities and co-author of the government report, said, "If a woman or couple has decided to conceive, then at least one pre-pregnancy visit is recommended, and the five most important things to do are":
· Take 400 micrograms of folic acid a day for at least three months before pregnancy to reduce the risk of birth defects.
· Stop smoking and drinking alcohol.
· Consult with a health-care provider to manage any and all medical conditions, including, but not limited to, asthma, diabetes, oral health, obesity, or epilepsy, and maintain up-to-date vaccinations.
· Talk to your doctor and pharmacist about any over-the-counter and prescription medicines you are taking, including vitamins and dietary or herbal supplements.
· Avoid exposure to toxic substances or potentially infectious materials at work or at home, such as chemicals, or cat and rodent feces.
Atrash was also co-editor of a special supplement of the Maternal and Child Health Journal, published last September, devoted entirely to the topic of preconception care.
The movement to intervene prior to conception is based on evidence linking certain factors, such as lack of folic acid, smoking, alcohol misuse and obesity, to unwanted pregnancy outcomes.
"Some of these risk factors have stronger associations with particular adverse outcomes than others," Atrash explained. "For instance, daily consumption of 400 micrograms of folic acid before or early in pregnancy can reduce the occurrence of neural tube defects," such as spina bifida.
And while single interventions, such as taking folic acid or quitting smoking, are effective in modifying behaviors in pregnancy, "we do not yet know the effectiveness of multiple interventions packaged together in the form of a preconception care model," Atrash said, "mostly because this is a new approach that has not been widely practiced, and we have very little or no data to analyze."
"It's a hard thing to measure," Pollack agreed. Still, he always tells patients contemplating pregnancy to make an appointment to talk about some of these issues and begin taking steps to address health issues.
"It's always easier to try to prevent a problem than to catch up with it later on," he reasoned.
For more on preconception health, visit the American Pregnancy Association.