Getting a Health MOT

Health advice for those wanting to get pregnant is one of the most written about topics on the web. To make things easier for you, we have put all the best advice in one place. We've also outlined below some of the risks and problems that can arise when trying for a healthy pregnancy and a healthy baby. Remember, getting advice from a website will never replace the benefits of talking to your GP if you have a particular concern around your health and pregnancy.

Your age

It is an unavoidable and uncomfortable truth that as women get older the likelihood of conception decreases and the possibility of infertility increases. In blunt terms, you are much more likely to conceive and not experience problems with your pregnancy before you are 35 than after this age. By 40, only 2 women in every 5 who wish to have a baby will succeed in doing so. Women over 35 should also be aware that their chances of conceiving twins or children with certain genetic conditions increases from this point on. You are at your most fertile between 20 and 24, and even at 35, 94% of women who have been trying to conceive for 3 years will have succeeded. But by 38 years of age this figure drops to 77%. If you have been trying to conceive for more than six months and you are over 35, seek advice from your GP.

Your weight

Being either overweight or underweight can limit your chances of getting pregnant. The ideal body mass index, or BMI, score for those trying to conceive is between 18.5 and 25. There are plenty of online BMI calculators if you are unsure of your score. If you find that you need to lose weight, try to do it in a sustainable fashion, as crash dieting is not a healthy strategy, and can deprive you of important nutrients that are necessary for conception. If you need advice about losing weight sensibly, your GP may be able to refer you to a dietician.

Your gynaecological conditions

A number of gynaecological conditions can have an impact on your chances of conceiving, including irregular periods, polycystic ovaries, endometriosis, fibroids, or an STI (For more information about the impact of STIs on your fertility see Sexually Transmitted Infections and pregnancy.) Let's look at each of them in turn to assess their impact on fertility.

• Irregular periods can be caused by a large range of factors, from anything from stress, extreme weight loss or excessive exercise to hormonal imbalances, thyroid problems or one of the conditions described below. Without regular periods it is hard to predict ovulation, so it is important to assess the causes with a medical professional if you are trying to conceive.
• Polycystic ovaries (or PCOS) contain a large number of harmless cysts that are no bigger than 8mm each. Normal ovaries have only about half this number of cysts. The cysts are under-developed follicles which contain eggs that haven't developed properly. Women who suffer from this condition also suffer from a higher level of male hormones than normal, or male hormones that are more active than normal. Often in PCOS, these follicles are unable to release an egg, meaning ovulation doesn't take place (anovulation).
• Endometriosis is the name given to the condition where cells like the ones in the lining of the womb (uterus) are found elsewhere in the body. During your monthly cycle your hormones stimulate the endometriosis, causing it to grow, then break down and bleed. This internal bleeding, unlike a period, has no way of leaving the body. This leads to inflammation, pain, and the formation of scar tissue. Endometrial tissue can often be found in the ovaries and fallopian tubes, where it can form cysts, called 'chocolate cysts' because of their appearance. These cysts can block the passage of your eggs and prevent them from being fertilised.
• Fibroids are firm, round swellings that develop in the muscular wall of the womb. They may be as small as a grape or as large as a melon. They are extremely common - between 50% and 80% of women can be found to have them if you look hard enough. Typically, a woman will have several fibroids in her womb, all of different sizes. Fibroids are thought to account for about 2-3% of all infertility. If fibroids develop just under the surface lining of the womb this can interfere with the way in which a fertilised egg implants or attaches to the womb. This may lead to recurrent early miscarriage. More rarely, a fibroid may block the cervix or the opening of the fallopian tubes into the womb.

If you suspect that you are suffering from one of these conditions, but have never had it diagnosed, it is important that you seek medical advice before proceeding any further with your plans to get pregnant. Happily, there are medical ways to help you overcome these problems, so it is important not to assume that a positive diagnosis marks the end of your hopes of having children.

Medication

A few long-term drugs, including warfarin and some statins, and some short-term drugs (including some antibiotics) are contraindicated in pregnancy. If you use any prescription medication routinely or daily, you should check with your GP whether their use is advised during conception or pregnancy.

Previous pregnancy and labour complications

Unfortunately, for many women the joy of falling pregnant can be overshadowed by the fear of things going wrong - or going wrong again. While anyone who has a difficult labour, a sick baby, or worse the first time round, will have been given tremendous support by their medical team, here's a brief overview of the statistics in relation to the worst case scenarios.

• Miscarriage: One in five pregnancies ends in miscarriage before 24 weeks, and the risk increases with age. However, recent research shows that women who conceive again within six months of a miscarriage have the best chance of enjoying a full term pregnancy.
• Stillbirth: Sadly, around 4,000 babies a year are stillborn. While it is still the case that 30% of these devastating losses cannot be explained, medical research can establish a cause in the majority of instances. Issues with the placenta, a number of different infections, problems with the mother's liver, and haemorrhaging in labour can all be a factor. Stillbirth is also more likely with multiple births, when the mother is over 35, is obese or has diabetes. Some of these conditions can be addressed in order to ensure that they do not cause issues in a second pregnancy, and others can be managed to reduce the risks. Take your time in bringing yourself back to full health, and when you are ready, talk to your GP or consultant before becoming pregnant again.
• Premature birth: Around one baby in every 13 will be born prematurely, which is defined as being born before the 37th week of pregnancy. Rather like stillbirths, the causes are complex; some can be addressed, some, managed. It is important to allow yourself time to recover, to keep yourself healthy and well, and to seek medical advice before looking to get pregnant again.
• Pre-eclampsia: The term pre-eclampsia describes a set of symptoms that cause hypertension in the mother. The causes are complex, may be hereditary, and are yet to be fully understood. It is among the most dangerous of the common problems associated with later pregnancy and labour. Caesarean section and early induction of labour are the best options for the medical team taking care of mother and baby. If you suffered from this condition in your first pregnancy or labour, your consultant will be able to answer your questions in relation to future pregnancies, so be sure to seek advice before falling pregnant again.
• Rhesus incompatibility: The Rhesus disease arises in some second or subsequent pregnancies of Rh negative women where the foetus's father is Rh positive and leads to an Rh+ pregnancy. During her first labour, the mother may be exposed to the infant's blood, and this causes the development of antibodies, which may affect the health of subsequent Rh+ pregnancies. The consequences range from anaemia to, in severe situations, stillbirth. Thankfully there are steps that can be taken and again, you will have been given advice and support during your first pregnancy. Do make sure you are clear about your own circumstances before getting pregnant for a second time.
• Abortion: While abortion is a somewhat different issue to the ones discussed above, it does deserve consideration here. Deciding to have an abortion is a difficult, complex and personal decision. It is important to be aware of all the implications of this decision. Recent research at the University of Aberdeen has found a 37% increased likelihood of experiencing a premature birth in a subsequent pregnancy, although there is not critically a link between abortion and a woman's future chances of having a healthy baby.

Genetic conditions

There are a substantial number of hereditary illnesses that can be passed down from one parent or another. Some are well known, such as Down's syndrome (the risk of which increases with age), cystic fibrosis or haemophilia, and other less so. In some cases, we know of the potential risks before we are pregnant because of our family history, and in other cases, we won't. If you have any concerns, see your GP who can refer you for genetic counselling prior to pregnancy.

Giving yourself the best chance of conceiving

Here's our quick guide to maximising your chances of conception.

• Reduce your alcohol intake. Experts vary in their opinions as to whether it is best to stop drinking all together or to stick to no more than a couple of units a week. Either way, it is time to put an end to your big nights out!
• Stop smoking. One of the biggest single improvements you can make to your health is to stop smoking. Stopping smoking reduces the risk of miscarriage, stillbirth, premature birth and low birth weight, and increases your chances of getting pregnant in the first place. Visit smokefree.nhs.uk for a wealth of support and advice on giving up the habit.
• Take a 400 mcg folic acid supplement. This important B vitamin prevents neural tube defects such as spina bifida, which develop in the very young foetus. You are advised to start taking it before you attempt to conceive, and keep on taking it throughout pregnancy as it does not store readily in the body.
• Eat a broad, healthy diet. Make sure you include fresh fruit and vegetables, fish, poultry, pulses and whole grains, but leave out liver and certain fish, (marlin, shark, and swordfish as they contain an excess of mercury). Keep your caffeine intake at moderate levels.
• Get some exercise. Three 30 minute exercise sessions a week will improve your fitness and your chances of getting pregnant. Try walking, swimming or cycling, anything that raises your heart rate and is not too hard on the body.
• See your GP who can check your basic fitness for pregnancy and help you explore any issues you are concerned about. Be aware of how easy it is to cause yourself unnecessary anxiety by 'over' researching conditions and symptoms on websites; keep a balanced view and seek advice where necessary.