Age is important. Younger women have specific nutritional needs that must be addressed. Moms over the age of 35 can have an increased rate of genetic abnormalities and may be at more risk to develop complications in later pregnancy. The complications may be offset by being prepared nutritionally and by more frequent visits throughout pregnancy.
    The age of Dad also is important. There is now evidence that fathers over the age of 50 may have an increased risk of genetic abnormalities. Because the age of Mom and Dad is important, you need to be advised of the risks that may be encountered.

    Having a significant other, be that husband, lover, or live-in friend makes the pregnancy easier to cope with emotionally. Remember, this is a time of extremes in feelings. Your doctor needs to know the emotional support structure you have so that she can give your needs extra attention if the situation warrants.

    Certain diseases are more prevalent in some races than in others. Examples of this are Tay-Sachs disease in those of Jewish heritage, sickle cell disease in those of Black heritage. We will discuss this more when we talk about family history.

    You should have ongoing teaching throughout your pregnancy. Your doctor needs to be aware of your level of understanding so that she can talk to you in language you understand. As an example, if you have completed a college degree in history you should not have things explained in medicalese, but with the medical terms explained in English.

    Occupational and environmental hazards need to be identified in both Mom and Dad. Dad's exposure to chemical, lead, cadmium, PCP's, and other metallurgical agents may affect sperm production and could cause an increased rate of miscarriage.
    Mom may be exposed to solvents, lead, mercury, biologic agents, and pharmaceutical agents that could affect the growing baby. She may need to change her exposure to such agents. An example of this: a photographer who develops her own work may not want to develop the color work since there are agents in the developing solutions that can affect the baby. If you have exposure to these agents, you may want to change the level of exposure before trying to get pregnant. Mom can also be exposed to viruses and other contagious illnesses in the workplace such as we saw with Karen.
    In this computer age, a word about video display terminals is in order. Multiple studies have been done and there is no evidence that video display terminals cause miscarriages or birth defects.
    Physical labor is also important. Heavy physical activity, such as lifting heavy objects may need to be modified.
    Your doctor should discuss these risks in detail with you.

    If you travel for your job, you may have to limit this at the end of your pregnancy. You have to think ahead about altering this. Travel can also expose you to certain diseases we do not see often, such as malaria.

    Animals can carry diseases that can be harmful to the developing human baby. For example, cats carry a disease called toxoplasmosis which will not usually affect an adult if infected. If you have a cat, Dad should start changing the litter box before pregnancy and you should be tested to see if you have ever had toxoplasmosis.

ALCOHOL
    The affects of Mom's alcohol use during pregnancy has long been recognized. It can cause decreased growth before and after birth, specific facial abnormalities (such as low set ears), and mental retardation of varying severity (including learning disabilities and possibly hyperactivity). These problems are called the Fetal Alcohol Syndrome (FAS).
    More recent studies have now shown that Dad's alcohol use can also cause problems. These can include decreased growth before birth, learning disabilities, behavior problems and changes in the babies immune system. These problems are called Fetal Alcohol Effects (FAE).
    There is no question that the mother's alcohol intake can cause the more severe problems. But in light of the recent findings about Dad's consumption, refraining from alcohol should be done by both parents-to-be.

CIGARETTES
    If Mom smokes during pregnancy, she may have up to twice the risk of miscarriage. Decreased growth of the baby before birth has also been seen. Abruptio placentae ( premature separation of the placenta from the uterus), placenta previa (the placenta covering the opening of the birth canal), premature rupture of the membranes (early breaking of the bag of fluid around the baby) and premature delivery can be caused by cigarette smoking.
    There may also be an association between Dad's smoking before pregnancy and an increased risk of brain cancer in the baby in later life, especially if the child is a boy.
    Secondary smoke from Dad or others in the household or in the workplace can increase the risk of minor learning disabilities.
    Cigarette smoking should definitely be discontinued in the pre-conception period. Your doctor can prescribe the patch and/or various behavior modification classes that could help with this.
    A study by the American Medical Association has proved beyond doubt that second hand smoke gets to your baby. If you are around someone who smokes, your baby is 'smoking'.

CAFFEINE
    The use of caffeine has NOT been associated with birth defects of any kind. What may pose a problem is drinking caffeine drinks and not eating. Because caffeine is a stimulant that can affect the baby, Mom may want to limit caffeine use to 3-4 cups/glasses a day. Otherwise the baby may be break dancing all night when you are trying to sleep. If you are a heavy caffeine user, it takes time to decrease your use. The best time to begin is before pregnancy.

ILLEGAL DRUGS
    The use of illegal drugs on a recreational and addictive level, can be a big problem for your child.

MARIJUANA
    The evidence is still not conclusive on marijuana use either in pregnancy or before. Because the question still exists of possible problems, the smart thing is not to use it.

COCAINE
    Cocaine and crack use by Mom during pregnancy has been associated with heart and brain defects, learning disabilities, stillbirth, prematurity and decreased growth. Crack use has been shown to cause abruptio placentae and increase in the number of miscarriages.
    Dad's use of cocaine is has been studied and shows there is been an association with learning disabilities in children born to fathers who used cocaine. Evidence exists that cocaine may attach itself to sperm and be carried to the egg during fertilization.
    Because the effects can be devastating for your baby, illegal substance use should be stopped before attempting to get pregnant.

    The old adage "You are what you eat" can also be applied when preparing for your pregnancy. If you are not practicing good nutrition, this is the best time to correct it. Moms who are more than 10% underweight can have babies who are smaller than they should be at birth. Mothers who are more than 30% overweight have slightly larger tha normal babies and are at an increased risk for complications in pregnancy such as diabetes and high blood pressure.
    Many women are deficient in iron, calcium, zinc and folic acid. Iron deficiency can cause Mom to become anemic during pregnancy and put her baby at risk to be anemic after birth. Anemia is a condition that decreases hemoglobin, which is the blood component that carries oxygen throughout the body.
    Zinc and calcium are also needed to grow healthy babies. Folic acid is extremely important for a healthy spinal cord for your baby. We now know that by giving Mom prenatal vitamins beginning three months before pregnancy, we can decrease the number of birth defects by 50%.

    Continuous high-stress situations affect you and can affect your growing baby. If Mom is under continual stress while pregnant, the baby can stop growing or decide to make an early appearance. This does not mean that daily ups and downs will bother you or your baby, that is part of life. I am talking about continual stress such as job deadlines that cause stress for weeks to months at a time. You will want to assess your situation now so that problems do not occur later. You should also learn to relax now by learning meditation, yoga, biofeedback or anything else that help.