Melanie Cole, MS (Host): Thanks for tuning in to Back to Health, the podcast that brings you up-to-the-minute information on the latest trends and breakthroughs in health, wellness and medical care. Today's special episode is part of our Women's Health Wednesday series, which features in-depth conversations with Weill Cornell Medicine's top physicians on issues surrounding women's health throughout the life course. Listen here for the information and insights that will help you make the most informed and best healthcare choices for you.

I'm Melanie Cole. And today, on this Women's Health Wednesday, we're discussing preparing for pregnancy. Joining me is Dr. Sydney Wu. She's an Assistant Professor of Clinical Obstetrics and Gynecology at Weill Cornell Medicine. Dr. Wu, thank you so much for joining us. I just love this topic and I loved being pregnant and I loved having babies, I know not everybody does. But what would you tell a woman that she can be doing now before she gets pregnant to ensure that healthy pregnancy. Speak a little bit about a preconception care checkup. What do you want women to know before they get pregnant?

Dr Sidney Wu: Well, thank you, Melanie, for having me on this. This is a great topic because I'm really excited that more and more women are thinking about getting pregnant and being very thoughtful about their choices prior to getting pregnant. So, you know, the best thing you want to do prior to getting pregnant is, of course, optimizing your health, right? So, it's great that people are trying to cross their T's and dot their I's. So, I think being mindful and starting to really think about how does pregnancy change your life, what kinds of lifestyle changes may you need to make prior to getting pregnant so that you can have the healthiest pregnancy possible.

Melanie Cole, MS: Well, this is, as you say, such an important topic. It is nice to see that women are planning ahead of time. So, let's speak about some of the lifestyles as we're thinking about getting pregnant. How can being overweight affect a pregnancy and also how can being underweight affect a pregnancy? And indeed, both of these things affect our fertility and our ability to get pregnant.

Dr Sidney Wu: Oh, I was just going to say that. So, that's number one. A lot of people don't realize, but weight does play a big part in the ability for somebody to get pregnant. So, I think that the body ultimately likes to be optimized at a certain point so that, I guess from an evolutionary point-of-view, the idea is, "This is a great time. My body's perfect and ready to get pregnant." So, when you're on sort of the extremes, people who are overweight or underweight, not only may have a harder time getting pregnant, but during pregnancy, some of the weight issues can cause problems. So, being overweight or obese can contribute to high blood pressure problems, something called preeclampsia, which is a special high blood pressure problem that can occur during pregnancy, preterm, birth and diabetes and also just being overweight also can increase the risk of having larger babies, which can also cause birth injuries and also lead to a higher rate of Cesarean deliveries.

On the flip end of things, being underweight can also be problematic, because then that kind of translates potentially to the baby being of a low birth weight as well. So, trying to have good nutrition and optimizing your weight prior to getting pregnant will really go a long way in terms of helping you get pregnant and being healthy during the pregnancy.

Melanie Cole, MS: So, let's talk about some basic things that a woman can do to have a healthy pregnancy. I'd like you to speak about prenatal care, but while you're doing that, prenatal vitamins are a big thing. And I love how that's evolved over time. People used to be skeptical of vitamins in general, but we learned what folic acid really can do. So, this is such an important aspect of that healthy pregnancy. Tell us a little bit about prenatal care, prenatal vitamins, what we're supposed to have.

Dr Sidney Wu: Folic acid is really sort of the first initial building block for a lot of cell synthesis. So, folic acid is one of the key components and sort of the bare minimum of prenatal vitamins. So, the idea is a lot of foods in this country are, I guess, supplemented with some folic acid. But pregnant women or people who are trying to conceive should take either folic acid, about 400 micrograms of folic acid at least each day or take a prenatal vitamin that has that.

Melanie Cole, MS: How much?

Dr Sidney Wu: About 400 or more of folic acid. So, what makes something a prenatal vitamin is essentially that it should have a high amount of folic acid; a low amount of vitamin A, which we know can in higher doses lead to birth defects; and a good amount of iron. So, iron is another important part of a prenatal vitamin as the baby and mom will continue to need iron to make red blood cells throughout the pregnancy.

Melanie Cole, MS: I think, Dr. Wu, one of the biggest questions that I've heard from women over the years is how much weight do we gain? "Oh, I'm eating for two." Is that a myth? Because we're not really eating for two and we never quite know. And I know It's based on our starting weight as it were into how much weight we end up gaining or not. But is there some parameters for this?

Dr Sidney Wu: Yeah. So, the guidelines are for healthy weight gain for someone who's starting off with a normal weight, the weight limits, if you will, recommended weight limits are 25 to 35 pounds. For someone who's starting off a little bit heavier, then we're asking them to consider trying to be more towards 15 to 25 pounds.

Now, in general, in my practice, I tell people not to focus so much on numbers as to focus on nutrition in terms of eating well and not being so worried about, you know, being on a scale all the time, right? So, we want to make sure that someone's not gaining too much weight, and if someone is throughout their pregnancy, then I ask them to kind of look at their food groups. Are they eating things that are particularly calorie-dense and trying to kind of cut down on that.

But on the other hand, if somebody is eating well, then they don't really have to-- exactly like you said, that eating for two, that really is a myth. What you want to do is you want to eat like you normally would, and maybe just a little bit more, maybe like a couple of hundred calories more. And I really focus on things like making sure that people don't skip meals, making sure that you're keeping your blood sugars constant throughout the day and providing the baby quality and not necessarily quantity in terms of nutrition.

Melanie Cole, MS: What an important point. Now, as we're talking about the healthy pregnancy and things we can do to protect baby. What about vaccinations? What vaccinations should we be planning to get before we get pregnant and/or is it okay to get a flu shot while we're pregnant? I mean, speak a little bit about some of these vaccinations.

Dr Sidney Wu: Vaccines are important. And I think that just kind of going back altogether when you say, "Well, what can a woman do to optimize her future pregnancy, I think having a preconception consult, having a prenatal visit with an obstetrician, who can really kind of go through your medical history, and family medical history, going through the medications you're taking, trying to identify potential problems that might come up. And also, thinking about what kinds of vaccines you might want to have before you get pregnant.

So, yes, flu shots are recommended for everyone, in general, and also during pregnancy. And there are some vaccines that you can't get while you're pregnant because they're contraindicated in pregnancy. So for instance, MMR, measles, mumps, rubella that might be something that, if you go to a preconception visit, a doctor can check. And if you don't have immunity, you might want to get that and optimize that prior to getting pregnant. Also, having a vaccine for varicella, which is really for coverage for chicken pox, can be helpful prior to getting pregnant. So, those are 2 vaccines that you wouldn't get while you're pregnant, but you may want to do prior to getting pregnant.

And then during pregnancy, again, we mentioned flu shot. We are asking everyone to consider being up-to-date on their COVID vaccines. Later in pregnancy, there is a recommendation in the third trimester for all pregnant women to get the Tdap vaccine. Tdap is tetanus, diphtheria, acellular pertussis. And pertussis, for the purposes of pregnancy, is the bacteria that causes whooping cough. So, it's really a protection for whooping cough for the baby. And then, there is a new vaccine that just came out for RSV, which is a disease that can affect babies very adversely. And so, that vaccine is also now recommended for women between 32 to 36 weeks who are delivering during RSV season, so September to January.

Melanie Cole, MS: Well, thank you so much for that. And what about while we're pregnant? Do you have any tips for us on feeling good, whether it's exercise, morning sickness, general nausea, all these things that we women go through while we're pregnant for nine months. Give us some of your best advice about things we can do to feel better.

Dr Sidney Wu: I think that, we obviously want everyone to have not only a healthy pregnancy, but a happy pregnancy. And as much as possible, we try to ameliorate some of these symptoms. Now, some of the pregnancy symptoms, such as nausea, and vomiting of pregnancy, they're very common and sometimes we can do things to help with that, whether it's taking some extra vitamins, like vitamin B6 during the pregnancy or, for patients who are really having hard time, there are medications that can help with the nausea of pregnancy.

So, we being doctors like to try to help patients have a healthy and happy lifestyle. And so, we encourage exercise and I tell patients that they should try to be active as they normally are. So, someone who is very active and does a lot of exercise should stay with that regimen. And most non-contact sports and activities where you're not going to fall or hit your belly are good. The goals of exercise in pregnancy are to have good cardiovascular activity, as well as improving tone. So, let's say if somebody's not particularly active, then walking and not being sedentary, I think, is a good way to proceed and also consider things like prenatal yoga, stretching exercises.

Another thing that I think is very important is trying to optimize mental health and well-being prior to pregnancy and during pregnancy. And so, trying to figure out what kind of support we can, help when people have, let's say, underlying mood disorders or during pregnancy, if they're having a hard time hormonally, they can have triggers for anxiety and depression and really kind of trying to get people tucked into services that will provide them with that support so that they can feel well through the pregnancy.

Melanie Cole, MS: Wow. This is great information. Dr. Wu, you work with women every single day. If you were to offer your best advice for women that are thinking about getting pregnant or women that have just gotten pregnant or thinking about a second baby, what do you tell them every day about a healthy pregnancy?

Dr Sidney Wu: I think just being cognizant of your lifestyle, realizing that much of what we do can and will affect the pregnancy. So, like I said, trying to stay active, eat well, get adequate sleep, be happy, be healthy throughout the pregnancy. And also, on the other hand, not to get too focused on some of the details. I think the flip side of wanting to do everything perfectly is forgetting that you don't have to do everything perfectly. If you think about during pregnancy, we have restrictions about different types of food. So, for instance, most of the food-borne diseases are the driving factors as to, you know, what you should avoid in terms of eating and pregnancy. So, I think it's good to be aware, to be trying to cross your T's and dot your I's, but don't take it that seriously. It also isn't that crazy. So, sometimes I'll have patients during pregnancy who hear like, "Oh, I have to sleep on my side during the pregnancy." And they get themselves so upset if they wake up on their backs. And I say, "Look, you know, what happened when people weren't going to obstetricians for years and years," right? People were still having healthy pregnancies. So, do the best you can. Don't take it that seriously. If you try really hard and you're watching out, you're going to do fine.

Melanie Cole, MS: Wow, thank you so much, Dr. Wu, for joining us and really sharing your incredible expertise. Thank you again. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. We're so glad that you joined us for Women's Health Wednesday. We hope you'll tune in and become part of a community and a fast-growing audience of women looking for knowledge, insight and real answers to hard questions about our bodies and our health. Please download, subscribe, rate and review Back to Health on Apple Podcasts, Spotify and Google Podcasts. And for more health tips, please visit weillcornell.org and search podcasts. And parents, remember to check out Kids Health Cast too with lots of great stuff there. I'm Melanie Cole. Thanks so much for joining us today.

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