Thinking About Starting a Family

When you and your partner decide that it's time to grow a family tree, it's a good idea to make an appointment with your gynecologist/obstetrician for what's called a pre-conception appointment. At this appointment your doctor will go over your family history, your medical history, and your lifestyle to help you plan a healthy pregnancy.

Your Family History

Your mother and father, and grandmother and grandfather, and brothers and sisters—even your cousins!—all have something to say medically about the health of your child-to-be. If you are at risk for carrying a genetic disease that runs in your family or ethnic group (cystic fibrosis or Tay-Sachs, for example), there are things you can do before you get pregnant to decrease the likelihood of passing the gene on to your baby. The facts of your family history will also help your doctor decide if you should be referred to a genetic counselor to talk about hereditary risks, or to a doctor who specializes in high-risk pregnancies, or even if you should be scheduled for tests during your pregnancy to evaluate the health of the fetus. This is all precautionary to help you have the safest and healthiest pregnancy possible.

Although family history is very important in determining your risk for certain diseases and disorders, it's also possible that you might carry a gene that hasn't shown itself in your family prior to your pregnancy. That is why certain races and ethnic groups are routinely screened for genetic disorders. Tay Sachs and canavan disease, for example, are more commonly found in the Eastern European (Ashkenazi) Jewish population, sickle cell anemia in African Americans, thalassemia anemia in those of Asian and Mediterranean descent, and cystic fibrosis in Caucasians. So be sure to discuss your ethnic background at this pre-conception appointment.

Your Medical History

A growing fetus will depend on your body to supply a cozy and healthy place to grow. If you are in overall good health, your doctor will give you the thumbs-up to go ahead and get pregnant. But if you are struggling with health issues, it's best to get them under control before you conceive a baby. If, for example, you have diabetes, you'll want to stabilize your blood sugar before you get pregnant. Or, if you have high blood pressure, your doctor will want to make sure it is under control. If you have other chronic health problems (such as an immune disorder, epilepsy, or asthma) your doctor will want to make sure you're in good health before conception and that your medications are carefully monitored while you're trying to conceive.

Your Lifestyle

It's time to fess up about lifestyle choices that might not be the best for your health—or your baby-to-be. Your doctor isn't going to scold you about drinking coffee or alcohol, smoking cigarettes, or using recreational drugs, but she will want to know honestly how much and how often you engage in these activities. The following substances are known to directly affect the health of a growing fetus:

• Caffeine is a central nervous stimulant that passes quickly to the fetal bloodstream and increases the risk of miscarriage when consumed in excess (more than 8 to 10 servings per day).
• Alcohol increases the likelihood of having a miscarriage, a stillbirth, or babies with low birth weight.
• Smoke and nicotine cause fetal growth retardation, low birth weight, and increased risk of miscarriage, premature birth, or stillbirth.
• Recreational drugs (including marijuana, cocaine/crack, heroine, methadone, LSD, and PCP) can cause severe damage to a fetus.

You'd be smart to clean out these toxins from your body before you get pregnant and break any bad habits. Your doctor can advise you how to do this, and he can refer you to specialists or support groups if you need help.