Pregnancy Info

When a couple has fertility problems, it’s usually the woman who wants to get advice early on, but there’s no point in her doing this on her own. If a couple is having difficulty in conceiving, it really doesn’t make sense for the man to delay testing. A semen analysis should always be the first test to be done if fertility is to be investigated.

How Men Can be Helped

Studies suggest that sperm counts decreased during the 20th century because of environmental factors such as exposure to estrogens in foodstuffs and chemicals used in the plastics industry that enter the food chain. At one time, much more was known about female infertility than male, but fertility clinics now deal just as much with male problems and diseases. There’s a greater chance than ever before that men who have low fertility or are infertile can be helped to achieve natural fatherhood.

Male infertility has nothing to do with virility. A man’s sperm may be incapable of fertilizing an egg, yet he may be an excellent lover. In contrast, a man who is unable to make love to a woman may have perfectly viable, fertile sperm.

Semen Analysis

One of the first tests for a man is semen analysis. Two samples are usually analyzed, since sperm counts can vary according to circumstances, such as how often he has sexual intercourse. The analysis checks the number of sperm in a sample, how well and how much they move, and their shape. Many specialists believe that even a relatively low sperm count may not affect a man’s fertility. But if he has a low sperm count combined with many sperm that are malformed, move poorly, or both, or if there is a high white blood cell content, then it’s likely that his fertility will be affected.

Low sperm counts - There are several types of low sperm counts. A semen analysis decides which of the following definitions apply to a particular sperm sample.

• Azoospermia: there’s no sperm in the semen, either because the man cannot make sperm, he has a blockage affecting the sperm transportation, or he fails to ejaculate
• Oligospermia: there are fewer than 20 million sperm per ml of semen. A mild case is fewer than 10-20 million, a moderate case is 5-10 million, and a severe case would be fewer than 5 million
• Aesthenospermia: sperm are unable to wriggle even if the count is normal
• Teratospermia: a high number of abnormal sperm. This is severe if the man has more than 70 percent abnormal sperm, possibly caused by a chromosomal abnormality or by some kind of environmental damage.

Secondary Test For Sperm Function

After routine semen analysis, microscopic tests of sperm function would be done only at a specialist clinic as part of the secondary stage of investigation of a couple with infertility problems. Special tests examine

• the ability of sperm to penetrate mucus so they can get through the cervix to the uterus, and from there to the tubes and egg
• the ability of the sperm to recognize the egg and latch on to it­
  the first step in fertilization (the acrosome test)
• the ability to fuse with and fertilize the egg (the egg penetration or hamster test).

Many women “know” when they’ve conceived. The special intuitive feeling is probably due to the very early outpouring of female hormones. First of all, you’ll have prolonged high levels of progesterone (which you don’t experience unless you’re pregnant). Then fetal tissues start to produce human chorionic gonadotrophin (hCG) as soon as the embryo is implanted in the uterus, about seven days after fertilization.

Suspecting that You’re Pregnant

A few classic signs can make you suspect that you’re pregnant before you do a test to make sure.

Missed period You may miss a period within two weeks after conceiving your baby. Although pregnancy is the most common reason for a missed period, it’s not the only one, so don’t take this as an absolute sign of pregnancy. There are other things, such as jet lag, severe illness, surgery, shock, bereavement, or great stress, that can cause you to miss a period. Periods don’t always stop in pregnancy, though. Some women continue having light periods up to the sixth month, and occasionally all the way through their pregnancies.

Urinating more often As soon as your progesterone levels rise and the embryo starts to produce hCG, blood supply to your pelvic area increases, which leads to pelvic congestion. This affects the bladder, which becomes irritable and tries to expel even the smallest quantity of urine. This is why most women feel like they want to pass urine more often than usual, although it may be in only very small quantities. This can happen as early as one week after conception.

Tiredness The very high levels of progesterone in your body have a sedative effect on your body, and this is one of the reasons for tiredness when you’re first pregnant. Early in your pregnancy, your metabolism speeds up to support your developing baby and your vital organs, which are having to do so much more work than usual. This can cause you to feel so tired that there’s nothing you can do but sleep. If that’s how you feel, you must rest-for your sake and your baby’s.

Odd tastes and cravings Your saliva often reflects the chemical content of your blood and, as hormone levels rise, the taste in your mouth can change-many women describe it as metallic. You many also notice that certain foods taste different from normal, and that you stop liking things you usually enjoy(coffee is a common example)

Some women begin to crave certain foods-and occasionally want to eat very strange things, such as coal. There’s no real scientific explanation for this, but cravings may be the body’s way of trying to make up for a deficiency in certain minerals and trace elements. It’s best to control cravings for inedible substances and for high-calorie foods that are low in nutritional value. Otherwise, there’s no harm in eating what you feel like, within reason.

Morning sickness Although it’s most common in the morning, nausea can come on at any time of day. It’s more likely to affect you if you don’t eat often enough and your blood sugar level is allowed to drop.

Smell You may notice that your sense of smell becomes more acute when you’re pregnant, and everyday odors such as cooking smells make you nauseous. Perfume may also affect you this way, and the way your own perfume smells on you may also change, because your skin’s chemistry alters.

Breast changes Even at the start of pregnancy, you may feel changes in your breasts. They may become quite lumpy and sore to the touch; your nipple area may feel tender and sensitive, and will also deepen in color; and veins in your breasts may look larger and more obvious.

Confirming that You’re Pregnant

Once you suspect that you might be pregnant, you’ll want to confirm it as soon as possible. There are a number of tests that can be done at different intervals following conception. Some are more accurate than others.

Urine tests The pregnancy hormone known as hCG (human chorionic gonadotrophin) can be detected in your urine. Urine tests can be done at home, at your doctor’s office, at family planning clinics, in a hospital, or at a pharmacy. These tests are more than 90 percent reliable. They can be carried out as early as two weeks after conception, although you’ll get the most reliable result if you wait four weeks longer before taking them.

Blood test This test has to be carried out by your doctor and is usually only done when there’s a problem such as bleeding or pain, or after a cycle of assisted reproduction. The test also accurately detects the hCG in the blood as early as two weeks after conception-about the time your next period is due.

Internal examination At your first prenatal visit, you will probably have blood tests, a pelvic exam, a pap smear, and possibly an ultrasound to confirm fetal viability. A pelvic exam can help the doctor estimate how many weeks pregnant you are.

Home Testing

You’ll probably prefer to find out whether or not you’re pregnant in the privacy of your own home so you’re sure of complete confidentiality. There are a range of pregnancy testing kits available from pharmacies. They’re all simple to use and give immediate results that are more than 90 percent accurate.

How the tests work Urine tests check for the presence of hCG (human chorionic gonadotrophin), the hormone that’s made by the developing embryo. Two of the main types, the ring and the color tests, involve mixing a chemical solution with a sample of your urine. The chemicals react according to the amount of hCG in your urine. The reaction is shown by a color change in the tube or window strip, or coagulation is prevented, causing a dark ring to appear in the tube. A third test can be done by simply placing the absorbent part of the test in contact with the urine. Signs of hCG may be detected in urine from two weeks after conceiving. Most kits advise using the test between one and four days after the first day of your missed period. If you do perform the test then, repeat it two weeks later when the hCG is more concentrated and the result will be more reliable. Most kits provide two tests so you can confirm the first result.

Take care Use a sample from the first urine you pass in the morning because it will contain a higher concentration of hCG. Don’t drink anything before the test, because this will dilute the sample. Make sure you collect your sample in a clean, soap-free container. Follow the kit’s instructions very carefully and don’t use the test if it’s been damaged in any way or is past its expiration date. If you can’t do the test immediately, store your urine sample in the refrigerator, but don’t keep it for more than 12 hours. Unexpected result Sometimes you may have a positive first test but a negative second test, followed by your period starting a few days later. Don’t worry. Half of all conceptions don’t become established pregnancies, as the fertilized egg fails to implant in the lining of the uterus and there’s a natural termination. Your first test may have been positive because it was done before the fertilized egg was lost. To avoid this error, do the test around the time of your first missed period. If there’s a weak but positive result, repeat the test a few days later with a fresh sample.

Expected Arrival Date

Once you know you’re pregnant, your next question will almost certainly be “When will my baby be born?” There are usually about 266 days or 38 weeks between conception and birth. This is the same as 40 weeks from the start of your last menstrual period (LMP) because ovulation, and therefore conception, is normally two weeks after the start of your period. You can work out the approximate date of your baby’s arrival calculating from the first day of your last period. The estimated date of your baby’s delivery (EDD) is therefore at 280 days (40 weeks) from the first day of your last period. How accurate this date is depends on whether you have a regular 28-day cycle. If your menstrual cycle is shorter or longer, your delivery date may be earlier or later. If you conceived immediately after coming off the pill, it will be harder for your health care provider to give you a firm date, and they will probably have to be guided by your baby’s growth. Medical staff use the EDD when monitoring your baby’s development and checking the expected rate of growth. Sometimes too much emphasis is put on this date, leading to unnecessary intervention, and doctors may want to induce labor if they believe your baby is overdue. However, risks to you and your baby don’t rise much until after 42 weeks, and most doctors are prepared to let a pregnancy continue, without inducing, if tests show the baby is not at risk.

If you’re having difficulty getting pregnant, it doesn’t necessarily mean you’re infertile. Infertility means different things to different people; it certainly means something different to doctors and to couples. Most couples who think they are infertile are only subfertile, and with help they do manage to conceive successfully.

What is Infertility?

Fertility isn’t always a straightforward case of being able, or unable, to conceive. A couple may have no difficulty in conceiving their first child but find they cannot get pregnant a second time; this is called secondary infertility. Another couple, who have both had children with previous partners, may now find that they cannot conceive together.

The fertility of a couple is the sum of their individual fertilities. If both partners have fertility problems, it may be hard for them to conceive. But if one partner’s fertility is strong, it may still be possible for the couple to conceive. Most couples do conceive within four to six months of trying. If a couple doesn’t manage to get pregnant after six months and they go to their doctor for advice, they’re likely to be told to go away, keep trying, and come back after a year if nothing happens.

Age is a factor for women. As a woman gets older, the quality of her eggs declines. Statistics show that about 90 percent of women in their twenties will become pregnant within a year of trying, and the rest still have a good chance of becoming pregnant naturally within another year or so. But women in their thirties have a much lower statistical probability of becoming pregnant after a year of trying. They shouldn’t wait any longer to get advice.

Ways in which a couple can be helped to conceive a child range from simple advice on sexual technique to drug treatment, surgery, and ultimately the new assisted reproductive technologies (ART). The help is there, but the investigation of infertility can try your patience and resolve. Whichever partner has the fertility problems may feel threatened and even guilty, so be prepared to be generous and supportive.

The Emotional Impact

Couples who are having problems conceiving may be having other difficulties, too. And if they do go ahead with treatment for infertility, they may find it very stressful-it can mean almost intolerable interference with their sex life and can even erode the love a couple feels for each other. The huge financial costs of investigation and treatment can also be a major source of stress. so it’s vital for both partners to be fully committed to this course of action.

Most couples see children as an extension of themselves, as someone to carry on the family name as well as an expansion of their hopes, aims, and ambitions. Being unable to have children can seem like a denial of basic human rights, and an infertile couple can experience feelings of injustice, great disappointment, and grief. The unfulfilled desire for children is a major crisis in the lives of some couples and can made them feel bad about all aspects of life, as well as depressed and guilty. One or both partners may become introspective and antisocial and the relationship may break down under the strain.

The Importance of Counseling

With all the tensions that surround the treatment of infertility, couples need and deserve sound psychological support. If you do decide to start on a course of investigation and treatment, ask your doctor to refer you to a counselor who can help you with the stress of infertility at all stages of its management. Don’t feel you have to wait until you find yourselves well into secondary referral; you need help and advice right from the start. Some procedures involve deep self-questioning, which strikes right at the heart of your relationship, and a couple will need a great deal of support. The treatment can also be lengthy and invasive, and there are many ethical issues surrounding assisted reproductive technologies, insemination, and the use of donors.

Psychological factors affecting fertility - The way you feel can in itself affect your fertility by causing a hormone disturbance or impotence. So without proper support, fertility treatment may make matters worse. On the other hand, doctors have plenty of anecdotal evidence that some couples suddenly conceive very soon after making the decision to have their infertility investigated. It’s as if making the decision to do something about the problem releases the psychological tensions that may have been stopping them from getting pregnant.

Unexlained Infertility

About 15 percent of couples suffering from fertility problems have to face the fact that their infertility cannot be explained. In those couples, it’s tempting to consider radical treatments, but experts generally agree that it’s best for them to wait for up to three years, depending on how old the woman is, to see if anything happens naturally. After this there are treatments that can be successful such as GIFT and intrauterine insemination as well as ovarian stimulation by FSH (follicle­Stimulating hormone).

Drug treatments with clomiphene, danazol, and bromocriptine are not effective. Investigation to find out whether there could be immunological factors involved may also be fruitful.

The miracle of birth begins when one of your partner’s sperm fuses with one of your eggs to form a single cell. This cell contains its own unique genetic blueprint, which is a mix of genetic material from both parents. The cell then divides and divides again until eventually a new human being is made. The vast majority of normally fertile couples manage to conceive within the first two years of trying.

A woman’s entire stock of eggs is made in her two ovaries before her birth. By the fifth month of development, a baby girl’s ovaries contain about seven million eggs. Many of these eggs will die before she’s born, leaving her with about two million eggs at birth. Eggs continue to die until at puberty most women have between 200,000 and 500,000 eggs. Of these, only 400-500 mature, and they’re released by the ovaries during a woman’s fertile years at the rate of roughly one a month.

The ovaries are located in the pelvis, close to the trumpetlike endings (fimbriae) of the fallopian tubes. The germ cells that eventually develop into a woman’s eggs form in the yolk sac that sustains the embryo in the first weeks of development. If the embryo is male, these cells are reabsorbed as the placenta develops. If the embryo is female, about 100 germ cells actually move from the yolk sac, along the umbilical cord, and into the tiny female embryo. Once inside the embryo, the cells migrate to the tissues that will later develop into the ovaries, and there they begin to multiply.

The Ovarian Cycle

During a woman’s reproductive life, her ovaries release eggs in cycles. Each of these ovarian cycles lasts about 28 days, and the development and release of an egg ready for fertilization by a sperm is called ovulation. Ovaries usually ovulate alternately. In the first half of each ovarian cycle, about 20 eggs begin to ripen, and occupy fluid-filled sacs (follicles). One of these follicles, outgrows the others, matures, and then ruptures, releasing its egg. This happens on or around 14 days before the end of the cycle, whatever the total length of the cycle. The other follicles that had started to ripen then shrivel up and their eggs die.

The ruptured follicle becomes a yellow-colored structure, called the corpus luteum. This grows for some days and produces the hormone progesterone, which is essential for the development of an embryo. If the egg is not fertilized, however, the follicle withers away.

A new cycle begins when the lining of the uterus, which is called the endometrium, is shed at the beginning of the woman’s next period.

Very few couples will need genetic counseling, but if you do, the main aim is to discover how great a risk you run of passing on an inheritable disease to your child, Perhaps you’re worried because you or your partner have a blood relative (including, perhaps, a previous child) who has suffered from an inheritable disorder. Depending on what you find out, a genetic counselor will also help you decide whether or not to go ahead with trying to conceive.

How Genetic Counseling Works

When you first meet a genetic counselor, you’ll be asked lots of questions about your health, and about your family background. Take along as much information as you can-you may need birth and death certificates of close relatives, for example-and be prepared for the whole project to take some time. The advice you’ll be given at the end of it depends on a precise diagnosis of the disease (what it is and why it happened), and on the making of a family tree, with details of all blood relationships and any diseases suffered. Your counselor will assess the degree of risk in your case and help you make an informed decision. If there’s a small risk, you may decide to go ahead and try for a baby. If the risks are very great, you may prefer not to take that chance.

For many genetic disorders, such as sickle-cell anaemia or Tay-Sachs, prospective parents can be checked to find out if they are carriers. This can be done by seeing evidence of the disease itself, such as sickle-shaped cells, on a blood sample; by looking for the product of the disease, such as the proteins that are present in Tay-Sachs; or by flagging a gene or chromosome. Flagging is a sophisticated technique that is used to find out if a fragment of DNA will attach itself to the patient’s chromosome. If it does, the gene, and therefore the disease, is present; if not, it’s absent. In most diseases, though, more than one gene is involved, so it can be difficult to check all the elements involved. This is true of cystic fibrosis, although at present the diagnosis can be more than 90 percent certain.

If a couple has already had a child with a congenital defect, the counselor will first rule out any possible causes that aren’t inherited-for example, rubella. Other possible causes such as exposure to radiation, drugs, or injury will also be looked at. The counselor will examine the child and will arrange for genetic testing to be done.

Sometimes it can be difficult to pinpoint the exact cause of a problem, but you’ll be given as thorough a diagnosis as possible, and your chances of having another child with the same disorder outlined. Remember that many disabilities are not genetic and cannot be predicted; genetic evaluation can only reassure you that there’s no evidence of an inheritable disease.

The Importance of Your Family History

A counselor will examine the medical history of both your families to find out if there’s any pattern of disease over several generations. For example, James, a six-year-old boy, was suffering with painful, swollen joints. During a conversation with James’ parents, the counselor learned that a cousin, and probably a great-uncle as well, suffered from the genetic bleeding disorder known as hemophilia, which is carried on the female X chromosome.

This information pointed almost immediately to the probable diagnosis-James, too, was suffering from hemophilia. The pain and swelling that he was experiencing was caused by the blood that was leaking into his joints.

Genes are chemical codes that control the way every cell in the body works. A gene is a minute unit of DNA (deoxyribonucleic acid) carried on a chromosome, which is also made up of DNA. In every body cell, there are at least 50,000 unique genes.

The “Blueprint” of the Body

Genes influence and direct the growth and working of everything in the human body. They control the pattern for growth, survival, reproduction, and possibly even aging and death for each individual. All cells (except for egg and sperm cells) come from the single egg fertilized by the male’s sperm, so the same genetic material is duplicated in every cell in your body. But not all the genes in an individual cell are active; it’s where the cell is and what it does that determines which genes are active. For example, different sets of genes are active in bone cells and blood cells.

With the exception of identical twins, there are lots of differences in people’s genetic makeup. Genes account for all the little variations in height, hair and eye color, body shape, and gender, for example. Your genetic inheritance also decides how likely you are to have certain diseases.

Chromosomes Genes are carried in pairs along a chromosome and each gene is either dominant or recessive. A recognizable effect is the result of the dominant gene or genes in each pair; the effect of recessive genes will only be seen when there are two recessive genes. Every cell in your body, except egg and sperm cells, normally contains 23 pairs of the threadlike structures called chromosomes. Egg and sperm cells contain only 22 chromosomes plus an X or Y chromosome. Each chromosome contains thousands of genes that are arranged in single file along its length. Chromosomes are made up of two chains of DNA, which are arranged together to form a ladderlike structure, the sides of which are sugar-phosphate molecules. This spirals around on itself and is known as a double helix. DNA has four bases (adenine, cytosine, guanine, and thymine) arranged in different combinations according to the functions of the genes on the different parts of the chromosome. Each combination of bases provides coded instructions that control and regulate the various activities of the body.

Genetic Counseling

Inside the nucleus of each cell are the genes and chromosomes that control how the body develops and functions. Genetic disorders happen when genes and chromosomes are abnormal. Genetic diseases can be caused by a single defective gene, several faulty genes, or a fault in the number or shape of chromosomes. There may also be complicating environmental factors. A single defective gene that results in a genetic disorder can be either dominant or recessive, a mutation, or attached to the X chromosome. Abnormal chromosomes that result in genetic disorders are usually new mutations, but may be inherited.

If either of you has a history of a genetic disease in your extended family, it’s best to ask for genetic counseling before getting pregnant. The number of tests available for genetic diseases is increasing every year, although they can’t tell how severe the condition is likely to be. The ultimate decision about whether to attempt to conceive, to go ahead with an existing pregnancy, or to ask for a termination is always up to you, the parents. It’s a hard choice, but always remember that although a handicapped child will need lots of special care, many are both affectionate and responsive, and can lead happy, fulfilled lives.

Dominant Genetic Diseases

Fatal diseases due to dominant genes are rare because affected individuals normally die before they can pass on the genes. However, some, such as familial hypercholesterolemia, can be managed.

Familial hypercholesterolemia FH is the most common dominant genetic disease. Sufferers have such high levels of blood cholesterol that they risk heart attacks and other complications caused by narrowing of the arteries. This condition affects one in 500 people and can be detected by a blood test at birth.

Recessive Genetic Diseases

A defective recessive gene is usually masked by a normal dominant one. But if both parents carry a defective recessive gene, each of their children has a one in four chance of inheriting both recessive genes (and therefore one of several disorders) or neither, and a two in four chance of being a carrier. Thus there are always more carriers than sufferers.

Cystic fibrosis CF is the most common recessive gene disorder. One in 20 of the white population carries the CF gene, and one in 2,000 white babies born is affected by the disease. In nonwhites, the incidence is about one in 90,000. This disease mainly affects the lungs and the digestive system. The mucus inside the lungs becomes thick and sticky and builds up, causing chest infections. The mucus also blocks the ducts of various organs, particularly the pancreas, preventing the normal flow of digestive enzymes. If not treated promptly, CF results in malnutrition. Rapid and accurate carrier testing involving analysis of blood or mouth cells is possible. Over 60 percent of sufferers survive into adulthood; some have been helped by heart transplant surgery.

Sickle-cell anemia This is the most common genetic disease among black people (one in 400). It’s so called because the red cells are sickle-shaped from defective hemoglobin; this causes them to break down and the small blood vessels to clog, which may result in a stroke. It’s usually diagnosed by a blood test, and the mother will be offered chorionic villus sampling (CVS) if both parents are sufferers. People with sickle-cell are susceptible to meningitis and other serious infections but can, with care, live a productive life despite some ill health. Being a carrier of sickle­cell does give protection against malaria.

Thalassemia This is common among Asians and black people, and people of Mediterranean descent. The gene may be dominant or recessive. It causes anemia and chronic ill health, and sufferers may need blood transfusions. If you’re at risk, you can have a blood test to check for the disease and find out whether your hemoglobin level is reduced. Thalassemia can be severe, but many cases are mild, allowing people to live more or less normal lives.

Tay-Sachs disease Common among Ashkenazic Jews, this is a fatal condition causing deterioration of the brain because of a deficiency in enzymes. Few children with the disease live beyond three years, and no adequate treatment is known. Tay-Sachs is diagnosed by testing blood for enzyme deficiency.

Gender-Linked Diseases

These are conditions caused by defects on the X chromosome, and only men are affected. If a second normal X chromosome is present, as in a healthy female, it compensates for the abnormal gene. Women, therefore, only carry the disease. Men with the
abnormal gene do develop the disease because they have only one X chromosome (the other is a Y chromosome).

Hemophilia This results when the crucial protein involved in blood clotting, Factor VIII, is missing. Sufferers bleed profusely from any injury, external or internal. Effective treatment with factor VIII derived from normal blood is now available, and hemophiliacs can lead relatively normal lives. Diagnosis can be made from a sample of fetal blood at 18-20 weeks of pregnancy.

Duchenne muscular dystrophy This type of muscular dystrophy affects one boy in 5,000. Symptoms are progressive and children become unable to walk. The disease is usually fatal before age 20.

Health really does matter when you’re conceiving a baby. The healthier you and your partner are at the time of conception, the better your chances of having a trouble-free pregnancy and labor, and a healthy baby. And the father’s health is just as important as the mother’s. There’s no doubt that becoming a parent will change your life in lots of ways, so it’s a good idea to plan ahead as much as you can and think about how these changes might affect you both.

Your Changing Lifestyle

All the things you take for granted about your life and what you do will be affected by the arrival of your baby.

Time -Most of us live very busy lives and many new parents think that their new baby will just fit in somehow and life will go on as usual. It won’t. Babies and children need a lot of time and attention, and as parents you’ll have less time to spend with each other-and other people-than you did before.

Costs - Whatever you earn, you’ll probably need to spend about 15-25 percent of your income on things related to your child, such as clothing and equipment. But other household costs, such as heating, will rise, too, and you may find you want extra items such as a new washing machine or even a larger car.

Relationships - Your relationship with your partner will change when you have a baby, and so will relationships with other people. You may feel closer to your parents-now they’re your baby’s grandparents-but you might find you have less in common with your childless friends. Make new friendships with other parents if you can-they’re going through the same experiences as you.

Smoking - This is one of the worst things you can do for the health of your unborn baby, and it’s the major cause of avoidable health problems. Risks linked to smoking include miscarriage and still­birth, damage to the placenta, a low-birthweight baby who fails to thrive, and a higher risk of fetal abnormalities. Smoking is one cause of a low sperm count, and a man who smokes while his partner is pregnant may damage his unborn baby’s health through passive smoking. And the problems continue. When tested at five, seven, and eleven years old, children of heavy smokers were found to suffer from impaired growth and learning difficulties. Studies have also shown a link between smoking and SIDS (Sudden Infant Death Syndrome).

Alcohol - This is a poison that can damage the sperm and egg before conception, as well as the developing embryo. The main risks to an unborn baby are mental retardation, retarded growth, and damage to the brain and nervous system-well documented as fetal alcohol syndrome. Alcohol can also cause stillbirth.

Research suggests that the effect of alcohol on pregnant women varies: some are more affected than others. But one thing is certain: if you don’t drink during your pregnancy, you’ll avoid alcohol-related problems. Women tend to have a lower tolerance to alcohol than men. And because a woman has a higher proportion of fat to water in the body, alcohol can become very highly concentrated in the blood that nourishes the developing baby.

Drugs - Only take over-the-counter medicines if you have to, and always check the label. Your pharmacist will advise you about what’s safe to take. Illegal drugs should definitely be cut out before trying to conceive. Marijuana interferes with the normal production of male sperm, and the effects can take three to nine months to wear off. Hard drugs such as cocaine, heroin, and morphine can damage the chromosomes in the sperm and egg, leading to abnormalities. When syringes are shared, there’s a high risk of contracting HIV, the virus that leads to AIDS. A mother can pass the HIV virus to her baby during pregnancy and the baby can become HIV positive in his own right.

Diet and exercise - Both are vital to your health and the health of your baby. Do your best to eat a sensible, balanced diet that’s low in animal fat and includes at least five portions of fresh fruit and vegetables a day. Make sure you’re getting enough folic acid in your diet, because it’s known to lower the risk of your baby suffering neural tube defects, such as spina bifida. Folic acid is contained in green leafy vegetables, cereals, and bread, and should also be taken in supplement form for at least three months before conception and three months after. It’s a very good idea to get regular exercise, too. Pregnancy puts a strain on your body; the healthier you are beforehand, the better you’ll cope.

Age - If you’re healthy and in shape, your pregnancy should not be any more difficult in your 30s or 40s than in your 20s. Whatever your age, you’re likely to have a normal pregnancy and birth, although some problems, such as infertility and chromosomal defects-for example, Down syndrome-do become more common in older parents. Older mothers, and younger women in high-risk groups, are always offered tests for chromosomal abnormalities.

Hazards - Be aware of your environment, at home, at work, and elsewhere, and avoid anything that could be dangerous to your own or your baby’s health. What we eat, where we work, the places we travel to, and sometimes even the people we meet may be risky for a pregnant woman.

Health Considerations

If you suffer from a chronic long-term condition, such as diabetes mellitus, heart disease, or epilepsy, you can, of course, still have children. It’s important, though, to talk with your doctor before you get pregnant so you get the best possible care and help.

Asthma - This is the most common respiratory problem in mothers-to-be and is usually controlled by bronchodilator drugs and inhaled steroids. Asthma drugs don’t seem to be a risk to the growing baby, although oral thrush, which is often made worse by pregnancy, can be a side effect for the mother.

If you do suffer from asthma, it’s important to take extra care of yourself while you’re pregnant. Any stress and tension, as well as dust, pollen, and pollution, can cause breathlessness, and this could trigger an asthma attack.

Epilepsy - From a momentary loss of consciousness to grand mal seizures, epilepsy affects one in every 200 people. Research has found that the effect of pregnancy on the frequency and intensity of seizures varies-50 percent of epileptic mothers are unaffected, 40 percent find they are slightly improved, and 10 percent worse. If you do suffer from epilepsy, talk to your doctor well before you hope to conceive. There’s a slightly increased risk of neural tube and other defects linked to antiepileptic drugs such as phenytoin and valproate, and your doctor should warn you about this.

Changing the drug treatment can increase the risk of seizures, but women with epilepsy are usually advised-under the supervision of their doctor-to reduce the drugs they take before pregnancy, not during it. While you’re pregnant, you’ll continue with any drug treatment, but you’ll need to be seen frequently by a neurologist who can adjust your drug dosage. Phenytoin prevents absorption of folic acid, so it’s very important to take high doses of folic acid supplements before you conceive as well as after, to help lower the risk of birth defects. All pregnant women on phenytoin or sodium valproate are also advised to take vitamin K supplements from 36 weeks of pregnancy to help mature the baby’s liver.

Diabetes mellitus - Diabetes arises when the pancreas produces insufficient insulin to cope with glucose (sugar) levels in the body. Pregnancy hormones have an anti-insulin effect, which can make diabetes worse, or lead to gestational diabetes in those with an underlying tendency. All pregnant women should have a glucose challenge test at 26-28 weeks to screen for gestational, or pregnancy-induced, diabetes. Diabetes can cause the baby to be large or have heart and respiratory problems, and complications for the mother include chronic thrush, preeclampsia, and birth trauma to either the mother or the newborn. So it’s important for insulin-dependent diabetic women to have their condition under control before conception, and to monitor blood-sugar levels closely.

Heart disease - If you suffer from any kind of heart condition, your doctor will give you special advice about your pregnancy. Generally, you’ll be told to get plenty of rest-put your feet up in the afternoon for at least two hours, and spend ten hours in bed at night. Depending on what type of heart condition you have and how severe it is, your doctor or maternal-fetal medicine specialist will make different recommendations. Most women with heart disease can have a safe labor and delivery.

Kidney disease - A woman with kidney disease should be able to have children but will need careful monitoring. Women with kidney disease have a higher-than-usual risk of hypertension and preeclampsia. Urinary tract infection is another common problem, but as long as the kidneys remove waste effectively, the pregnancy can continue. If the fetus isn’t growing properly, though, doctors may recommend early induction.

Sexually transmitted disease -There’s a risk of infection to your baby if you have a primary herpes infection at the time your membranes rupture or at labor. Herpes simplex II virus infection may slow your baby’s growth, and about half of infants born to a mother with these conditions will develop some form of herpetic infection after birth, possibly affecting the eyes, mouth, and skin. If you have no symptoms, and you’re not shedding the virus from your cervix or vagina, the risk that your baby will become infected is less than one in a thousand.

If you have a history of genital herpes, you should still be able to have a normal vaginal delivery, even with an active secondary infection. But if you have herpes ulcers and a primary infection just before labor commences, you’ll probably be advised to have a cesarean section to reduce the risk that your baby will catch herpes as he descends the birth canal. Doctors will check for signs of infection at the time of delivery. If you get herpes simplex for the first time when you’re pregnant, your doctor may prescribe medication to reduce the severity.

HIV / AIDS - The outlook for babies of mothers who have tested HIV-positive is much better than it used to be. The use of oral AZT may protect the developing baby from infection, and the mother will be scanned regularly to check the baby’s growth. Doctors may suggest a cesarean delivery to protect the baby, and they will aim for as little invention as possible during labor (for example, no use of scalp electrodes or fetal blood sampling) to lessen the risk that the baby’s blood will be contaminated. Although it’s not inevitable that the baby of an HIV-positive mother will be HIV-positive and develop AIDS, there’s a risk that the baby will be born with HIV antibodies; these are usually maternal antibodies and may disappear within 18 months. Because of the risks, an HIV-positive mother will be given counseling and may be offered the chance to terminate her pregnancy if she wishes.