I met Sumera after 10 years when she came back to India. She is married now for 2 years. She is the daughter of my bosom friend. My friend confided in me - Sumera does not want to have a baby, you talk to her. Sumera told me that she does not want a baby for the next 3 years and that she was using some contraceptive methods. She was obese and suffering from hypothyroidism.
Wow, this is the time when she is not planning pregnancy, but she can prepare herself for a better pregnancy outcome and use this interval time for many other necessary preparations.
Yes, in today's world, many young couples do not want to become pregnant immediately after marriage, and they plan for pregnancy. They should visit an OBGYN specialist and use this time for preparation. The foremost thing is to use contraception to avoid unwanted pregnancy. Nothing is more painful to me than when a young girl comes to me with a ruptured ectopic, especially when she is only in a relationship. However, I am not going to discuss contraception, as Sumera is aware of this fact to use contraception.
I have taken this window of opportunity to talk to her and share my thoughts. I told her, "Ok Sumera if you do not want to have a baby and are using contraception, it's good. You only go for pregnancy when you are mentally ready. It is your decision when to plan for pregnancy. But I want to share some important facts about pre-preconception care with you.
When did you have your body checkup? Sumera starts laughing saying “Aunty I am a commerce student, working for a finance company and I do not know anything about health and pregnancy, please enlighten me.”
She made my day by being an eager person to know about motherhood’s journey.
Why it is so important to understand this journey toward motherhood because it can shape the whole future of this child and can affect the future generation. The sub-optimal atmosphere of the womb can affect the developing baby physically and mentally and can carry that genetic defects in future also.
Despite all efforts, 5 per cent of embryos may develop defects and problems, many are spared. A mother who has better health will have fewer complications during pregnancy and delivery and better neonatal outcomes. In recent years, babies with neural defects have decreased to a minimum due to the pre-conceptional use of folic acid. So, every woman in her reproductive years when she can become pregnant should continue with the folic acid supplement.
Let’s start to discuss one by one what you can do in this window of time when you are not planning a pregnancy.
1. Complete your vaccination
a. HPV
b. Rubella
c. Hepatitis A & B
d. Typhoid
e. Chickenpox
f. Flu
2. Optimal Weight - Obesity affects at the cellular level. It is a condition of chronic inflammation. It can lead to subfertility and diabetes. During pregnancy, many complications like GDM, high blood pressure, increased chances of DVT and operative deliveries can occur. A balanced diet and exercise are essential for better health. You should have lifestyle modifications towards better health, so eggs are healthy.
3. Stress reduction is a must. One has to understand that non-consequential stress like “my baby will be ok” and work stress all affect a baby’s mental health. If the work environment is too stressful and demanding, plan for a job change also.
4. Correction of Hb, Vitamin D and B12 is necessary.
5. Strengthen your core muscles so pregnancy will be smooth and post-delivery recovery is early.
6. Interpersonal relationship matters a lot. Pregnancy preparation is needed for the husband too. Baby is formed from both gametes.
7. Smoking and alcohol and recreational drugs affect gametes. It has to be stopped or minimized even by the husband. It is better if women stopped it completely as during pregnancy you cannot continue with it.
8. Other health parameters like vaginal health and breast awareness are a must for all women. It is better if you are not planning for pregnancy to use condoms.
9. Correction of any pre-existing disease and modification in medicines which are compatible with pregnancy is necessary. Subclinical hypothyroidism and increase HbA1C can lead to subfertility and defects in the baby. There are certain medications like tretinoin (acne medicine) one has to stop at least 3 months before planning.
10. Certain tests like Hb electrophoresis are done to know your thalassemia status. Treatment of UTI should be done.
When you are ready for pregnancy one visit to the gynecologist for a detailed preconception evaluation is a must. Do remember to start counting your ovulation days, when to have sex or not to become depressed if unable to conceive in a month or two.
When you plan, give yourself time. It can take 1 year also. By definition, if after one year of regular unprotected sex, the woman is unable to conceive, only then she should start an infertility evaluation (if more than 35 years of age, then 6 months).
So enjoy your life, de-stress yourself and take care of your health because your health matters.
