Before You Become Pregnant
Healthy babies start with healthy mothers. The preconception period, or the time between puberty and pregnancy, is critical to a healthy pregnancy and pregnancy outcome.
Pre-Existing Conditions
Although certain pre-existing conditions do not preclude women from having a healthy pregnancy, it is important for women with these conditions to take certain precautions and measures to ensure the healthiest outcome for their baby.
Meeting with a prenatal healthcare provider before becoming pregnant is important. Certain pre-existing conditions that require medications may harm the developing baby. Pre-existing conditions may also require special maintenance during pregnancy due to the changes in a woman’s body. A woman and her healthcare provider can determine the best way to manage any conditions that existed prior to or during the pregnancy. A healthcare provider can recommend medications and treatment options that are safer for the developing baby while still managing the mother’s condition (e.g. diabetes, high blood pressure, epilepsy, chlamydia, HIV, etc.).
Pre-Existing Diabetes and Pregnancy
If a woman has diabetes, it is important for her to talk to her doctor before becoming pregnant to discuss how to manage her diabetes during pregnancy. Achieving and maintaining proper control over insulin is important in the prevention of poor outcomes for the baby.
During pregnancy, the baby will use some of the mother’s glucose, and therefore glucose levels may need to be adjusted. Pregnant women should be prepared for low blood sugar reactions by monitoring their insulin, meals and exercise closely to ensure their insulin requirements are being met.
Blood sugar control is extremely important before and during pregnancy as it decreases the risk of certain congenital anomalies (e.g., heart, neural tube, genital and/or urinary system defects). During labour and delivery, blood sugar levels should be monitored and maintained to ensure the healthiest outcomes for the mother and child.
If any of the following symptoms occur during pregnancy, contact a healthcare provider immediately:
Hepatitis B and C
Hepatitis B (HBV) and Hepatitis C (HCV) are viruses that cause serious liver disease. Both forms of the virus can be passed to a baby during pregnancy. It is therefore important to be tested prior to pregnancy as a woman may not even realize she has the virus.
If Hepatitis B is detected before pregnancy, a woman can be treated to prevent her baby from being infected. If the virus is detected during pregnancy, treatment should begin for both the woman and her developing baby. If a woman is not treated for Hepatitis B, there is an increased risk of her passing the virus onto her baby.
There is no vaccine for Hepatitis C. However, a newborn baby can be vaccinated with the Hepatitis A and Hepatitis B vaccines to provide some protection from the Hepatitis C virus.
HIV and Pregnancy
HIV is the acronym for Human Immunodeficiency Virus. This name highlights the fact that HIV can only be transmitted from one human to another human, and that it is a virus that causes a deficiency in the immune system. Once a person becomes infected with HIV, the virus begins destroying the cells that are responsible for the human immune system, making it difficult for the body to fight off infections and diseases.
HIV is a progressive disease that continually causes changes and damage to an individual’s immune system. When a person’s immune system becomes damaged and they contract one or more opportunistic infections (e.g. respiratory infections, fungal infections, cancer) they are said to have AIDS (Acquired Immune Deficiency Syndrome).
HIV can only be transmitted when there is a direct exchange of specific bodily fluids between two humans. The five fluids capable of transmitting HIV are blood, semen and pre-cum, vaginal and anal fluid, and breast milk. HIV can also be transmitted from mother to child during pregnancy and/or delivery. Although there is no cure for HIV or AIDS, with appropriate care and treatment the risk of transmission from mother to infant can be reduced to less than 2%. Without treatment, the risk of transmission from mother to infant is approximately 25%. A woman may not know that she has been exposed to the HIV virus and therefore a doctor will advise women who are pregnant or thinking of becoming pregnant to be tested for HIV.
Sexually Transmitted Infections and Pregnancy
Sexually Transmitted Infections (STIs) are spread through unprotected sexual contact. Many people who have STIs do not know that they are infected because many STIs do not produce visible symptoms. Testing for STIs during pregnancy is very important, as some STIs can be passed on to the developing baby prenatally, during delivery, or during breastfeeding.
There are many different STIs, such as syphilis, chlamydia, gonorrhoea, nongonococcal urethritis, trichomoniasis, hepatitis B, hepatitis C, human papilloma virus, and genital herpes. Certain STIs can cause very serious damage to a baby. For example, untreated syphilis can cause brain damage, blindness, deafness or even death in the developing baby. Many STIs can be treated during pregnancy (e.g., chlamydia, gonorrhoea, syphilis). There are others that cannot be treated (e.g., genital herpes), but knowing a woman’s status presents the opportunity to reduce the risk of transmitting the infection to the baby. For this reason, testing for STIs informs health professionals of the woman’s condition, which can in turn, help to prevent the baby from becoming infected.
Folic Acid
Folic acid is important for the prevention of neural tube defects. Neural tube defects are congenital malformations of the neural tube; the embryonic structure that develops into the brain and spinal cord. Every unborn baby’s spine is open when it first forms, and normally closes by day 26 to day 28 post-conception; this often occurs before the pregnancy is confirmed. In the case of an NTD, the backbone and spinal cord never completely close.
Studies show that women who consume recommended doses of folic acid can reduce the risk of having a child with an NTD by 50% – 70%. However, it is important to note that not all NTDs can be prevented by maternal intake of folic acid. It is therefore very important that all women of childbearing age take folic acid supplements, even if they are not planning a pregnancy, as neural tube defects can occur before a woman even knows that she is pregnant.
The amount of folic acid a woman should take before and during pregnancy, as well as while breastfeeding, is dependent on a number of maternal and paternal risk factors. The Society of Obstetricians and Gynaecologists of Canada classify women as either low risk, moderate risk, or high risk for having a baby with an NTD. Healthcare providers assist women to determine the amount of folic acid they should be taking.
Healthy Lifestyles
The lifestyle choices a woman makes prior to becoming pregnant and during pregnancy can affect her health and the health of her baby. What a woman ingests (e.g. eats, drinks, smokes) when pregnant, can affect her unborn baby. Women should avoid smoking, drinking alcohol, and using street drugs. Women should check with their healthcare provider whether prescription drugs and over-the-counter medications she is taking are safe to take during pregnancy. It is also important to eat a nutritional diet and stay active to maintain a healthy weight. If a woman is in an unhealthy relationship she may need to seek help as domestic violence may begin or intensify during pregnancy.
If a woman finds it difficult to abstain from smoking, drinking or taking drugs; or if she is in an abusive relationship, she should seek help and guidance from a healthcare provider, counselor or close friend to discuss her options.
Alcohol Use and Pregnancy
When a pregnant woman drinks alcohol, there is a chance that her baby will be born with Fetal Alcohol Spectrum Disorder (FASD). FASD describes the range of disabilities that can occur when the unborn baby is prenatally exposed to alcohol. Prenatal alcohol exposure primarily affects the central nervous system (the brain), and can affect physical, behavioural, learning, and social development. It is also strongly associated with mental illness. Because the damage to the fetus affects the developing brain, FASD is life long and is not something that can be “cured”. However, with support, individuals with FASD can lead fulfilling and productive lives.
FASD is a preventable condition … if a woman does not drink during pregnancy there is no chance that her child would be born with FASD. There is no known safe time, kind, or amount of alcohol to drink while pregnant. Binge drinking and heavy drinking have been found to be especially damaging to the developing baby. Stopping or reducing drinking at any time in pregnancy will benefit the child’s health. If a woman is having difficulty stopping drinking, she should ask for assistance from a healthcare provider, counselor, or someone she trusts.
Pregnancy and Physical Activity
Pregnancy should not stop women from being active. Exercise can be safe and enjoyable during pregnancy. In fact, healthy pregnant women should participate in regular physical activity. It’s good for both women and their unborn children.
During pregnancy, women who exercise may benefit from:
Cautions for physically active pregnant women
The Get Active Questionnaire for Pregnancy (GAQ-P) is a useful pre-screening tool for pregnant individuals who wish to start or continue exercising. This tool helps ensure that physical activity during pregnancy is safe and suitable. The GAQ-P helps determine if a pregnant individual should speak with their healthcare provider before starting or continuing physical activity. For more information and to access the GAQ-P, please refer to the document Get Active Questionnaire for Pregnancy.
Prescription Drugs, Over-the-counter Drugs, Supplements, “Street Drugs ”, and Pregnancy
During pregnancy, a woman’s body needs certain nutrients and supplements to give her baby what it needs for proper development. However, there are medications, supplements and drugs that can be detrimental to a developing baby. During pregnancy, an unborn baby is nourished through the mother’s placenta, and this connection allows many substances, including the by-products of many drugs, to pass from the mother to the fetus.
Some prescription medications are teratogenic (agents that can disrupt normal development of the embryo or fetus) and can cause congenital anomalies. It is important for a woman to see her healthcare provider, to discuss her options for managing her condition while pregnant. In some cases the risk to mother, by not taking the medication, may outweigh the risks to the fetus, in which case a doctor will recommend continuing therapeutic use of the medication.
Over-the-counter medications such as cough syrups, painkillers, antacids, nose drops, laxatives, sedatives, diuretics, and vitamin supplements are drugs that should be used carefully and only on the advice of a healthcare provider. Even if a medication has been found to be safe during pregnancy, it is important that women adhere to the recommended doses that have been tested for safety . “Street drugs” (e.g., cocaine, ecstasy, heroin, methamphetamine) can have harmful effects on the developing baby and expectant mother. Some drugs are associated with a risk of congenital anomalies, miscarriage, preterm birth and low birth weight as well as possible withdrawal in the newborn. Drugs may also be passed through the mother’s breast milk and can have varying effects on the infant. If a woman has difficulty stopping her drug use, she should seek assistance from a trusted healthcare provider or counselor.
Smoking and Pregnancy
Smoking has a negative effect on a woman’s health before she becomes pregnant and can be very harmful to both the woman and her baby during and after pregnancy. Any exposure to cigarette smoke can affect a woman’s reproductive, prenatal and physical health. Pregnant women who smoke or who are exposed to second-hand smoke have a higher risk of pregnancy complications such as miscarriage, ectopic pregnancy or gestational hypertension. Chemicals from tobacco smoke, such as carbon monoxide and nicotine, can cross the placenta to affect the unborn baby. Babies born to mothers who smoke have a greater risk of preterm birth and low birth weight, as well as low oxygen levels, developmental and learning problems, visual and respiratory problems, bleeding in the brain and jaundice.
Environmental tobacco smoke (ETS), also known as second-hand and third-hand smoke can also cause health problems for children after birth. The harmful products in tobacco smoke can also be passed to the infant in breast milk. When children breathe in second-hand smoke, they are passively smoking, which can cause ear, throat and/or lung infections, asthma, allergies, coughing and wheezing. Babies born to mothers who smoke are also at a greater risk of dying of SIDS (Sudden Infant Death Syndrome).
Third-hand smoke, the chemicals from smoke that remain even after the smoke is gone, is also dangerous. Third-hand smoke can get trapped in hair, skin, fabric, carpet, furniture and dust, and buildings over time. These chemicals pollute the air and can therefore adversely affect people’s health. Infants are especially susceptible to third-hand smoke because they breathe more quickly and spend more time on the floor where there is a build-up of chemicals. The effects of ETS will continue to harm the health of children and their mothers until smoking is completely removed from their environment.
For more specific information on tobacco use and pregnancy, see the resources below:
Newland, J. (2009). Do your patients know about third-hand smoke? The Nurse Practitioner, 34(2), 5. doi: 10.1097/01.NPR.0000345259.26880.43
Infant Mortality
Infant mortality is a universal indicator for the overall health of a population. Health Canada describes it as the “single most comprehensive measure of health in a society” (Health Canada – Government of Canada, 2011). It is measured using the infant mortality rate, calculated as the number of deaths of infants less than one year of age per 1,000 live births.
Although the infant mortality rate in Saskatchewan has decreased since 2005, as of 2009 it was still well above the Canadian average and the highest among all the provinces in Canada. In 2009, the rate of infant mortality in Canada was 4.9/1,000 live births. The rate in Saskatchewan in the same year was 6.7/1,000 live births (Statistics Canada, 2012).
The infant mortality rate of a given population can provide valuable information about the health of that population. It can speak to the behavioural and social factors affecting the population and the interventions that may be required. The leading causes of infant mortality in Saskatchewan are:
For more information about infant mortality and its risk factors, please read the Saskatchewan Prevention Institute’s report on Infant Mortality in Saskatchewan: Evidence to Inform Public Health Practice.
This report outlines some promising practices to reduce infant mortality. A report from Health Canada, titled “Healthy Canadians – A Federal Report on Comparable Health Indicators 2010”, is also a valuable source of information on this very important topic.