Prakash Chandran (Host):  This program is a community service and is not intended to be a substitute for medical advice. Listeners having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the program are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.

This is “Healthy Conversations,” a podcast presented by Adventist Health.

If you’re trying to have a baby or just thinking about it; it’s not too early to start getting ready for the pregnancy. And to give yourself the best chance for a healthy pregnancy and a healthy baby; there are some important things you need to do before you head down the road to conception. Here with us to discuss is Dr. Christine Lopopolo. Dr. Lopopolo, thank you so much for being here today.

Christine Lopopolo, MD, FACOG (Guest):  You’re welcome. I’m excited to be here. 

Host:  Awesome. So, I’d love to get started by just understanding why it is so important for women to create a preconception plan ahead of time of getting pregnant.

Dr. Lopopolo:  Well boy we prepare for everything in life from getting our driver’s license to our wedding. We plan that in detail. Why wouldn’t we plan preparing for our most important thing in life our children. 

Host:  Absolutely. And I imagine that some of that is making sure that you are stress free, that the environment is good. So, maybe talk about some of the details around how women might prepare for pregnancy.

Dr. Lopopolo:  Well we always need to optimize our health in general when we are thinking about getting pregnant. So, starting with a healthy diet and exercise. You want to be at a healthy weight. You want to make sure you are eating all the food groups in balance and proportion. And then also looking back at some of your maybe not so good behaviors. Stopping alcohol consumption in those months before you get pregnant. Or if you are a smoker, stop smoking. Those are all important things as you start thinking about getting pregnant. Not to mention you want to get on a prenatal vitamin, folic acid is important for developing the neural tube and often babies whole neural tube or spinal column is completely formed before we’ve even missed out period. So, we need to have these vitamins on before we even conceive. 

Host:  It’s really good to hear this because I think so many women think that it’s only after they get pregnant should they start taking care of their bodies and potentially avoiding cigarettes and alcohol. But what I’m hearing from you is it’s so important to kind of create the best environment possible for that conception to happen and if you do that; I imagine that it will happen faster. Is that right?

Dr. Lopopolo:  Well absolutely. There are so many things that we’ve learned over the years in obstetrics about optimizing your pregnancy but a lot of it starts ahead of time. And I think it’s good to have an early appointment and get in with your doctor to review factors in your health history. Do you have thyroid issues? Are you a diabetic? Your blood pressure. Review your medications. Lot of women are treated for anxiety these days and can we continue on those medications. Or do they need to be changed just to optimize things. 

Host:  Yeah, you mentioned some of the pre-pregnancy issues to be aware of like a thyroid and diabetes. What are some other issues that women should potentially see their doctors about before they think about having a baby?

Dr. Lopopolo:  Sure. Well certainly a lot of women are coming off of a birth control pill and so backing it up a step as you stop your birth control pill and get on a prenatal vitamin what happens to your menstrual cycle so that we can talk about optimum timing and how to conceive and when is it irregular, if you haven’t gotten pregnant within what period of time. Which is actually about a year for most women unless you are hitting over 35.

But also these days, we need to look at are your immunizations up to date. We know there has been these measles outbreaks so some immunizations you can get when you are pregnant such as the T-DAP and of course the influenza vaccine. But there’s other vaccinations that we may want to update you on but then you need to have a time period before you conceive. And so that’s another early thing you want to look at. 

There’s work exposures. A lot of women now work very atypical jobs and looking at how that could affect your pregnancy. And then lastly, there’s lots of new things on the genetics forefront that are worth reviewing with your physician ahead of time. 

Host:  Can you talk a little bit about those genetic I guess improvements or just insights that we are able to see now before we conceive?

Dr. Lopopolo:  Absolutely. There’s lots of new testing that we like ideally in the perfect person to have the information before conception occurs. So, both you and your partner can be healthy, normal, however carrier recessive genes, so it’s a nonactive gene. But if both you and your husband or significant other pass that gene on to the baby; they could actually have the disease. And so a lot of patients are now eligible, and insurances will cover to some degree genetic testing to see if you are a carrier. 

In ACOG our national society recommends testing for certain genetic illnesses; cystic fibrosis, there’s one called spinal muscular atrophy, Fragile X is a mental retardation syndrome as well as genetic anemias to name just a few. And of course, playing into this what is your ethnicity? Are you African American? Are you Jewish? That may dictate other assessments. Although as a whole, we’ve now started doing panels of tests as our society becomes more complex genetically; we just screen everybody usually starting with the mom to see if they carry that – a particular gene. And then we can go from there with testing the father. 

Host:  So, I’m curious, let’s say you do a lot of the work to get your body prepared to have a baby; if there are certain issues that arise or that are found, is there anything that can be done preemptively to make your body safer to have a baby?

Dr. Lopopolo:  Well certainly if you are on certain medications. There are blood pressure medications for instance that aren’t good for fetal development. So, we would want to switch over your blood pressure medication. If you are a diabetic; we want to make sure your hemoglobin A1c is under 6. If you carry one of those genetic recessive genes; we obviously first want to test the dad but then more importantly, if both you and your partner were at risk; you can be referred to a reproductive endocrinologist to talk about well how do we avoid having an affected child. So, yes, just all the information that you have ahead of time, educate yourself; will help you make good choices along the way. I hope that answered your question. 

Host:  It certainly did. And I think it’s like you said at the top of the episode; we put so much effort and research and care into most of the decisions that we make, most of the big decisions especially and that’s certainly no different than having a child. It also sounds like the advancements in technology and prescreening with the genetics and everything like that are really able to help you understand the state your body is in before you conceive. So, thank you for all of that. And I’m kind of interested more in now getting your mind mentally prepared as a woman before you conceive. I think a lot of the stuff that we are talking about is around weaning off medication and birth control, etc. but how do we get mentally ready?

Dr. Lopopolo:  So, is anybody ever mentally ready? Knowing that it’s a time of transition, that every month is different than the next month. Making sure you have a provider that you feel you can openly communicate with, that you are in a stable relationship or at least that you have good communication with your partner. Those will be things that will help you as the different ups and downs, the unexpected things that come along during pregnancy arrive. It never helps to have somebody that you feel comfortable talking to. That’s where birthing groups, getting together with other women going through the same sort of things. For the vast majority of pregnant women, a lot of what we experience is normal and it is just helpful to have somebody else reassure us, yeah this is normal, this is what’s happening and then you’re like okay good, I can go about my day now.

Host:  Absolutely. And so for a woman or for a couple that is considering getting pregnant together; what I’m hearing from you is first and foremost, really start living that healthy lifestyle, start weaning yourself off of birth control. I think one of the things that you mentioned is that the normal time that you should give yourself is I guess a year to get pregnant and also just surround yourself with people that are doing this as well, so you know what’s normal and what’s not. Is there anything else that I missed?

Dr. Lopopolo:  No, I can’t think of anything right now. 

Host:  Great, so I actually have a question because my wife is actually pregnant. We are expecting our first in July. Which we are very excited about. 

Dr. Lopopolo:  Well congratulations. 

Host:  Thank you so much. When we had made the decision to start trying; I felt a little bit I wouldn’t say helpless, but I didn’t know what to do in order to kind of like help her feel good about what her body state was in when we were trying. So, I’d be interested in asking what a partner can do during the process of trying to conceive. 

Dr. Lopopolo:  During conception or just with early pregnancy. I don’t know it’s kind of maybe a little bit different.  I think being an empathetic supportive partner is probably a really important crucial step. Trying to join in those good behaviors, starting to exercise together, eating healthy diets, certainly reading through a good pregnancy book. ACOG has a lot of good resource educational material in that regard, also. Listening to your wife. It’s a time of hormones and hormonal changes and being there to reflect what she’s saying and support her. It’s probably the biggest step that a partner could do. 

Host:  I think that makes a ton of sense. I think that’s something that I definitely had to adjust to, definitely all the different hormone changes. But even before that; making sure that you help her on that regimen of potentially staying more active, avoiding situations where there’s just alcohol everywhere. You kind of go into the tendencies of living a lifestyle that isn’t conducive to a healthy pregnancy. So, Dr. Lopopolo I really appreciate you educating us here today. Is there anything else that you wanted to share with our audience before we sign off?

Dr. Lopopolo:  Well, it’s a fun, exciting time full of lots of transitions and just embrace the moments and if you are having stresses or struggles; talk to your provider. 

Host:  Yes, that is wonderful advice. My guest today has been Dr. Christine Lopopolo. I’m Prakash Chandran. Thank you so much for listening. 

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