In this day of instant education with medical information readily available at the click of a mouse, Stacy Sands (name changed) still believed that she did not have to visit her doctor for the first time during her pregnancy until after her first trimester (three months). When she finally visited a doctor during the fifth month of her pregnancy, she got what she thought was a light-hearted dressing down from the medical professional for taking too long to seek medical attention. But the doctor's tone quickly changed from light reproach to concern as he told her that all was not right with her pregnancy.

The mother who was in her early 20's said she immediately recalled the early days she had not felt well during her pregnancy, which she had chalked up to the heat and being pregnant for the first time.

Sands is like many women who don't know that there is so much more to a pregnancy than carrying a baby for nine months. She is one of many women who make the mistake of thinking that giving birth to a healthy child starts with pre-natal care - after they've already been impregnated - when in reality, preparations needed to give birth to an optimally healthy baby should have started before pregnancy.

"A pregnancy is something you need to prepare for even before you decide to get pregnant," says obstetrician/gynecologist Dr. Mildred Hall-Watson, who works out of the Healthcare Center for Women at #9 East Avenue North, Centreville. "The thing that [doctors] see, particularly in the public sector, is that the majority of pregnancies are not necessarily unwanted, but unplanned. As a result, women become pregnant when they are not necessarily in optimum health."

Women who are in less than stellar health when they become pregnant can find themselves at risk for diabetes and hypertension, says the doctor. For those women that don't seek early pre-natal checks, when conditions like diabetes and hypertension are present and not controlled prior to the female getting pregnant, they become complications.

Pre-pregnancy goals

"Our goal in pre-pregnancy care is to have women be more aware and properly prepare for a pregnancy so that they can be in optimal health when it happens. This will mean women with hypertension, diabetes, sickle-cell disease, thyroid dysfunction are appropriately diagnosed and treated so they are under control well before they achieve pregnancy because these conditions can affect how a pregnancy will go or its outcome."

For women still in their childbearing years who are open to becoming pregnant in the future, the doctor says it is best to get plans in motions now rather than later, as it is not in your child's or your best interest to wait until you become pregnant to change your habits - especially your dietary ones.

Changes that make an impact prior to even thinking about getting pregnant include regularly eating a balanced diet with adequate amounts from all food groups. Ensuring your body is in good nutritional condition for your own sake starts from childhood and continues into your childbearing years. By the time you start thinking about having children, you should already have been taking extra folic acid and a daily multi-vitamin to ensure your body is in balance and is prepared should a pregnancy occur. Your body should be healthy and prepared to nurture a child before the time comes.

Watch your weight

Weight is another aspect that needs to be taken into account when preparing to have children. The obstetrician/gynecologist says most people take for granted that obesity can affect pregnancies because it is not medically considered an illness and because it is common to see many people with weight problems successfully go through pregnancies.

"We find that patients who are morbidly obese (when your body mass index is above 30.0) tend to develop more of the conditions I mentioned, especially diabetes and hypertension during their pregnancies. They also have a higher incidence of delivering before their term is complete, so this is something that women need to be wary of."

The medical professional is all too familiar with the way women of this nation eat, and the level of obesity in the country, and says it is difficult for individuals to understand just how big a role their weight plays in pregnancies. "You look at other people with weight problems who go through pregnancies successfully all the time and come out okay, but your extra weight has negative affects on the pregnancy, for your health and the baby's that you will have to deal with before, during and even after your pregnancy."

If you are 50 pounds above your healthy weight range, the medical professional says that does not mean you have to lose all those extra pounds before getting pregnant, as it is impractical. But she does advise that if you can, to do it healthily, as it is better to work on getting to your optimal health in your current weight range while losing some weight. This means eating better, taking vitamins and exercising so your body is at least active and healthier than usual prior to pregnancy.

Oral hygiene is important

Oral hygiene is another issue women should focus on during pre-pregnancy, says Dr. Hall-Watson. Having good dental health may not seem like it has any connection to being pregnant, but she says it has a lot more to do with it than women can imagine, and that doctors find that babies born to mothers with poor dental health and ongoing oral problems tend to be smaller weight-wise, and that there is an increase in prematurity in these babies.

"Furthermore, it is important to stay on top of your dental health at this time especially because for the majority of instances, pregnancy has a negative effect on your teeth because of the changes in the level of calcium you will experience as the baby is growing. Many people often don't have pain or know they have dental problems until they become pregnant. If you take better care of your teeth [before you get pregnant], it can eliminate a lot of the problems you can face in this area during pregnancy." Good dietary habits prior to pregnancy is also key, so that your nutritional level is adequate to take you safely through a pregnancy.

"A lot of times, once the pregnancy goes okay without any major complications we tend to feel that all the things I have mentioned before was of no consequence since the child is seemingly fine. The thing is that you do not only want an anatomically healthy child, but one that is going to successfully pass through K4 to K5 to grade one. People just look at the fact that the baby looks fine, is developing fine, behaves well but they don't ask themselves what is happening in the brain."

Having a baby is like building a structure

Dr. Hall-Watson says having a baby is like building a structure.

"You pour down the foundation and if it is poorly constructed, after a while you will start having problems... seeing defects in the building because the foundation is not as good as it should be. The same thing occurs developmentally, particularly from a neurological standpoint. You have a child who is growing well; their weight is appropriate, so then why is it that we can't get this child to read? A lot of what happens to your child down the road has to do with the health and well-being of the mother before she becomes pregnant and subsequently during the pregnancy."

When it comes to actually being pregnant the doctor stresses that you not put off visiting a medical professional. She says doing so heightens the risk of your child having problems that may have been more treatable had a doctor been seen earlier.

"If you find yourself pregnant, go to the doctor as soon as possible. There is something in our communities like a wife's tale of sorts where young women believe that you go to see a doctor after being pregnant for four months. This is not the right thing to do because for a lot of patients the four month lag has many negative affects that could've been picked up earlier in the pregnancies, and we could've maximized what we could do to treat it."

If you are pregnant, you need to get early and regular pre-natal care. "What is good about our community today is that we have more than sufficient access to pre-natal services. There are multiple public clinics in the community which are strategically located so that people from anywhere can access healthcare. Still many do not [use these clinics] even if they live next door to the clinic. But we need women to focus more on the fact that 'Hey, I am already pregnant, so what is the best I can do for this child?' It is more important to focus on that than other issues so that the child has a good, solid foundation from as early as possible. That is a great gift you can give to your child."

Pre-pregnancy changes that can make an impact

oTake extra folic acid and a daily multi-vitamin

oWatch your weight oHave good oral hygiene

oRegularly eat a balanced diet with adequate amounts from all food groups

Things your doctor looks for during your pregnancy

oThat you gain weight steadily throughout your pregnancy -- two to three pounds per month is expected but it can be more due to mother's eating habits. Weight will gradually increase by the last trimester as the baby grows rapidly at this time.

oEnsure your womb is growing normally monthly.

oScreen you for diabetes by 20 to 24 weeks if there is not a strong family history.

oCheck your blood pressure monthly.

oBy five to six months, an ultrasound will be done to check for the anatomical development of the child.

oEnsure patient is not experiencing an unusual discharge which can indicate a problem.

oIf the pregnant female is over 35 years of age, do tests to determine if the child has chromosomal abnormalities such as Down's syndrome.

What your doctor wants you to do during your pregnancy

oVisit the doctor monthly for the first 28 weeks, then every two weeks until 36 weeks and once a week until 40 weeks or you give birth to your baby.

oEat regularly and opt for healthier choices.

oTake vitamins and refrain from smoking.

oAlways keep active during pregnancy but don't do anything too strenuous such as high-paced jogging/running or high impact aerobics. Slow your pace if you are an aggressive exerciser.

oTry pregnancy physio-therapy to ease the strain on your muscles as your pregnancy progresses.

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