There’s no better way to ensure a healthy pregnancy than to plan for it and optimize your health before you get pregnant. In my Integrative Gynecology practice I see a lot of women who are trying to get pregnant. They come to see me because they want to make sure they are eating the right foods and want know what to do for their own health to prepare for a baby. I think this is a wonderful thing to do and I recommend you come see me about 3 months before you want to get pregnant, so we have some time to optimize everything.
What does a pre-pregnancy evaluation look like from an integrative/functional approach?
First, we look at your diet and see how you are eating. We review what foods are healthy and what foods need to be avoided. I emphasize a whole foods diet that is largely plant based with some animal protein. I find most people aren’t eating enough vegetables and fruit, way too much processed foods and grains. I like to see a plate that is at least 50% veggies and fruits with 25% protein and 25% carb in the form of grain, legume, or starchy vegetable. We get our fats from healthy oils, nuts, avocados, etc.
We review the importance of eating organic, free range meat/dairy/eggs, and wild fish. Conventional meat, dairy, and fish are simply not as good for you. Conventionally raised animals are fed pesticide laden feed, antibiotics, and hormones. The saying, “you are what you eat” is true, and so is: “you are what you eat has eaten.”
Next, we look at your nutritional status. I do advanced nutritional testing to evaluate the following:
- Vitamins – many people are deficient in Magnesium, B12, Vitamin D. I put everyone on a prenatal vitamin that has 5 methyl folate instead of folic acid (since some people can’t metabolize that well). With testing we can see if you need other vitamins as well.
- Omega 3 and omega 6 fatty acid – many people eat wild salmon or take fish oil supplements which are full of healthy omega 3 fatty acids, but you can still have excess inflammatory omega 6 fatty acids in your diet. Our exposure to the bad kinds of omega 6 fatty acids comes from conventional beef, chicken, the wrong kind of oils, especially processed foods which are full of them.
- Heavy metals – lots of people have elevated mercury from fish. Before pregnancy it is important to look. If you need to modify your diet you can. But if you have very high levels and have signs of long term mercury exposure that needs to be removed, we do that kind of detox before pregnancy. We don’t want to mobilize heavy metals or stored toxins while you’re pregnant because you could inadvertently mobilize them and send them right to that growing fetus.
- Antioxidant – these are the compounds that help handle those toxins and free radicals that your body must neutralize to stay healthy.
Next, we look at your gut microbiome. The many bacteria we have in our GI tract we pass on to our babies. If you have bacteria overgrowth in the colon or the small bowel it is important to figure that out and treat it. If you have lots of GI symptoms like bloating, gurgly tummy, reflux, gas, cramping those are signs that you might have something going on, though many people have disturbances in the gut microbiome without even knowing it.
We evaluate your genital tract for bacterial overgrowth also. Bacterial vaginosis is quite common and is associated with preterm birth and low birth weight. We need to correct BV before pregnancy.
I recommend patients take a probiotic and eat fermented food. There are studies that show that probiotics during pregnancy and postpartum decreased risk of depression which is a huge problem in this country right now.
Avoid plastics (food containers, water bottles, plastic wrap) which contain harmful endocrine disrupting chemicals. Many plastic containers that used to contain BPA are now labeled “BPA free.” Unfortunately, we don’t know about the safety of what has replaced BPA. It is quite possible that the replacement compounds, BPS and others, are just as bad or worse.
Clean up your personal care products to avoid artificial fragrances, parabens, and other harmful chemicals that are hormone disruptors and carcinogens.
I spend a lot of time talking about stress during my visits. Excess cortisol takes its toll on both you and your growing baby. Making sure patients have a way to manage their stress is important – things like meditation, deep breathing, or other activities like a dance class, music, hiking in the woods. Everyone is different and I try to help people find out what is going to work best for them. I encourage patients not to think of these activities as self-indulgent, they are necessities!
I review sleep with everyone because many people don’t sleep well, and your body really needs good quality sleep to function. Pregnancy is a time of high metabolic demands and pregnant women are often tired and in need of extra sleep.
It’s important to exercise during pregnancy so I encourage people to find what they love and do it. Staying fit is important to have a healthy pregnancy and healthy labor and delivery.
Some people want to lose weight before they get pregnant and that is the best time to do so. I help many women with weight loss. I take a thoughtful approach and work with nutritionists and health coaches to assist in the important lifestyle components to weight loss. Eating healthy is truly a way of life.
It’s important to get screened for STDs, get your pap /HPV done and make sure you are up to date with basic screenings. If anything needs treatment, it’s always better to do before pregnancy.
As you can see, there’s a lot to think about! For anyone seeking pregnancy soon, having a pre-pregnancy visit is crucial. We want to help you take inventory of your nutritional needs and lifestyle habits to set you up for having the healthiest baby you can!