Planning for a healthy pregnancy (Part 2)

So you’ve been working through my prepregnancy list. You’ve got all those bad habits squashed and you’ve reached a healthy weight.

Or maybe, like me, you don’t have any bad habits to quit and your BMI is already between 20 and 30.

You’re (We’re) not off the hook yet. There’s more.

3. Get any pre-existing medical conditions under control

Are you currently on any medications? If so, it’s worthwhile to talk to your doctor and make sure they’re safe for use during pregnancy. If possible, it’s nice to switch to pregnancy-safe medications prior to trying to become pregnant–it can save you the grief of struggling to figure out how to get things under control while your hormones are swinging in early pregnancy (and reduce the chances of your baby being exposed to something potentially harmful while in utero.)

What if you’re not on any medications at present? That’s great, as long as that means that you’re healthy. But if you have asthma, depression, diabetes, epilepsy, lupus, phenylketonurea, polycystic ovarian syndrome, or thyroid conditions that aren’t being treated (or not being treated optimally), you could be putting your pregnancy at risk. If you have any of these conditions (or suspect that you have any of these conditions), it’s best to schedule a preconception appointment with your doctor to make sure everything’s under control.

Additionally, if you or your partner have ever had sex with anyone other than each other, you should have a gynecological exam and get tested for sexually transmitted infections. Getting evaluated and treated prior to pregnancy can make a big difference in the health of your pregnancy.

For my part, I have a thyroid condition, so I knew I wanted to make sure I was taking an optimum dose of replacement hormones. I scheduled an appointment with my doctor to get a TSH (thyroid stimulating hormone) and free T4 test done to check on the adequacy of my thyroid hormones. It looks like I’m doing well now, but I also know that I need to go in for another test as soon as I find out I’m pregnant as dose-changes during pregnancy are very common and can make a big difference to baby’s health.

I’m also on an antidepressant, so I knew I needed to take a look at that too. Depression during pregnancy can be dangerous to mom and baby’s health since depression often leads to a host of unhealthy behaviors, so it’s important that depression be under control. At the same time, antidepressant medications may pose some risk to the baby. For that reason, it’s important to balance the cost and benefits of medicating for depression during pregnancy. If counseling or behavioral techniques are sufficient to manage your depression, that’s fantastic. Otherwise, you want to be on the lowest dose of the safest type of medication that will manage your depression. In general, the safest types of antidepressants are SSRIs (selective serotonin reuptake inhibitors), medications like Prozac and Zoloft. Since my medication is an SSRI, I can stay with my current medication, but I want to find the lowest effective dose. The thing with psychoactive medications, though, is that they can’t just be cut off cold turkey. You need to talk with your doctor about the best way to taper your dose. The plan my doctor and I came up with was that I’d take a full pill every other day with a half pill on the opposite day for two weeks. At the end of two weeks, if my depression was still under control, I could move to a half pill every day, and so on and so forth. Depending on which medication you’re taking and the severity of your symptoms, your doctor may recommend another regimen.

My final medical condition that needed to be checked out was allergies. Grrr. Allergies.

About a third of women experience an increase in allergy symptoms during pregnancy. Another third see no difference in allergy symptoms. The final fortunate third experience a decrease in allergy symptoms. Since my allergies are currently awful, I have a 67% chance that I’ll still have awful allergies during pregnancy. Which means that it would do me well to get them under control (in a pregnancy-safe way) now.

The first step was evaluating what I was already taking and determining whether those medications were pregnancy-safe.

• Guaifenesin (Mucinex)-an expectorant, safety in pregnancy unknown. This is nice but not absolutely required to control my allergy symptoms. I can just drink lots of water or hot tea to keep my fluids running. I chose to discontinue this and use those non-drug options.
• Pseudoephedrine (Sudafed)-a decongestant, generally considered safe during pregnancy but not recommended for breastfeeding. Decongestants dry up body fluids, including cervical mucous (which is helpful when you’re trying to get pregnant) and breastmilk. Which means I could benefit from going off the psuedoephedrine now. To manage nasal congestion, I’m now taking an inhaled corticosteroid, which doesn’t have systemic effects (and therefore isn’t as risky for either pregnancy or breastfeeding.)
• Fexofenadine (Allegra)-an antihistamine, safety in pregnancy unknown. I tried going without and just using the inhaled corticosteroid–but my eyes itch and my sinuses plug, so I have to stay on some sort of antihistamine. The doctor recommended cetirizine (Zyrtec) or loratadine (Claritan), two better studied antihistamines. For now, I’m experimenting with cetirizine, trying to see if I can manage the drowsy side effect by adjusting what time I take it. If that doesn’t work, I may have to go with Claritan (less safe and, at least when I used it back in high school, not very effective for me).

Your process, depending on what sort of medications you’re on or what conditions you’re treating, may be a little different. But the general steps you and your doctor will want to take will be:

1. Evaluate the risks associated with a poorly controlled condition
   For example, uncontrolled hypothyroidism or diabetes can be horrible for the baby. Uncontrolled respiratory allergies? Not so much unless they’re accompanied by uncontrolled asthma. In my case, I’m going without a lot of my allergy meds because the only risk is decreased quality of life for me. If I start having more asthma episodes once I’m pregnant? I’ll probably be ramping back on to some more serious allergy meds
2. Evaluate the risks associated with your current medication regimen
   Depending on the risks of your current medication regimen and the process you went through to get to your current regimen (for example, if you tried multiple medications before you found one that adequately controlled your condition), your doctor may decide that no changes to your medications are needed. On the other hand, your doctor may want to try some lower-risk alternatives to your current regimen.
3. Adjust medications to maximize benefits and minimize risks
   Especially if you’re taking a high risk medication and haven’t tried a lower risk one, your doctor will probably try either switching to a lower risk one or adjusting your dose down to find the lowest possible risk (from medication) while still maintaining adequate control (to avoid risk from an uncontrolled medical condition.)

This step can be a long one, depending on what kind of medical conditions you have and what kind of medicines you’re on. That’s why it’s worthwhile to set up a preconception appointment as soon as you start thinking about trying to become pregnant.

And yes, I’m still not done. I’m guessing there’ll be one or two more installments in the planning section–and then, who knows, maybe I’ll be able to talk a bit about post-planning pregnancy health :-)