Preconceptual Planning and Education with Dr. Dani Steininger, MD, FACOG

Board-Certified Dr. Dani Steininger shares her tips and tricks for preconceptual planning and education. Read further to learn how you can better prepare for pregnancy and take proactive steps to increase the chances of a seamless delivery and a healthy baby.

Ashley: Why is it important to know my family health history before having a baby?

Dani: Some diseases are passed down genetically and can affect your child’s health before or immediately after their birth. It’s important to know these things ahead of time because it will change how we manage your pregnancy and possibly delivery.

A: When is a good time for genetic testing?

D: There are two main types of genetic testing that your OB/GYN can do that will affect your pregnancy: testing the parent’s genes and the unborn child’s genes. Genetic testing for parents can happen before or after they conceive and is recommended before getting pregnant or early in pregnancy. The child’s genes can be tested about 10-12 weeks after their mother’s last menstrual period. We do this by drawing the mother’s blood and extracting fetal DNA from her blood. Then, we test that for major chromosomal anomalies. Both of these tests can help us better prepare for what may turn out to be a high-risk pregnancy.

A: How long will it likely take me to get pregnant?

D: It’s a roll of the dice every month. About 15% of healthy couples will get pregnant having regular unprotected sex every month. By the end of six months, that increases to 60% of healthy couples will be pregnant. After a year, it’s about 90%. Keep in mind, these are all just statistics and it varies in each couple’s situation. Some people will get pregnant the first month they try, whereas others won’t get pregnant until later. Many couples ask me if they should start trying ahead of time in order to guarantee they’re pregnant by a specified time in the future when it will be a better time to be pregnant. My opinion as a physician and a parent: don’t start trying to get pregnant until you’re ready to be pregnant, but also, there’s no perfect time to get pregnant or have a child.

A: How long will it take for a fetus to show up on a pregnancy test? An ultrasound?

D: Home pregnancy tests have gotten really sensitive and are almost as good as our office testing. Most of them can tell you’re pregnant within the week that you miss your period. All of them should be positive by two weeks after you miss your period, if you have regular cycles. I always recommend taking two tests at the same time just in case there’s a false positive or a false negative.

An ultrasound, performed through a woman’s vagina, will be able to visualize a normal pregnancy at about five to seven weeks after her last menstrual period. We can usually see a heartbeat by seven weeks through this method. An ultrasound performed through a person’s abdomen won’t be as sensitive and can’t definitively diagnose pregnancy until later.

A: Are most medications safe to take during pregnancy? Which ones aren’t?

D: Medications during pregnancy are complicated because up until the past few years, it’s been considered unethical to specifically study medications’ effects on pregnant women. Now, we consider it unethical not to. The tide’s changed largely due to the problem we have recommending medications for pregnant women without much evidence. For pregnant women who take prescription medications regularly, I highly recommend a preconception consultation to discuss your individualized risk-benefit for continuing this medication once you become pregnant vs. switching to another medication that may be better researched and safer during pregnancy. Don’t discontinue prescription medications on your own without direction from a physician. If you find yourself unexpectedly pregnant while taking a prescription, call your doctor right away.  As far as over the counter medications, prenatal vitamins are always recommended. Acetaminophen is safer in pregnancy for minor aches and pains than other over the counter pain relievers. It’s usually safer to not take medications for minor aches and pains There’s also been a rise in non-medication treatments, which include heat and rest of minor aches and pains, which hold very little risk for your pregnancy and I fully support.

A: What prenatal vitamins do you recommend and how much of each?

D: Most traditional pressed pills or capsules marketed as prenatal vitamins are safe and have the full recommended spectrum of vitamins and minerals. Meanwhile, gummies don’t have all that nutrients in them. I only recommend gummy prenatals to women who are experiencing nausea early in their pregnancy and find their regular prenatal vitamins are making their symptoms worse. Check the nutrition label, but prenatal vitamins should contain 800-1000Mcg of folic acid, 1000-4000 iU of Vit D, 27-30Mg elemental iron and 1000-1200Mg calcium.

A: How long before trying to conceive should I stop taking my birth control pills?

D: Once the medication in birth control pills is “out of your system,” usually about 48 hours after taking your last hormone pill, many women have a hormone withdrawal bleed, or a period. It usually takes one to three months after stopping the pills for the complicated signals of our monthly hormones to result in ovulation again. You can get pregnant the first month after stopping birth control pills, but there’s some evidence that the risk of miscarriage is slightly higher in those first few months. We think this is because hormones have not returned completely back to normal yet. However, more studies are needed to clarify exactly why. To simplify things, I usually recommend using a condom after stopping birth control pills and wait for two normal periods before trying to conceive.

A: If I can’t conceive, what could be the cause?

D: The most common causes of difficulty conceiving are irregular ovulation and a lack of quality sperm. If a woman isn’t having a predictable period every four weeks, give or take a few days, then I recommend seeing an OBGYN to evaluate what’s going on. Beyond that, a lot of different things can cause difficulty conceiving and it’s reasonable to consult with your OBGYN or fertility specialist. It’s also a fair move to just try to conceive and see what happens. Most people won’t have difficulty conceiving — half of recorded pregnancies are unplanned. Just because a couple hasn’t conceived after years of sex on birth control, doesn’t mean that they can’t. It just means the birth control method they’ve been using hasn’t failed.

A: When is it ok to tell my loved ones I’m pregnant?

D: I recommend couples tell their loved ones when they feel ready to. However, consider the risk of miscarriage is about 20-25% in early pregnancy. It goes down exponentially after the first few weeks and decreases to about 1% or less after 14 weeks. Before 14 weeks, I suggest you tell those with whom you would feel comfortable discussing a miscarriage. For some people that’s their partner. For others, they’d share that on social media, but for most, it’s close friends and family.

A: What do you wish your patient’s knew before pregnancy?

D: Take care of yourself and become the healthiest you can before you get pregnant, but don’t strive for perfection. Take your prenatal vitamins a few months before getting pregnant to ensure you build up nutrients in your body and are ready to nurture a baby. Make sure you’re up to date on all your vaccinations since it’s not safe to get some vaccines during pregnancy. For those who don’t have a chance to do this, don’t worry. You’re not alone; fifty percent of pregnancies are unplanned. Take control of what you can by taking your prenatal vitamins and calling your doctor.

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