nikaLIVE: How to prepare for pregnancy?

Proper preparation for pregnancy is very important if we want to reduce the risk of pregnancy-related complications and increase the likelihood that the baby will be healthy . However, in medical offices this topic is not always given enough attention. That's why we asked gynecologist, andrologist and anti-aging medicine doctor Mariusz Łukaszuk from the Novique clinic for tips on how to approach this process wisely . You can watch it live at this link , and below is the text version of the conversation.

When preparing for pregnancy, do we need to meet any special conditions that will help us in this process?

Bow. med. Mariusz Łukaszuk: I would pose this question a little differently - how should you prepare for pregnancy depending on your age ? We look at a patient aged 20 differently than at a patient aged 40 . Currently, I notice a tendency to get pregnant later. As a doctor, I rather recommend not postponing these plans to the so-called "later", because as time passes it simply becomes more difficult for the female body .

In the case of pregnancy in a woman in her twenties, I would rather not recommend a whole package of additional tests, but everything depends on the interview. During the first visit to our clinic, we always focus on a thorough interview and, depending on the answers obtained, we can proceed according to the patient's needs. If a patient has hypertension , we will prepare her for pregnancy differently than if she does not have any health problems. For my part, the first visit always focuses on many detailed questions about the patient's health. I ask about hypertension, proper functioning of the thyroid gland, hemoglobin level to rule out possible anemia. The tests I recommend are, of course, a basic blood count, TSH and additionally infectious tests to assess whether the patient has been vaccinated or has had rubella , whether she has antibodies to toxoplasmosis or cytomegalovirus .

All the tests you are talking about are included in the list of mandatory tests during pregnancy. Is it also worth doing them before pregnancy?

From what I remember, before 2010, the Polish Society of Gynecologists and Obstetricians recommended performing these tests also before pregnancy . And I think that's a pretty good idea. However, official recommendations later changed.

More and more people eat healthily, and yet, as research shows, nutritional deficiencies still occur. They can also affect your overall health. And in this situation, a woman may not know that something is wrong with her if she only undergoes a blood count test from time to time. Therefore, isn't it worth doing a check-up of the whole body before pregnancy to minimize the risk that something will surprise us in terms of health during pregnancy?

I will say this - there is always a chance that something may come up in terms of health. The only thing we can do is reduce the risk. As for the tests I mentioned earlier, I believe that such a package should be sufficient . In the case of insulin resistance, it is definitely worth considering checking the level of vitamin B12 and folic acid in the body if the patient is taking metformin . In the case of metformin, we know that taking it will reduce vitamin B12 stores, and this is quite an important microelement that we should be provided with. Nowadays, veganism or vegetarianism is fashionable , and in this case I would also recommend taking a vitamin B12 test.

When thinking about pregnancy, do we have to allow for a certain preparation period, for example 3 months or half a year? And will it differ depending on the woman's age?

If we are - for example - 35 years old or older, I would first order an assessment of the ovarian reserve - an ultrasound examination that will show the condition of the antral follicles in the ovaries. The more we know about our health, the greater the chance of getting pregnant. However, if we have doubts about the condition of the follicles, I recommend checking the AMH level in the blood , i.e. the level of anti-Müllerian hormone - then we can be absolutely sure whether the ovarian reserve is normal or not. When the ovarian reserve is low, we go to people who specialize in infertility . We do not have to go straight to an infertility treatment clinic. It may be a specialist who simply visits the doctor's office. And under its control we must assess whether we are ovulating . Consultation with a specialist will help us increase the chances of pregnancy .

However, in very young patients, around 20 years of age, loss of ovarian function is very rare. If the tests indicated above are normal, then further treatment depends again on the interview. If, for example, the patient is genetically predisposed to autoimmune diseases or is at risk of Hashimoto's disease (which is very common now), I recommend a package of hormonal tests , especially TSH control . Everything depends on an individual interview, because each patient is different, just as each body functions a little differently.

Let's assume that we don't necessarily lead a healthy lifestyle, we like partying on weekends, etc., but at some point we come to the conclusion that we want to have a child. How far in advance should we improve our habits to help us increase the chances of proper pregnancy development and a healthy baby? Is there a time frame that we need to consider?

I would assume a period of 3 months here because the immature egg cell, which is initially in the primordial follicle, then needs this time to grow into a proper, mature egg cell . During these 3 "preparatory" months, I would recommend giving up alcohol, cigarettes and other stimulants .

That's probably why most recommendations on taking folic acid before pregnancy focus on these 3 months (although I have seen that in some countries, depending on the opinion of scientific societies, this period is extended up to half a year before the planned pregnancy). ). So let's move on to the topic of supplements when trying to conceive. What is worth taking and for how long?

As for the recommendation of the Polish Society of Gynecologists and Obstetricians , the use of folic acid and vitamin D3 is recommended . Folic acid in the amount of 400 micrograms per day, and vitamin D3 - 2000 units per day. Additionally, we also have endocrinological recommendations that recommend the use of iodine at a dose of 150 micrograms. If the patient is undergoing treatment for thyroid disease, the endocrinologist must decide whether iodine is indicated at this time or not. For example, in the case of hyperthyroidism, we try not to use iodine.

And what about Omega-3 acids? They also appear in the recommendations of the Society of Gynecologists and Obstetricians.

I recommend using Omega-3 acids for everyone , not only during the peri-pregnancy period. Each of us should consume a certain dose of these microelements because we, Poles, do not often include fish or seafood in our diet. If we eat fish less than twice a week, additional intake of Omega-3 acids is necessary. They protect our cognitive functions and have a neuroprotective effect. In my opinion, it is a "must have" for the body .

Returning to the topic of folic acid - there are products on the market containing various forms of folic acid. For example, an inactive form - which our body still needs to metabolize, and we do not know how quickly and whether it will cope with it well. There are also products with an active form of folic acid that the body can use immediately. Which form of preparation should I choose?

PTGiP recommendations state that there is no need to use active forms of folic acid. However, I personally have a slightly different opinion. It results from the fact that approximately 50% of our population has some type of mutation in the MTHFR gene and this part of the population may activate the acid we provide to a lesser extent. From my point of view, it is more convenient to give something that will definitely work, rather than something that may only work at higher doses. Therefore, I recommend methylated forms of folic acid.

I have another question about choline. There are more and more scientific studies showing that choline is very important during pregnancy, and at the same time - that many people are deficient in this nutrient. The Polish Society of Gynecologists and Obstetricians does not include choline on its list of recommendations. So, does it make sense to supplement choline before getting pregnant to compensate for its possible deficiency?

For me this is absolutely logical . Please also note that the list of recommendations is constantly evolving, but is updated periodically - not monthly. Choline is the basic building material of cell membranes and, to some extent, our brain. Taking a preparation with choline is, in my opinion, very helpful before pregnancy , so that at the moment of conception the body is protected with all these substances.

Is taking choline for 3 months before getting pregnant enough to provide the body with the appropriate level?

In my opinion, definitely yes. These 3 months are the optimal time to prepare for pregnancy, but if we start planning and preparing for pregnancy earlier, it is even better . If we have conception plans, it is also worth visiting a gynecologist and asking what we can do to make this pregnancy optimal.

Are there any other activities that we can implement in addition to the above to prepare for pregnancy? Maybe something less obvious but very important?

I would depend on the woman's health condition and the interview during the first visit. In case of back and spine pain, I always recommend consulting a physiotherapist or osteopath . We should check whether there are any irregularities that we will be able to correct before pregnancy. With subsequent stress on the body, these problems may deepen, so such preparation is also advisable. As I mentioned earlier, if a patient is struggling with endocrine problems, she should stay in constant contact with her specialist. In case of hematological problems, I always insist on a consultation with a hematologist who will advise how to prepare for pregnancy in this case. The same happens with cardiac treatment , in which it is very important to select the appropriate medications for pregnancy. The same principle also applies to neurology . In patients with epilepsy, a change of medications may also be necessary. The situation is identical in the case of psychiatry - only a few preparations on the market are safe for the child's health, so it is absolutely mandatory to adjust them before pregnancy.

What about a visit to the dentist? In Poland, it is routinely recommended at the stage of preparation for pregnancy. However, on the other hand, the American Dental Association emphasizes that safe treatment of caries is possible at any stage of pregnancy. Hence my question - do we really have to rush to see the dentist and do it before pregnancy?

Of course, there is no need to worry if we don't make it in time. You can visit the dentist at any time during your pregnancy , but the truth is that all medical procedures are simply easier to perform before you become pregnant. For example: I would definitely recommend performing root canal treatment before pregnancy. During my medical practice, I had a patient with whom we could not find the cause of her high white blood cell count. During pregnancy, the patient had permanently elevated CRP levels, which turned out to be caused by large tartar on her teeth and inflammation of the gums. When the teeth were completely dentally cleaned and the gums were healed, the CRP level dropped and the leukocytes returned to normal. Such a visit before pregnancy may be important. And the problem here is not so much caries, but periodontal disease . They may correlate with the development of inflammation and, consequently, make the process of getting pregnant more difficult . There are scientific publications that prove that periodontal diseases correlate with the occurrence of miscarriages .

I would never connect tartar with problems getting pregnant. Is there anything else worth paying attention to when preparing for pregnancy?

I would like to point out one more thing - I am an andrologist by profession, so I must emphasize that getting pregnant involves two people - men also need to be taken care of. Men should take supplementation according to their doctor's instructions, because folic acid and vitamin B12 deficiencies or hormonal disorders may negatively affect semen parameters . Weakened sperm may cause problems with getting pregnant. Chronic inflammation in the pelvic area or epididymis will also cause deterioration of semen quality. And again – oxidative stress , which is actually everywhere because we are constantly exposed to inflammation. This will worsen semen parameters. The remedy for this type of problems may be taking preparations, for example those containing antioxidants .

Is a man's visit to an andrologist recommended or should it be a man's obligation when preparing for pregnancy?

If a couple fails to get pregnant during the year, we can start talking about infertility . And here comes the time to examine the man. One of the most difficult things is probably sending a man for semen analysis . I know that this is mentally difficult for some patients to experience, so I am asking women to reassure their partners and explain that it is not such a terrible test. If such a test, after a year of trying to conceive, shows abnormalities in semen parameters, we provide the patient with more extensive care and start the diagnosis in order to implement appropriate treatment. If the partners are over 35 years old, andrological diagnosis is often started after 6 months of trying.

So such a visit to an andrologist is not necessary for preventive purposes before fertility problems occur?

Personally, I think that there is no need for this, but it will also depend on the age of the partner - at the age of 45 and later, men have increased DNA fragmentation in sperm . When meeting a 45-year-old patient trying to conceive, regardless of the age of his partner, I recommend performing a general semen test , as well as a test measuring DNA fragmentation in sperm . An increased percentage of abnormally constructed sperm strongly correlates with the occurrence of miscarriages. We can, of course, treat increased sperm fragmentation , so I encourage you to perform such a test as soon as possible in my office.

The doctor mentioned a little about supplementation in men. Can we assume that a set of ingredients for women will also be suitable for men if a couple is trying to conceive?

Absolutely, although I would also add more antioxidants to this set , e.g. L-carnitine or coenzyme Q10.

So men can "steal" their partners' supplements for women planning pregnancy?

Of course.j. I encourage you to do so. They have a beneficial effect on both the female and male bodies. I would also like to mention the regularity of intercourse . Patients often come to me and say that they have been advised by their doctors to have intercourse every other day . I think this shouldn't be the case . The rapprochement should take place when both parties want it, not when the calendar says it is necessary. Additionally, there is a belief from years ago that intercourse every other day ensures better semen parameters. And here, based on the knowledge obtained from scientific research, I can say that semen parameters, in terms of sperm quality, are much better with regular, most frequent intercourse . Studies in which

the semen was collected one, one and a half, four hours after the previous collection, show that the parameters are getting better and better . That's why I encourage couples not to force themselves to act "now." There is no need to call your husband who is on the road somewhere and tell him he has to hurry home because now is the best time. You need to have intercourse when both partners are willing and able, so that it is not "mechanical".

I also did not mention that it is worth taking care of the correct body weight , thanks to which we can significantly reduce the risk of complications during pregnancy.