• Saswati Mukherjee

Pregnancy Planning

Pregnancy Planning


Planning a pregnancy is as vital as is any other context of design. In the management jargon “Planning” is the process of deciding the objectives to be achieved and selecting the ways and means of achieving the pre-decided objectives. It entails physical mental and psychological efforts and a similar approach is necessary for planning a pregnancy.


Like any other purpose, pregnancy has an important purpose. Babies have to be wanted and healthy and this can be achieved with effective pregnancy planning. Children are our contribution to society and the human race and our legacy for nation-building. The health of the nation is contributed by every individual of the country and it therefore is


Our prime responsibility to deliver healthy babies to nurture the health of the country. Therefore the goal is HMHB, I.E. HEALTHY MOTHER AND HEALTHY BABY.


World over and especially in India many pregnancies are unplanned. They are a result of ignorance about pre-conceptional optimization strategy, improper use of birth control methods, or as an accident. Many such unplanned pregnancies either are medically aborted or land in a spontaneous miscarriage, growth-restricted babies, preterm or growth-restricted babies, and many more associated complications. The important fact to understand is that all this is avoidable with proper pregnancy planning.


The World Health Organisation has proposed the concept of the first 1000 days of life of a human being as a critical window of opportunity for lifelong health. The mother’s nutrition, her lifestyle practices, her habitus determined by her disorders such as obesity, thyroid dysfunction, anemia, etc, her mental attitude and experiences and responses towards her pregnancy have consequences that have a lifelong impact on the health of the baby.


The early part of these 1000 days is 6 months before you even get pregnant and that is what is the Preconceptional Optimization Strategy and the first 450 days of these 100days are determined by the mother’s nutrition and this is a critical parameter and absolutely modifiable.


So, let us look at all this is in a simple Qand A pattern and these are based on the questions I have been asked in my practice or observations I made.


What is pregnancy planning?


Pregnancy planning is a mindful strategy to ensure a healthy baby is borne to a healthy mother in a healthy environment to achieve HMHB.


How do I strategize pregnancy planning?


Following self-questions can help


1. Am I mentally or physically tuned to having babies?

2. Have I checked my own health parameters as under?

  • BMI: Weight to height ratio: the desired range is 19–24 kg/M2Blood pressure

  • Heart conditions

  • Hemoglobin level: 12 g/dl is ideal

  • Thyroid dysfunctions

  • Blood group: If its Rhesus negative it needs a special approach

  • Am I diabetic or prediabetic: Determined by HBA1C level: ideal being less than 5.6

  • Any blood abnormalities such a Thalassemia or Sickle cell disease

  • Are you suffering from any urinary, dental, vaginal infections on and off?


3. Am I taking any prescription medicines?


· Medicines for Blood pressure control

· Retinoic acid for acne treatment

· Antidepressants, anti-psychotics

· Anti-epileptic medicines

· Anti-cancer medications

· Medicines for some chronic diseases e.g., Rheumatoid arthritis, diabetes, etc.


4. Am I physically fit?


· My food habits

· My physical fitness routines

· My mindset


5. Am I Up-to-date with my vaccinations?


· Rubella: to prevent the congenital rubella syndrome in the baby

· Hepatitis B: To protect you and your baby

· HPV or cancer cervix vaccine: As your reproductive (sexual life is already underway)


Visit: https://www.drgirijawagh.com/post/pregnancy-planning-swift-checklist

https://www.drgirijawagh.com/articles/search/immuni for vaccination info


I am now describing here the above points with a little rationality. Having babies is a mindful act and this needs the woman and her family to balance their life appropriately. It’s a good time point in life to self-audit one’s mindset. A healthy and positive mindset helps in dealing with this wonderful responsibility much at ease.


Many women and couples are flustered with their own time schedules, professional commitments, and lack of role balances and are driven by fear of complications or pressurized by family demands of bearing children. It helps to take guidance about these issues from experienced reproductive health counselors such as me and this is a part of your Pre-conceptional Strategy. Many couples today do come for such guidance and I have seen it yielding wonderful results.


Physical fitness is important for the fact that the pregnancy causes many changes in the mother’s body such as the blood volume rise, blood pressure changes, and increased bone

recycling, hormonal changes, changes in the metabolism making it essential to have a good reserve potential to deal with these alterations. A woman’s body has a wonderful natural gift in the form of a capacity to adapt to these changes during pregnancy.


The entire 9 months end into a process of delivery which is classically named “Labour” as it needs the mother to be strong mentally as well as physically to endure these 16- 20 hours of the act of delivering the baby. The process of delivery is a demanding activity that further pressurizes all these systems and good physical endurance is important.


So, pregnancy planning entails a fitness regime consisting of a combination of muscle-strengthening exercises especially the back, the tummy, and the pelvic floor muscles, deep breathing exercises to enhance respiration, and mindfulness exercises to enhance a positive attitude to help endure the pain because of all these processes. This also needs a good food strategy. Ensuring a healthy wholesome diet replete with proteins, healthy carbs, and balanced fats, micronutrients is essential.


If you are suffering from digestion issues, constipation, acidity you need to get it treated. If you consume alcohol, smoke, or eat unhealthy foods this needs to be curbed as a lack of micronutrients and such vices can have a teratogenic effect on the fetus( baby in the formative stage in the womb ) leading to congenital abnormalities in the baby. https://www.drgirijawagh.com/articles/search/birth-defects


It's always a good practice to visit a doctor for screening for the health parameters mentioned above in point number 2. Many of these issues are better assesses by the doctor. Screening for these ailments and treating them appropriately can ensure the ‘Healthymom, Healthy baby’ goal that we want to achieve. Also, this can be a window of opportunity to start taking folic acid, DHA, and calcium supplements at least 3 months ahead of conception to ensure optimum levels of these during the periconceptional period which is a critical window.


Research over 30 years now has proved that folic acid deficiency during this period is known to cause neural tube defects # https://www.drgirijawagh.com/articles/search/birth-defectsin the baby which many times are an indication of termination of the pregnancy as these babies may be incompatible to live or it can live will lead a very poor quality of life. Additionally, calcium and DHA supplements along with Vitamin D help in preventing miscarriages, preterm births, and pregnancy-related complications associated with raised blood pressure the “Gestosis”.


Prescription medicines as mentioned in point 3 also have teratogenic effects and may have to be changed to safer options. Even abnormal blood pressure itself or high blood sugar levels can act as teratogens and cause heart or other defects in the baby. If a woman is taking them it is better to consult a doctor before embarking on pregnancy to make these changes to help achieve the goal of pregnancy planning.


Today’s busy schedule has caused a whole lot of change in lifestyle from a sedentary (Physically inactive) to a completely stress-filled life. But everyone wants to achieve all from professional success to financial stability for which a lot of planning ensues. Same strategies are essential to ensure a healthy reproductive and family life and therefore pregnancy planning is essential. A busy life makes us source foods from outside, unhealthy food habits and timings, a lot of junk resulting in a paucity of fibers and fresh vegetables and fruits. All these can give rise to inner oxidative stress which can lead to pregnancy complications. So Point number 4 requires a serious entry in the pregnancy planning strategy and this aspect is something I usually base my treatments upon. Time and again my experience has taught me that the best strategy to achieve the HMHB goal is this one.


I have dedicated an entire article to vaccination https://www.drgirijawagh.com/articles/search/immuni in the adult women and I request the readers to read that for detailed information on vaccination update mentioned in point 5.


Dear readers, this writes up is with a purpose.


1. To empower you with the information that is necessary for pregnancy planning and achieving the goal of HMHB

2. To alleviate anxiety and fear in your mind about babies and parenthood.

3. To infuse confidence in you to embark on this wonderful journey of making babies

4. To realize my professional and personal purpose to contribute to healthy nation-building.


If you have any questions to ask feel free to put your queries as I would love to understand you better and would love to assist you to find answers.