How to Prepare for Pregnancy

My biological clock went off in September 2017. My husband and I had been married for almost two years, and though we knew we wanted to have kids, I wasn’t in a hurry. That feeling changed overnight.

Within a few weeks, I went from starting a home bartending hobby to nixing alcohol, tracking my ovulation schedule, and scheduling a pre-pregnancy appointment with my OB-GYN.

I furiously Googled what I should be doing and how to prepare for pregnancy — and I was quickly disappointed. Most guides, like from the CDC, offer vague and obvious recommendations like seeing your doctor, avoiding toxic substances, taking a prenatal vitamin, and generally living a healthy lifestyle. Most of what I read didn’t specify the reason for the recommended dose of folic acid and worse, it didn’t even look like there was a consensus on whether you should see your dentist prior to pregnancy and those who did mention it didn’t detail why that would be important.

So I started my own research, sticking with trusted and well-known sources, and being careful to look at peer-reviewed studies using a statistically significant sample and/or a randomized trial. I started collecting my findings in a Google Doc, which I’ve shared with friends and friends-of-friends over the years. Here, I edited and updated those findings with links and sources.

I also have a TL;DR at the bottom if you want to skip ahead to that.

What This Guide Is Not

These findings are not my theories on pre-pregnancy. Any health advice I offer is backed by research and supplemented by my personal experiences when relevant. 

This guide is also not about how to mentally or financially prepare for a pregnancy. Because mental and financial stability are vastly different for each person, I don’t believe there’s a universal piece of advice to offer besides, sure, yes, being secure in those areas is a great idea. I doubt anyone would disagree with that or find that interesting.

The Guide: A Checklist of Things to Do Before Getting Pregnant

This guide is essentially meant to be a checklist for how to prepare for pregnancy. I tried to steer clear of habit recommendations, but where I felt it necessary to discuss that, I did so. I also indicated whether I would have done something differently in hindsight.

See Your OB-GYN

This is definitely on the CDC’s list. When I scheduled a doctor’s appointment with my primary care physician who is also an OB-GYN, I did so because it seemed like the rational thing to do. I reasoned, “If I were taking a cross-country road trip, I’d at least want to check my tire treads and possibly do an oil change. Why would this be any different?”

But more than that, I’m the kind of person who rarely sees her OB, and admittedly, I was overdue. So I especially felt the need for this appointment.

When you see your doctor, consider coming up with your baby and lady-part-related questions in advance so that you don’t forget. You might want to discuss your health history, vaccination record, and if you’re currently taking medication, you’ll probably want to ask about how that may affect your pregnancy.

And speaking of medication, you should definitely ask your doctor’s opinion about any over-the-counter medication that you’re taking. For instance, I was taking Prilosec, a delayed-release tablet that needs to be taken for 14 days. The warning label advises pregnant women to not take Prilosec, especially during the first trimester.

My opinion: If your OB-GYN is not the same as your primary care physician and you want to choose one doctor to see, you should probably see your OB. They can check on your reproductive health, will be best equipped to answer questions about pregnancy, and would still be knowledgeable enough about OTC medication to offer guidance on what to avoid.

See Your Dentist

This was a recommendation that I was surprised not to see on most pre-pregnancy checklists, though at least WebMD suggested it. Even though routine dental work can be done during pregnancy, your dentist won’t do elective procedures. There’s a good chance your dentist will want to do as little as possible. 

Routine dental work might include getting a new cavity filling or a root canal, so fortunately, local anesthetics, like lidocaine shots, are considered safe. But if you need more intense dental work, your dentist might want you to wait until your second trimester, when potential risk of miscarriage or birth defects is lessened.

I didn’t know any of this when I had my biannual dental exam in 2017. When I mentioned to the dental assistant that I was two months pregnant, she immediately put away the lead apron and noted on my chart that they would skip the X-ray just to be on the safe side. That being said, X-rays are generally considered safe during pregnancy, especially dental ones because it’s just your mouth that’s exposed. But given that I stay up-to-date on my dental appointments, I knew the X-ray they had on file wasn’t that old, so I was happy to skip it.

My dentist would have wanted to change my filling, but since I was in early pregnancy, he made a note on my chart to do that procedure after I gave birth. His reasoning was that since it wasn’t absolutely necessary, we may as well punt on it just to be safe.

What I would have done differently: I would have simply gone to the dentist prior to getting pregnant. Pregnancy or no pregnancy, visiting the dentist makes me anxious. I’m worried I’ll need a filling, a root canal, or they’ll say I need gum grafting. And I’ll be frank: if I need a root canal, I’d much rather be put to sleep for that procedure. Although research about the effects of general anesthesia on pregnant women is fairly limited, some studies have found an increased risk of miscarriage in patients who have been exposed to anesthesia.

But hey, talk to your dentist. See what’s right for you.

Start Taking Prenatal Vitamins

Even before you try to conceive, take a prenatal vitamin with at least 600 mcg of folic acid. You need folic acid in your body at least one month prior to pregnancy to best prevent major birth defects of the baby’s brain and spine.

If you Google this, you’ll see that the recommended daily intake of folic acid for non-pregnant women is 400 mcg, and a couple sources like March of Dimes and Healthline recommend 600 mcg. The American Pregnancy Association recommends 400-800 mcg, cautioning not to exceed 1,000 mcg daily. That excess of folic acid has been linked with slow brain development in children.

At my pre-conception doctor’s appointment, my then-pregnant OB-GYN advised me to get a prenatal vitamin with 800 mcg folic acid. Although they’re expensive, I ended up taking MegaFood Baby & Me 2 Prenatal and Postnatal Vitamins. At the time (2017-2018), their formula included 800 mcg folic acid though it’s now made with 600 mcg, still within the recommended range.

Another reason this vitamin worked well for me is that at 18 mg, it offered a relatively low amount of iron. I actually started out with a mostly-full bottle of Rainbow Light Prenatal One Multivitamins (given by a newly postpartum friend who didn’t need it anymore), which, at the recommended dose of 27 mg iron, made me constipated. Turns out iron in prenatal vitamins can do that. But once you’re pregnant, you need double the amount of iron (compared to non-pregnant women) to make more blood to supply oxygen to your baby. What ended up working best for me was sticking with the vitamin with 18 mg iron while also eating iron-rich foods like eggs, sardines, lentils, tofu, and spinach.

Get a Flu Shot and Other Needed Vaccines

The need for vaccines pre-pregnancy is arguable — because you absolutely can get vaccines while pregnant. (In fact, you will get offered a Tdap vaccine in your third trimester, which in addition to protecting you, will also protect your newborn from whooping cough until they’re old enough to get their Tdap shot.)

It may depend on the season in which you try to conceive, but if you try to conceive during the fall like I did, you may as well get your flu shot first and cross it off your list prior to pregnancy.

As for other vaccines, there are several you cannot get while pregnant, including chickenpox, measles mumps and rubella (MMR), and shingles because they contain live viruses and so, theoretically pose a risk to your baby.

My opinion: Check your vaccine record. It’s not a bad idea to get your shots and get them out of the way.

Prepare for the Possibility that Getting Pregnant May Take Awhile

I have sometimes held off on this advice for fear of seeming negative. After all, about 84% of couples will get pregnant within a year of trying. 

But when one yearns for a baby, that feeling only becomes more intense — and can even become isolating — if one ends up having a hard time conceiving or even suffering a miscarriage.

And since all people and pregnancies are different, it’s worth keeping in mind several statistics and potential outcomes:

• Consider that there are only three days in a given month that you have the highest chance of getting pregnant — and that chance is about 30%.
• In a 1980s study, researchers found that as many as 50% or more of fertilized eggs do not result in pregnancy. (I’m referencing that study via economist, professor and author Emily Oster, of the book, Expecting Better.)
• That same study also found that 22% of pregnancies ended in miscarriage. At the time, they used advanced pregnancy tests which are similar tests to what you could buy at the pharmacy today. As I type this, Mayo Clinic currently says 10-20% of known pregnancies end in miscarriage, which they caveat with the admission that that rate is likely much higher since many miscarriages occur before a woman even knows she’s pregnant.
• Up to 13% of couples in the U.S. have trouble becoming pregnant.
• About 10% of women in the U.S. have difficulty becoming or staying pregnant.
• Birth control has an effect on how long it takes for a woman to become pregnant. After an IUD, a woman can get pregnant as early as her next cycle. If coming off the pill, getting pregnant can take three months. And Depo-Provera shots have the longest-lasting effects of all — it can take a woman up to 10 months from her last shot to return to fertility. 

All this is to say that having trouble getting pregnant and staying pregnant, devastating as it may be, is common.

I’m not suggesting you should expect the worst outcome, but I do think it’s a good idea to be aware of these unfortunate possibilities because if you have trouble getting pregnant, it’s better to realize sooner rather than later that you’re not alone. 

You likely have a handful of loved ones who had trouble getting pregnant. If you need the support, you could reach out to them, or even ask them for specialist recommendations if you need to go down that path.

Consider Improving Your Diet and Exercise

I know. I said I would try to steer clear of habit recommendations. But exercise and a nutritious diet are good for you. There’s no denying that. And if you establish these healthy habits prior to pregnancy, you’ll probably be more likely to maintain it. 

As far as healthy eating goes, consider that during pregnancy, your body will produce almost 50% more blood, and that if you don’t get enough calcium in your diet, your baby will take that calcium from your bones. Suffice it to say, you will need to make changes to your diet while pregnant, so it may be a good idea to prepare for that.

As for exercise, I will say this: It actually seems like certain exercise is only marginally beneficial to pregnancy. Some trustworthy sources, including Mayo Clinic and Medical News Today, say that pregnant women who exercise regularly can lower their risk of developing gestational diabetes. But other randomized studies, including this 2012 study of 1,115 women and this 2013 study of 510 women, found no significant difference in those who exercised and those who developed gestational diabetes. And you can be a healthy, fit person and still develop gestational diabetes.

I’ll also point out that Emily Oster has said (in Expecting Better and on Slate) that when looking at studies of exercise that are randomized, the findings suggest there is little impact of exercise on pregnancy, labor, delivery, and the baby. 

“…No change in preterm birth rates, gestational age, frequency of cesarean sections, or fetal growth. There is no evidence of a difference in baby Apgar scores or in the length of labor. The studies also don’t find any negative impacts on the mom.”

Excerpt from Slate.com

And arguably, the biggest benefit to exercising during pregnancy, is that it can help relieve constipation. Constipation affects almost half of all women at some point during their pregnancy, and exercise can ease constipation by decreasing the time it takes for food to move through the large intestine.

But there is at least one specific exercise that is good during pregnancy: Kegels.

Kegel exercises, which strengthen the pelvic floor muscles, can prevent urinary incontinence during late pregnancy or after delivery. And in one study, women in the Kegels group spent a slightly shorter time pushing, and only 22% of the Kegels group pushed for more than an hour, versus 37% of the no-Kegels group.

(I’ll admit I did Kegels every day during my pregnancy, and during labor I pushed for 4.5 hours before getting a c-section. But I digress.)

So why am I saying all this stuff about exercising while pregnant in a guide for what to do before pregnancy?

Because ultimately, everyone wants a healthy pregnancy. As far as what’s in your control, your best chance of having a healthy pregnancy is by establishing healthy habits prior to pregnancy so that your body is already in good condition, and so that you have a greater chance of sticking to these habits for the subsequent nine months.

TL; DR: Summary

So you can save this for later:

As you start to prepare for pregnancy, I wish you a healthy and easy journey. May your joints and pelvis not ache, may your maternity clothes be gorgeous, and may your bowels be smooth. That wasn’t a joke. I really do wish that for you. 

If you have found this guide helpful, I would love it if you shared it. If you have feedback or suggestions on how I can make it better, please reach out to me.