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Scott Webb: Most of us parents probably spent a lot of time before our kids were born thinking about names and what color to paint the baby's room. But many of us may not have spent as much time on making sure that we were doing all the right things in terms of preconception. And joining me today to discuss the importance of preconception checkups, genetic counseling, and more, is Dr. Kayla Nebelsick. She's an OB GYN at the Franciscan Physician Network Legacy Hills Health Center.

This is the Franciscan Health DocPod. I'm Scott Webb and doctor, thanks so much for joining me today. We're talking about preparing and planning for pregnancy. So what do women need to know about preconception?

Dr. Kayla Nebelsick: I think most important with preconception is patients need to already be on a prenatal vitamin. I would say a lot of times patients come to me already pregnant, and that's the first that they get on a prenatal vitamin, but it's advised that they should be on a prenatal vitamin at least a month, if not more, prior to conception. And so that's a good one. And a lot of people don't know the reason we don't want them to be on a women's daily, and instead we want them to be on the prenatal is because for the women's daily, there's usually sometimes too much vitamin A, so always check your bottle on your multivitamin to see how much vitamin A, because there's usually a little bit too much for pregnancy, and then there's not enough of that really important folic acid that we need prior to conception.

So that's the first thing, are you on a prenatal vitamin?

Scott Webb: Okay. So, and then we talk about the preconception check-up what's involved. How does that go?

Dr. Kayla Nebelsick: That's a great question. So with the preconception check-up, we're going to look at how is your weight, how is your blood pressure? Are you overall at a healthy weight, meaning not obese and your blood pressure's in normal range, because we would prefer that we get you to a healthy weight for pregnancy prior to even becoming pregnant, as well as if your blood pressure is elevated, having that under control prior to even getting pregnant. Another one would be diabetes to make sure that your sugars are well under control, before you get pregnant. Other things we would do is talk about what medications you're on, because sometimes you're on medications that you shouldn't be on during pregnancy. So the time to change those medications are prior to getting pregnant. Another thing would be, are there any genetic conditions in your family that predispose you to and your future baby to some health concerns? So we would go over those risks and, go from there.

The other thing is, is just actually having a good track of your menstrual cycle. A lot of times, women don't know when their last period was, and it's very important to know their last period, because that helps us to date the pregnancy.

Scott Webb: And doctor, is it just a situation where basically, and maybe I'm oversimplifying, but a healthy mom tends to lead to healthy babies.

Dr. Kayla Nebelsick: Absolutely. It definitely decreases your risk factors if you're healthy. Some things, for example, women who are obese, meaning their BMI is greater than 30. They have an increased risk of birth defects, such as problems with the neural tube or even heart defects or cleft palate. So there's a lot of things that just having extra weight on your body will put the baby at increased risk especially in that first trimester, when the baby's developing.

Scott Webb: Yeah. And when we talk about what's safe for the baby, let's talk about chronic conditions that moms to be may have and how do we address those and treat those and do that safely for babies.

Dr. Kayla Nebelsick: So if the mom has a condition such as diabetes, we want her hemoglobin A1C to be optimized. If the hemoglobin A1C is elevated, that's a huge risk of a heart defect in baby. So always work with both your OB GYN as well as the health care provider that manages your diabetes, to optimize your hemoglobin A1C, ideally to under seven, even under 6.5 would be even better. Another one would be if you have high blood pressure. There are some blood pressure medications that you absolutely cannot be on in pregnancy. One of which would be like a lisinopril. That's a huge no-no. So, it might be the case that you need to have your blood pressure medications changed prior to you getting pregnant, because if you're on lisinopril, your baby could have problems with its kidneys. Other things would be, if you have a history of blood clotting, and we might have to get you on a blood thinner right away even though maybe you haven't had a blood clot in a long time, so maybe your regular doctor took you off of your blood thinner. We definitely want you to be on a blood thinner during pregnancy. It helps to maintain the pregnancy as well as prevent blood clots for you.

The other big thing would be, are you exercising because you always want to establish a good exercise routine prior to pregnancy, because we want you to exercise in pregnancy, but a lot of times your body is going through tons of changes, right at the beginning of pregnancy, and you're so exhausted from growing a baby that we already want that good exercise regimen in place.

Scott Webb: Let's talk about the role that family history and abnormalities may play in a decision to have a baby.

Dr. Kayla Nebelsick: So I would always gather information prior to coming to see your OB GYN, ask your mom, ask your, mom's sisters and brothers or your own, sisters and brothers, just find out everybody's medical conditions so you can discuss with your OB GYN if there's just something that runs in the family. Because sometimes it's not that it's hereditary, to the point where it we'll see it at birth, for example, maybe your family gets high blood pressure in their older age, you're probably not going to see that at birth, but there are definitely some things that we have to, just look out for, for families, for example, like cystic fibrosis or Thalassemia, different things like that, that it's important to know your family history prior to coming in.

Scott Webb: Yeah, it does seem like it's just better to know. Maybe it doesn't prevent or preclude people from having babies, but better that they know. And definitely better that the OB GYN who's going to go on this journey with them also knows, right?

Dr. Kayla Nebelsick: Exactly. And another one, I don't know why I haven't hit on it yet. It's smoking. That's a big one. You always want to stop smoking even prior to getting pregnant. A lot of women stop smoking once they're pregnant, but it's even better if you can do it prior to just to help those blood vessels that are developing between the mom and the placenta. And, just to be able to optimize that as to actually try and stop smoking prior to, so just like you're going to be on your prenatal vitamins, start working out, all the things and make sure you get your partner involved.

A lot of people don't know that secondhand smoke is the number one cause of sudden infant death syndrome. And so even if you decide to stop smoking, but your partner keeps smoking, your baby is still at high risk.

Scott Webb: And doctor in terms of COVID-19, should women be concerned about getting pregnant during the pandemic?

Dr. Kayla Nebelsick: We know that COVID-19 isn't unfortunately going anywhere and women want to have babies. I'm never going to advise a woman not to have a baby because it's your family. That's, what's important, even during a pandemic. The biggest thing with COVID-19 is just try and stop the spread of the pandemic.

So do your part, wear your mask, wash your hands, social distance, all the things. We haven't seen too much of effect I would say directly from COVID-19 meaning in pregnancy, but in recent weeks, they've started to update the literature and say that possibly an increased risk in pregnancy.

I guess what I'm trying to say is in the flu, we already know that women who get the annual flu that we think of they do when they're pregnant, they do much worse than if they weren't pregnant. And at first, we were saying, well, I think they do about the same as the general population, but latest research that's come out in the last couple of weeks is they might actually be doing a little bit worse than the general population, which makes sense because their immune system is fighting for two instead of just their own.

Scott Webb: You know, I mentioned earlier about dads and I'm a dad myself. And what advice do you have for dads to be?

Dr. Kayla Nebelsick: Oh my goodness. Well, first off, I want you to view the pregnancy that it's your pregnancy with your partner, because if your partner's getting healthy, you get to get healthy too. It's not fair to tell the mom that she has to quit smoking and eat the healthy foods and exercise, and meanwhile, you don't adopt any of those habits.

So I think if you take a team approach to it, that you're in it together, that I think that's the number one advice. For dads is you want to be healthy too, because you want to be a support system to your partner, but just be healthy for your baby and, be a good example. And we already talked about like sudden infant death syndrome with smoking.

And so that's very important. And also a lot of times, guys don't know that when you're struggling to be able to get pregnant, that much of the time, it actually is a problem on the guy's side with the guy's health. And so a lot of times we'll work up the women and everything's healthy and normal. And then we'll finally get that guy to give us a sample, and we find out that the whole time it was the guy. So you want to be just as healthy as your partner is as you're trying to get pregnant.

Scott Webb: Yeah. I love that. That it is such a team approach, you know, team mom and dad. And as we all know, it is exhausting being a parent, especially of a newborn. So the best thing that a dad could do is to be in a little better shape, eat a little healthier, work with the mom, as a team to make sure healthy mom and dad, healthy, baby, all that good stuff.

Dr. Kayla Nebelsick: The other thing we know is that unfortunately, a lot of domestic violence increases believe it or not in pregnancy. So I would just encourage any couple, going or trying to get pregnant or, pregnant to always go to therapy. I'm the number one advocate of everybody going to therapy.

Don't even wait until there's something wrong to go to therapy. But there are a lot of stresses that can go into a relationship again, just trying to get pregnant. Sometimes that becomes a huge source of stress if you're struggling to get pregnant. And then when you are pregnant, the hormones that are going on with mom and she's not able to sleep at night, it just tends to be a little bit more stressful in the home.

So I'm always going to encourage all couples to get into therapy even before they need it.

Scott Webb: Doctor, as we wrap up here, let's go through the preconception checklist for women, one more time just to make sure they know, as they're considering this before, maybe they get to an OB GYN like yourself, what do they need to know? What should they be doing?

Dr. Kayla Nebelsick: I think a good checklist would be number one, see your doctor or doctors before you become pregnant. If you're healthy, then just make an appointment with your OB GYN. But if you have other medical conditions, make an appointment with both your OB GYN and your primary care physician who takes care of those conditions so everybody has a plan.

Next, I would definitely know your risk factors, meaning your own health history, as well as your family's health history. Next, I would say, are you taking that daily prenatal vitamin, prior to getting pregnant? Next, I would just see what is my weight?   Am I at a healthy weight? Is my BMI less than 25? Am I eating a healthy diet? That getting my vegetables in and all that stuff. Next, are you on medications and are you using, are you taking them as you're supposed to? And have you cleared them with both your OB GYN and your primary care providers that it's safe to be on?

Next a big one would be, alcohol, marijuana, illegal drugs or if you're on prescription drugs for non-medical reasons, that type of thing, this would be something you want to be off of way before you get pregnant.   Next would-be prevention of infection. So if you don’t know if you've been vaccinated again s certain diseases, I would ask your primary care or your OB GYN if there's any vaccines you should be getting prior to getting pregnant and then always avoid harmful agents that might be in your home or at work, that type of thing. Most work sites, you can talk with your department head and ask is there any harmful agents that I can't be around during pregnancy that type of thing, but at home it would be like, is there lead paint, that type of stuff? I think that's a pretty good checklist to get started.

Scott Webb: Yeah. That is a really comprehensive list and a great way to get started. And doctor, I just have to say, I know you were up all night with a patient. I don't know where you find the energy, your expertise and your just overall energy and positivity is really great. Moms and dads to be you're in good hands, obviously when they're with you. And I just want to say stay well.

Dr. Kayla Nebelsick: Oh, thank you so much.

Scott Webb: For more information, visit Franciscan health.org and search pregnancy, and we hope you found this podcast to be helpful and informative. This is the Franciscan Health DocPod. I'm Scott Webb. Stay well.