Kitabı oku: «Need to Know Fertility, Conception and Pregnancy»

2. A healthy pregnancy

Every woman knows that it is really important to take good care of her health when she is pregnant. But many women are not aware that their health before pregnancy is critical to producing a healthy baby. This means that you need to think about your health and, in particular your diet, not just after that positive pregnancy test, but for several months before.

Your pre-pregnancy health

Doctors have known for a long time that pre-pregnancy care is important. Although women are becoming increasingly health conscious and some now seek specific pre-pregnancy advice, there are many women who don’t understand its importance.

Take care of yourself

We all lead hectic lives and all too often missing your first period is the catalyst for thinking about your pregnancy, but you are already two weeks pregnant at this point and it may take a further few weeks before you see your obstetrician. By this time, your baby is developing rapidly and you may have missed opportunities to influence the pregnancy positively.

• The first twelve weeks of pregnancy is the time when all of the major organs are developing in the baby’s body.

• The heart, lungs, liver, kidneys, brain and nervous system are all formed at a time when many women do not even realize that they are pregnant.

This is why pre-pregnancy care is so important. It is important not just for women with a health condition, but for every woman contemplating pregnancy.

Your diet

If you are thinking about becoming pregnant, diet is important. It has been said that you are what you eat and, of course, your baby will be too. Indeed, eating a well-balanced diet before you conceive is one of the most important things you can do for your baby.

Your weight

In addition, if you are overweight, it is best to reduce your weight before trying to conceive. This is because not only does being overweight reduce your chances of conceiving, but it also puts you and your baby at greater risk of many complications.

Smoking
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Conception and stress

If you have been trying desperately for a baby and you have not conceived, you can end up feeling stressed and anxious, which can have an adverse effect on conception. Having a balanced diet, getting enough sleep and taking regular exercise should help. If you have a very stressful occupation, you might want to consider ways of limiting or avoiding stress at work.

If you are a smoker, you should know that smoking can not only reduce your fertility, but also make you more prone to miscarriage and restrict your baby’s growth in the womb. Stopping smoking is easier said than done and it may take you some time to give up smoking completely. Ideally, you and your partner should try to stop several months before attempting to conceive. You should also know that it is never too late to stop. Stopping smoking even after you are pregnant can make a difference for your baby.

Be aware of your surroundings

If you work with certain chemicals, lead, anaesthetics or X-rays, this may involve a risk to your unborn baby. Talk to your doctor about it. It has been suggested that computers, visual display units (VDUs) and copying machines give off harmful rays encouraging miscarriage, but despite several large studies there is no scientific evidence to suggest that they present any risk to pregnant women or their babies. Other studies on women who delivered small babies have likewise identified no link between VDU exposure and low birth weight. So if you work with a VDU, there is no need to be concerned or to take any special precautions when you are pregnant.

Your diet

Diet is fundamental to good health, and no more so than when you are preparing for pregnancy or in early pregnancy. All the ‘building blocks’ of your baby’s body are derived from your food.

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Meal times

Eat regular meals with a wide variety of healthy foods that you enjoy. If you get your diet right before conception, you will have established an ideal pattern for your pregnancy.

A balanced diet

A balanced diet provides you with:

• protein for muscles and other structures

• calcium for bones

• carbohydrates for energy

• fats for cell growth

• vitamins for key body functions

An optimal nutritional balance is the first step to giving your baby the best start in life. The requirements for protein, iron, calcium and vitamins B, C, D and E increase in pregnancy, but a well-balanced diet usually provides you with enough protein, vitamins and minerals to meet these extra demands.

Your baby’s health depends to a great extent on the health of not only you but also your partner at the moment of conception. You increase your chances of conceiving a healthy baby if you both eat a healthy, varied diet. Ideally, you should keep your intake of foods rich in fat and sugar to a minimum and your diet should include:

• a good selection of fresh vegetables and raw fruit (taking care to wash them thoroughly) to provide vitamins and fibre

• foods rich in protein, such as lean meat, fish, poultry, eggs and beans

• foods rich in calcium, such as milk, cheese and yoghurt

• cereals, bread, pasta and potatoes to provide carbohydrates and additional fibre

It is also sensible to combine this diet with an adequate fluid intake. Water is better than coffee, tea or sugar-rich drinks, such as cola.

Fruit and vegetables

Try eating more salads using a wide range of fresh vegetables, and try to take two portions of vegetables or fruit with each meal. Avoid over-cooking vegetables as this breaks down many of the vitamins they contain; try steaming them instead. Have fresh (not canned) fruit for dessert and drink fruit juices.

Protein

You can get most of your protein from meat like chicken, beef and lamb as well as nuts and pulses, but fish is an excellent source of protein, and oily fish like salmon and herring are rich in essential fatty acids (so-called omega 3 essential fatty acids), which are important for the development of the baby’s brain and nervous system. Moreover, a high fish intake is associated with a reduced risk of pregnancy complications such as premature labour or a low-birth weight baby. That said, there are some fish that should be avoided if you are trying to conceive or if you are pregnant.

Calcium

Foods rich in calcium such as milk, cheese and yoghurt are important to eat to ensure you have good calcium stores for the developing baby. When you are pregnant, drinking 500 ml (18 fl oz) of milk per day or 250 ml (9 fl oz) of milk and eating a yoghurt or portion of cheese is enough to ensure that you have sufficient amounts of calcium in your diet.

Carbohydrates

These are essential for energy. Many women worry about carbohydrates being related to weight gain and thus cut down on all forms of carbohydrate when trying to become pregnant. There are ‘good’ and ‘bad’ types of carbohydrate, however. Starchy foods such as pasta, wholemeal bread and potatoes are ‘good’. ’Bad’ carbohydrates are sugar-laden foods, such as cakes, biscuits and sweets. Cut down on these and think about increasing your intake of starchy carbohydrates. You should try to eat wholemeal bread, and take a portion of potatoes, pasta or wholegrain rice with each main meal. For breakfast think about having porridge or a high-fibre or wholegrain breakfast cereal, and avoiding cereals with a high sugar content.

Fibre

Otherwise known as ‘roughage’, fibre is found in foods derived from plants. It cannot be easily digested and absorbed by our bodies and so it stays in the bowel, providing roughage. It can be broken down to some extent by bacteria in the large bowel and some of these breakdown products can be absorbed and used as a source of energy. Because it provides roughage for the bowel – aiding the process of peristalsis (contractions in the bowel) by which the food is pushed through the gut. Fibre is important in ensuring that bowel function is normal and in preventing constipation. This is especially important in pregnancy when your bowel function often slows down. Many women thus find constipation a problem during pregnancy, and eating a fibrerich diet is very good at preventing this.

You should therefore eat foods with a high-fibre content, such as wholemeal bread, pasta and fruit. However, if you increase your fibre intake suddenly, you may find that you feel bloated and have excess wind, so it is better to increase your intake gradually. You should also ‘match’ the increase in fibre with an increase in fluid intake, preferably water.

Fluid

It is all too easy to get slightly dehydrated. We have busy lives and often drink too much caffeine in tea and coffee that can add to the dehydration. It is a good idea to increase your fluid intake. You should aim to drink around six glasses of water a day. In pregnancy you will be prone to constipation as the bowel tends to become more sluggish because of the effect of pregnancy hormones, so along with an increase in fibre in your diet, drinking water helps to prevent constipation.

Reducing fat intake

It is best to avoid fried food and foods with a high fat content such as meat pies, sausages and pastries. If you want to fry food, then cook it in unsaturated vegetable oil, such as olive oil, or try grilling it instead. You should choose lean meat and trim off any excess fat before you cook it.

Reducing sugar intake

When pregnant, you should avoid high levels of sugar in your diet. Try to avoid or at least minimize your consumption of sweets and chocolate and also sugar-rich soft drinks. It is, of course, easier said than done, but try to eat fruit for a snack instead, and drink mineral water.

Reducing salt intake

You do not want or need to eliminate all salt from your diet. Moderation is the key: try not to put extra salt on the foods you eat and minimize the salt you add during cooking, as well as eating fresh foods rather than processed or tinned products, which are often high in salt. Meat extracts and soy sauce are high in salt, too, so keep intake of these to a minimum.

Vitamins and minerals

A regular intake of vitamins C and D are important both before and during pregnancy. In a well-balanced diet, it should be possible to obtain the necessary quantities without resorting to vitamin supplements. In fact, the only vitamin supplement that is usually needed before and during pregnancy is folic acid. Specific supplements of vitamins C and D are not usually required prior to pregnancy unless you have particular medical or nutritional problems, in which case you need to seek advice from your doctor. If you are vegetarian or vegan, you may need specific supplements of vitamins and minerals. These, too, require individual advice from your doctor.

Vitamin C

Available from fresh fruit and vegetables, vitamin C is important as it helps you absorb iron and also because it is needed for the production of the red blood cells that carry oxygen around the body. In pregnancy, there is a significant increase in the number of red blood cells in a woman’s body – around 25 per cent on average by 32 weeks of pregnancy. So there is an extra demand for vitamin C, iron and folic acid, not just for the baby but also for the mother as all these vitamins and minerals are essential for red blood cell production.

Vitamin D

Vitamin D is essential for the good development of bones. It is available from dairy products.

Vitamin A

Too much of certain dietary component can sometimes cause potential harm. When it comes to vitamins in pregnancy, vitamin A is one to know about. Vitamin A is a fat-soluble vitamin that is stored in your liver and it is vital for the maintenance of good eyesight, and healthy skin, hair and nails. In the developing baby, vitamin A is essential for tissue growth.

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Foods containing vitamin A

• liver

• liver pâté

• carrot

• full fat milk

• egg

Vitamin A occurs in two main forms in our diet: the first form is ‘retinol’ – the ‘real’ vitamin A; the second is the ‘carotenoids’, which your body converts into retinol. Beta-carotene is a carotenoid and is converted into retinol only when it is required. It acts as an antioxidant in the body (helping to prevent damage to blood vessels caused by free radical molecules) and is the pigment that gives the green, yellow or orange colour to vegetables and fruit. The brighter the vegetable, in fact, the more beta-carotene it contains. Fresh liver is a particularly rich natural source of vitamin A, as animals, like humans, store vitamin A in their livers.

Very high intakes of ‘true’ vitamin A – ‘retinol’ – have been linked with an increased risk of fetal abnormalities during pregnancy. Such high levels are likely to be far in excess of those you would find in your normal diet, however. The amount of retinol linked with fetal abnormalities is in excess of 3,300 mcg per day. This level is very high: you would need to eat 30 eggs in one day, for example, to get that much vitamin A. At the same time, you should not take supplements containing vitamin A in the retinol form or eat foods that are very rich in retinol, such as liver or liver products like pâté, when you are planning to become pregnant or are pregnant. Similarly, fish liver oils (e.g. cod liver oil) should also be avoided.

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Women who are likely to have low iron stores

• vegans /vegetarians

• those who have had two or more pregnancies close together

• those who have suffered from anaemia

• those with heavy periods

• those who are expecting twins, triplets or more

Iron

Iron is a mineral that is stored in your liver, spleen and in the centre of certain bones. Maintaining an adequate iron intake is important both before and during your pregnancy. Your developing baby needs iron for the formation of several important proteins. In particular, iron is required for the formation in the red blood cells of haemoglobin, the substance that transports oxygen around your body.

If you have an adequate intake of iron in your diet before and during your pregnancy, you are usually able to meet your own and your developing baby’s needs. Iron supplements are not routinely required when planning a pregnancy. However, there are some women who are more likely to have low iron stores and therefore need to take supplements. These include women who had low iron stores or a diet poor in iron before pregnancy and women expecting twins or triplets. Your doctor is able to advise you about this.

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Foods containing iron

• breakfast cereal

• red meat

• baked beans

• green leafy vegetables

• eggs

• wholemeal bread

You find iron in foods such as baked beans, bread (fortified white, as well as brown and wholemeal), breakfast cereals, pulses (such as lentils and red kidney beans) and red meat (but avoid liver because of its high vitamin A content).

If you require iron supplements, you can maximize the absorption of iron by taking the iron tablet with a citrus drink such as fresh orange juice, which is rich in vitamin C (also important for treating anaemia).

If you suffer from heartburn or indigestion, do not take the iron supplements at the same time as antacid medicine as this reduces the absorption of iron. In pregnancy, iron supplements are often combined with folic acid, frequently in the same tablet.

Folic acid

Folic acid is an important member of the B vitamin family and, as such, is essential in small quantities for maintaining normal body metabolism. Because folic acid does not occur naturally in your body you need to obtain it from other sources such as your food or by means of vitamin supplements.

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There is one relatively uncommon form of anaemia due to deficiency of vitamin B12. Folic acid supplements could make it difficult for routine blood tests to pick up this condition. If you have a history of anaemia due to vitamin B12 deficiency, check with your doctor before taking folic acid.

The importance of folic acid

Folic acid is essential for the production of healthy red blood cells, which carry oxygen around the body. We are constantly making and replacing our red blood cells: it has been estimated that, on average, an adult makes more than 120 million new red blood cells every minute throughout their lives. Hence deficiency of folic acid means that an insufficient number of red blood cells are produced, leading to problems such as anaemia.

Folic acid is also known to reduce the risk of certain abnormalities in the baby known as neural tube defects, of which spina bifida (which in its severe form can be seriously dangerous for the baby), is perhaps the best known. All babies are potentially at risk of spina bifida, or other neural tube defects such as hydrocephalus, whatever the mother’s age and whether or not this is a first or a subsequent pregnancy.

The neural tube is the part of the developing baby that eventually becomes the brain and the spinal cord. It forms at about four weeks after conception or about two weeks from the time of a missed period. Research has shown that sufficient folic acid in the mother’s blood is essential for normal formation of the neural tube. Interestingly, in the USA, folic acid has been added to all flour for bread and pasta from 1998. Since that time, the number of babies with neural tube defects has fallen by almost 20 per cent. There is also some evidence that suggests that adequate folic acid intake might help prevent problems such as small-for-dates babies.

Spina bifida and hydrocephalus

In babies with spina bifida there is a defect in which part of one or more vertebrae (the bones making up the spine) fails to develop completely, leaving a portion of the nervous tissue in the spinal cord exposed, which leads to damage of the nerves. This defect can occur anywhere in the baby’s spine but is most commonly seen in the lower back. The condition varies in severity and much depends on where the defect is and how much of the nervous tissue is exposed. Mild cases may have no major disability but in more severe cases, there can be paralysis of the legs, loss of sensation and incontinence due to loss of bladder control.

Women who have had a child with spina bifida are more at risk than women who have had a child without the condition. In such instances, it would be worthwhile obtaining specific pre-pregnancy advice before conceiving again, and you should consult your doctor.

Hydrocephalus is where there is an excess of fluid in chambers within the brain. This often arises because the flow of fluid through these chambers is obstructed. The excess fluid builds up in the chambers and the pressure causes them to enlarge, which can damage the brain tissue. Hydrocephalus may occur with spina bifida or on its own.

Folic acid from supplements

The ideal time to start taking folic acid supplements is two to three months before starting trying to conceive. Make it a part of pre-pregnancy planning. The tablets can

must know

Folic acid allowance

• The recommended daily allowance for adults is 200mcg, but prior to becoming pregnant it is recommended that the intake is doubled to 400mcg a day.

• Continue to take 400mcg for at least the first 12 weeks of your pregnancy.

• Some doctors are happy for you to stop while others recommend you take it throughout pregnancy – folic acid is a vitamin that can help prevent health problems such as anaemia and might help to reduce any other pregnancy complications.

be obtained from all good pharmacies. If you don’t like taking tablets, try folic acid milk, also available from pharmacies; one carton usually represents the daily requirement. Always remember to follow the instructions on the pack carefully. If you are taking prescribed medicines, check with your doctor before taking any supplements to be on the safe side.

Folic acid from food

Folic acid is soluble in water and is stored mainly in the liver. It is largely destroyed by cooking, however, so serve salads and stir-fry or steam vegetables lightly rather than boiling them. You can obtain it from:

• fresh dark green vegetables like broccoli, Brussels sprouts, peas, green beans, chick peas and spinach

• oranges

• peanuts, although salted peanuts should be avoided if possible because of the extra salt. In addition, if you or your family has a history of peanut allergy or other allergic conditions, like asthma and hay fever, it is definitely recommended that you avoid peanuts during pregnancy

• many breakfast cereals have added folic acid (read the label) and milk and yoghurt also contain it

• wholemeal and wholegrain breads are high in folic acid, as are wheatgerm, brewer’s yeast and yeast extract, so add these to your diet

Many women with a healthy diet may already have a sufficient folic acid intake for pregnancy simply from their food without the need for supplementation. But folic acid deficiency commonly arises in pregnancy due to the many extra demands the development of the baby places on the mother’s body. Even women who have an adequate diet may not be taking in sufficient amounts of folic acid because the body is not absorbing it efficiently from food.

Folic acid supplements are therefore recommended for every woman trying to conceive to be sure that her intake is sufficient. In pregnancy, the kidneys filter folic acid from the blood at four times the normal rate, which is another reason why supplements are recommended. If you decide not to take folic acid supplements, however, ensure that you have a good daily intake of folic acid in your diet by eating suitable quantities of the foods listed on the previous page.

Foods to avoid

There are certain foods that are best avoided when you are trying to conceive and also in pregnancy. This is because of the risk of infection or because they contain potential toxins.

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When storing or preparing food, remember to keep raw meat and poultry separate from cooked or pre-prepared foods and use separate utensils for them. In addition, always wash your hands thoroughly after handling raw meat and poultry.

For example: unpasteurized milk, soft cheeses and pâté can contain a type of bacteria called listeria that can cause miscarriage and premature labour; raw and uncooked cured meats (such as ham and prosciutto) and unwashed (soil-covered) vegetables may carry toxoplasma, an organism that can cause abnormalities in the baby. Liver contains high quantities of vitamin A; and raw meat, poultry and eggs can carry salmonella, a type of bacteria that causes food poisoning.

Processed food

It is all too easy to rely on processed food from time to time when we have busy lives. But try if possible to avoid convenience foods that have been highly processed, such as canned foods and packet mixes. This is because these often have added sugar and salt as well as a high fat content. So if you have been taking care of what you eat and limiting salt and sugar intake, you might be unwittingly undoing the benefits of your efforts by eating processed pre-prepared food. These foods may also contain chemicals in the form of artificial flavourings, colourings and preservatives. The composition and additives in these foods can usually be identified by looking at the label.

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Foods to avoid eating in pregnancy

• unpasteurized milk and milk products such as soft and mould-ripened cheeses

• pâté

• raw and uncooked cured meat

• unwashed fruit, vegetables and salads

• raw or partially cooked eggs

• raw shellfish

• liver

• liver sausage

• dietary supplements rich in vitamin A, e.g. cod liver oil

• shark, swordfish, king mackerel

Fish

A US food and drug administration panel has recently recommended that pregnant women should limit their consumption of those fish that are at the top of the food chain. So you should not eat a lot of tuna, and completely avoid swordfish, shark, tilefish and king mackerel. This is because of concerns that these particular fish may contain levels of mercury that could be harmful to people, especially developing babies.

Mercury enters the sea environment through pollution and virtually all fish contain tiny amounts of mercury. Long-lived fish that are predators, such as sharks or swordfish, accumulate the greatest amounts of mercury in their bodies and so might be harmful to people who eat them regularly. The safe level of tuna intake with regard to the effects of mercury in pregnancy has not been established, but in the meantime it has been recommended that pregnant women should eat no more than two 175 g (6 oz) cans of tuna each week, just to be on the safe side.

Vegetarian and vegan diets

More and more people are turning to vegetarian or vegan diets. Some vegetarians eat dairy products and others eat dairy products but avoid eggs. Vegans avoid all animal products including meat, fish, dairy products, eggs and honey. Because a few micronutrients occur naturally only in animal products, planning a balanced vegetarian or vegan diet requires a little extra effort. There are not usually any problems with a well-balanced vegetarian diet before and during pregnancy, however. Such a diet provides sufficient protein, vitamins and minerals to meet the needs of most women, although sometimes iron supplements are required to help prevent anaemia caused by the extra demands of the unborn baby on the mother’s stores of iron.

Some very strict vegan diets contain no food at all that is derived from animal sources, including dairy products. Women following such a diet may need extra vitamin supplements and should discuss this with their GP. If you are a vegan, you may be prescribed supplements of calcium and vitamins D and B12. So there are not usually any problems with a well-balanced vegetarian diet during pregnancy; indeed, you will have some benefits, such as increased fibre in your diet from all the fruit and vegetables.

The quantity of food

How much food you need to eat depends on your body weight and BMI and also on how much exercise you take. However, if your BMI is in the healthy range for your age, typical servings per day of popular foods are as follows:

• one to two 75-110 g (3-4 oz) servings of lean meat

• six portions of fruit and vegetables, such as a medium-sized apple or peach or three heaped tablespoons of a vegetable

• five slices of wholemeal bread

• one to one and a half portions of rice (75 g (30 z)) or pasta (110 g (4 oz))

• one serving (medium bowl) of unsweetened breakfast cereal

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‘Eating for two’

Despite the old adage about eating for two during pregnancy, there is actually no need to substantially increase your food intake as your body becomes much more efficient in its use of food and energy when you are pregnant.

• 600 ml (1 pint) of milk or a 300 ml (½ pint) of milk and a yoghurt or serving (around 25 g (1 oz)) of cheese is enough to meet a pregnant woman’s extra calcium needs In addition, a portion (150 g (5 oz)) of fish can be eaten every other day

In late pregnancy, however, increase your energy intake by about 10 per cent, which amounts to an additional 200 calories for the average woman. This amount of calories can be gained by eating a large bowl of cornflakes with semi-skimmed milk, or two medium slices of wholemeal bread, very lightly buttered, although the amount can be spread out over several smaller meals if a large portion cannot be eaten in one sitting at this stage of pregnancy.

Dieting

Going on a diet to lose a lot of weight is not advisable or recommended immediately before or during pregnancy. This is because you may disturb your nutritional balance at crucial stages of your baby’s development. However, limiting weight gain in pregnancy is important for women who are overweight and this can be achieved by carbohydrate restriction, ensuring that you take no more than the recommended number of servings of carbohydrate in your daily diet.

Alcohol and caffeine

Every woman knows that excessive alcohol intake is harmful, especially in pregnancy, but few know just how much alcohol might be safe to consume. Similarly, we are increasingly conscious of our caffeine intake, with many of us now drinking decaffeinated beverages.

Alcohol consumption before pregnancy

Many women are unaware of the problems that excessive alcohol intake might cause for the developing baby, and few are aware that alcohol can reduce their fertility. Alcohol can upset the production of eggs from the ovary. A Danish study conducted in 1998 found that women drinking four or fewer units of alcohol a week were twice as likely to conceive than those drinking ten or more units a week. If your partner drinks heavily, this can affect his fertility, too, by upsetting the function of his testicles and their production of both the male hormone testosterone and sperm. However, moderate alcohol intake (up to three or four units a day) does not seem to cause male fertility problems.

The ideal is that you both give up alcohol while you are trying to conceive, or keep your alcohol intake very moderate as no one really knows what is the ‘safe’ level of alcohol. Remember, too, that if you are trying to get pregnant, you may not know that you have conceived until several weeks after

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Alcohol limits

• Generally, it is recommended that, to be on the safe side, you drink no more than two glasses of wine (or its equivalent in alcohol content) once or twice a week.

• Drinking more than 15 glasses of wine a week (or its equivalent) can be associated with a reduction in the baby’s birth weight.

• Drinking more than 20 glasses of wine a week can be associated with intellectual impairment in the baby.

conception, and continued alcohol intake at this point, especially if it is heavy, could harm your developing baby. If you frequently drink heavily and think that you will find it difficult to stop it is worthwhile obtaining specialist advice and counselling before attempting to get pregnant.

Alcohol consumption during pregnancy

During the first two months of pregnancy, the developing baby appears to be particularly vulnerable to the effects of alcohol and it is best to avoid alcohol completely at this time. In particular, avoid binge drinking, where you take a large amount of alcohol over a relatively short period, as the effects of this on the fetus are not yet clear. But if you are usually a light drinker and generally healthy, there appears to be very little chance that if you had too much to drink once early in your pregnancy that it will have harmed your baby.

The only way to be absolutely certain that alcohol does not affect your developing baby is to give it up altogether once you know that you are pregnant and throughout the rest of your pregnancy. Indeed, many women find that they lose the taste for alcohol in pregnancy. This may be the body’s natural way of avoiding a potentially toxic substance. However, if you do enjoy the occasional glass of wine, it’s worth knowing that there is no confirmed scientific evidence to prove conclusively that drinking under two glasses of wine a day during pregnancy causes a problem.

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Alcohol in pregnancy

• No one knows what the safe level of alcohol is in pregnancy.

• Drinking ten or more units a week can impair your fertility.

• Higher levels may also disturb the baby’s development.

• Very high levels can lead to fetal alcohol syndrome with physical abnormalities and intellectual impairments.

Fetal alcohol syndrome

There is no doubt that women who consume large amounts of alcohol in pregnancy can damage their developing baby and extremely high consumption of alcohol on a regular basis can lead to so-called ‘fetal alcohol syndrome’. This condition is rare, however, affecting between 1:300 and 1:2,000 pregnancies. The full syndrome affects only about a third of babies whose mothers drink around the equivalent of three bottles of wine a day in pregnancy. The fact that only a third of these babies are affected suggests that other factors such as poor nutrition, genetic make-up or drug abuse need to be present, in addition to heavy alcohol intake, for the syndrome to develop.

Fetal alcohol syndrome has several features: the baby is small; there may be abnormalities in the brain and nervous system that affect development and intellectual ability; there may also be physical abnormalities, such as a short, up-turned nose, receding forehead and chin and asymmetrical ears, causing a characteristic facial deformity.

Coffee consumption before pregnancy

There is no good and consistent evidence that establishes as fact the theory that drinking coffee reduces your fertility. The possibility of an effect has been raised, however, as it has been proposed that caffeine constricts the blood vessels and reduces the blood supply to parts of the body, including the ovaries and the womb, or because it interferes with the metabolism of the female hormone oestrogen.

Remember that caffeine is not only found in coffee. There is caffeine in tea and in some soft drinks like cola.

Coffee consumption during pregnancy

Caffeine crosses the placenta and blood levels in the developing baby are similar to those found in the mother’s blood. There is no good evidence to suggest that caffeine ingested in moderate amounts (up to four or five cups a day) harms the developing baby or causes problems, such as miscarriage or premature birth. However, large amounts of caffeine are not recommended in pregnancy as they might be associated with problems such as miscarriage, so you should avoid drinking more than five cups of coffee a day. Indeed, it is probably best to avoid taking that much caffeine even if you are not pregnant. Interestingly, many women go off coffee in the first few weeks of pregnancy. This might be the body’s own way of limiting caffeine exposure in your developing baby.

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Caffeine and smoking

Smoking is known to be linked to impaired growth of the developing baby. When a high caffeine intake is combined with smoking, however, this combination may have a more injurious effect on the baby’s growth than the effect of smoking on its own.

Smoking and drugs

Despite our awareness that smoking has a seriously adverse effect on our health, with particular concerns in pregnancy, many young women continue to smoke. They often think they will stop smoking when they conceive. However, smoking does not just affect the development of the baby, but also your ability to conceive successfully.

The effects of smoking
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• Smoking reduces male and female fertility.

• Smoking will reduce your baby’s growth.

• While it is best to stop smoking long before conception, stopping during pregnancy will make a difference to your baby and your health. It is never too late to stop.

Research has shown that smoking may triple your chances of not being able to conceive. If your partner smokes, he needs to give up as well. Smoking can damage his sperm as well as expose you to passive smoking. However, if you do stop smoking, your fertility returns to normal.

Smoking robs the body of vitamins, especially vitamins B and C, and can cause a build-up of free radicals in the body. Free radicals are molecules that can damage blood vessels, such as those supplying the placenta, thus reducing the supply of nutrients for the developing baby. So smoking is linked to having a small baby as it reduces the ability of the placenta to supply the baby with all the nutrients and oxygen it needs to develop to its full potential. In addition, if you stop smoking, you reduce the risk of certain bleeding problems from the placenta that can complicate the pregnancy and put both you and your baby at risk. Even after pregnancy it is important not to smoke around your baby. This is because the baby will be more prone to ‘cot death’ and to breathing problems.

All this means that it is important that you stop smoking before becoming pregnant. If your partner is also a smoker, it would be best if you gave up together so that you can support each other. Smoking is a powerful addiction and so it can be very difficult to stop. Your doctor can provide advice or support to help you come off cigarettes or refer you to a smoking cessation programme.

The effects of taking drugs
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Prescription drugs

Certain drugs or medicines can affect your chances of becoming pregnant and could go on to harm the baby in the womb. Equally, you may require medication for your own continued good health. If you take a prescribed medicine on a regular basis, be sure to discuss this with your doctor before you attempt to get pregnant.

When planning on getting pregnant or, indeed, if you are pregnant, you should not take street drugs. These are all potentially harmful to your baby. Some, like cocaine, can lead to birth abnormalities; others, such as heroin, methadone, amphetamines and marijuana, can affect the growth of your unborn baby so that it will be small. There is also an increased risk of premature delivery, bleeding from the placenta and an increased risk of infant death. The baby may also suffer from drug withdrawal symptoms after delivery as these drugs cross into the baby’s body while it is in the womb. The baby’s later development in childhood can also be impaired. In addition, there is a much higher rate of complications to the woman in pregnancy, such as anaemia, infections such as hepatitis and HIV and septicemia from infected needles, and thrombosis (blood clots).