Planning for your pregnancy

Both men and women’s fertility can be affected by drinking alcohol. If you are trying to get pregnant, both partners stopping drinking can be good support for each other and improve your chances of conceiving and having a healthy baby. Fertility New Zealand has some good information about fertility and alcohol.  

There is no safe level of alcohol during pregnancy, so women are advised not to drink any alcohol at all if they think they might be pregnant, are pregnant, or are trying to get pregnant. 

If you have any concerns about your alcohol drinking, or want help to stop drinking, you can talk to your GP or contact the Alcohol Drug Helpline on 0800 787 797 or free text 8681 and they will text you back for a free confidential conversation. The helpline is staffed 24/7, is anonymous, and gets you through to a qualified alcohol counsellor or social worker. You can also go to their website www.alcoholdrughelp.org.nz for more information about their service, and to find local services to contact.

You can also find more information at alcohol.org.nz, including a handy set of frequently asked questions [PDF] about alcohol and pregnancy.

Alcohol can be a very hard thing to give up. Making the first step to ask for some help can really make a difference for you and your family/whānau.

Folate is a naturally-occurring vitamin, part of the B group vitamins. It is found in leafy vegetables, citrus fruits, wholemeal bread, yeast, liver and legumes. We all need folate in our diet, to allow cells to reproduce and grow. It is recommended that NZ adults consume about 400 micrograms a day, but in pregnancy that requirement goes up substantially.

Having enough folate reduces the chance of having a baby with a neural tube defect. Neural tube defects (NTDs) are a major group of birth defects where the brain, spinal cord, or the covering of these organs has not developed properly. Spina bifida and anencephaly are the most common types of NTDs.

Folic acid is the tablet form of folate, and taking a supplement of folic acid greatly reduced the chance of having a baby with a NTD.

Take a folic acid tablet (0.8 milligram [mg]) every day for four weeks (one month) before you might become pregnant, through to 12 weeks after becoming pregnant. You can buy these tablets at a pharmacy, or get them on prescription from your GP.

For more information visit the Ministry of Health website or read this leaflet about Folic Acid [PDF].

Stopping smoking before you get pregnant is one of the best things you can do for your health and for your baby. Smoking during pregnancy is one of the main causes of complications in pregnancy, linked to miscarriage and stillbirth and an increased chance of going in to labour too early. 

If you are trying to conceive it is important for you and your partner to stop smoking as smoking can affect fertility. Both partners stopping smoking can be a good support for each other. Quitting smoking is easier when you’re not alone.

The stop smoking service in the Waikato is called Once and For All and their stop smoking support person will give you help and advice. You will set a quit date with them and they will support you on a weekly basis. You will be given free nicotine replacement therapy to help you with your cravings or withdrawal symptoms and you will receive a $50 voucher as an incentive if you are still smokefree 4-6 weeks after your quit date.

To contact Once and For All call 0800 6623 4255 or visit www.onceandforall.co.nz. You can also contact the national Quitline on 0800 778 778 for support, or speak to your GP.

Weight is a very sensitive subject for many people. However, if you are planning to get pregnant it’s a good idea to establish healthy eating patterns and try to reach a healthy weight before you are pregnant. Women who are underweight or overweight can have a higher chance of problems in pregnancy.

What is BMI?

For most women, healthy weight is calculated using a BMI measurement. Your body mass index (BMI) is a comparison of your weight to your height. This is your weight in kilograms divided by your height in metres squared. You can ask your health practitioner to help you with this, especially if you do not have accurate scales at home.

New Zealand Health Navigator has an online tool that can help you calculate your pre-pregnancy BMI.

While you are thinking about starting a family it is very important to keep taking your medicines to manage your condition (particularly if you have epilepsy) and continue using contraception until you have talked to your doctor.

• Stopping your medication without talking to your doctor can cause serious risk of harm to yourself and your baby if you are pregnant.
• If you get pregnant before having a plan in place for your medication you could cause problems for your baby. Some of the problems that can happen to your baby as a result of the medication can happen in the very early weeks of your pregnancy.

Talk to your doctor as soon as possible, ideally at least 6-12 months before you want to start trying to get pregnant. This is because it takes time to safely change your medicines.

This doctor’s appointment may take longer than your usual appointments as you will need to make a plan to keep you as healthy as possible and reduce the risk of harm during your future pregnancy.

You are making very important decisions at this meeting. Take your time and make sure you have all the information you need to make decisions. Your doctor will also talk to you about taking 5 milligrams of folic acid every day. This will help reduce the risk of your baby having neural tube defects such as spina bifida.

If you have epilepsy

Any changes to your medicine will include a neurologist (a doctor who is specially trained in treating problems that affect the brain, spinal cord and nerves). All the doctors looking after you will be working to:

• make sure you do not take any more medicines than you have to, reducing the risks of harm to your baby and you
• control your seizures as well as possible. 

If you do not have epilepsy and are taking antiepileptic medicines for other health conditions

Your doctor will be able to tell you if it is safe for you to stop taking your medicine or to take another medicine so there is less risk of harm for your baby and you.

List of anti-epileptic medicines

Below is a list of some of the anti-epileptic medicines and their brand names, which are available in New Zealand. If you take any of these medications and are thinking of getting pregnant, talk to your doctor.

Some medications for epilepsy can cause problems for the developing baby, especially for the first 12 weeks of pregnancy. Some medications carry a higher risk than others in causing malformations such as spina bifida and heart defects, or learning and behavioural problems.

This is not a full list of all the medicines that are available. New medicines are added from time to time and brand names can change. If you think you are taking anti-epileptic medication and your medicine is not on this list, talk to your pharmacist, doctor or nurse.

The ACC website has some useful information about pregnancy, epilepsy and medication

• Are you taking medicines for epilepsy, mood or pain? [PDF]
• Pregnancy, epilepsy and medication: Knowing the risks

If you have had gestational diabetes (GDM) in a previous pregnancy, then the chance of you developing it again in your next pregnancy is quite high. Studies estimate a 33-66 per cent chance of GDM happening again. You also have a much higher chance of developing type 2 diabetes within five years of having your baby.

Being at an ideal weight for your body type, exercising regularly and eating a balanced diet can reduce your chance of developing GDM in your next pregnancy. It will also help you to delay or even avoid the development of type 2 diabetes. Yearly screening with your GP is important for you to monitor this.

Talk to your GP about pre-conception care and the steps you can take to prepare for a healthy pregnancy before you conceive.

Your GP can refer you for a Green Prescription or you can contact the Waikato Active and Well team at Sport Waikato directly yourself. Green Prescription is an individual programme that will help you set realistic goals, give you information about healthy eating and physical activity advice. This programme is free and lasts between 3-6 months. To find out more call the Waikato Active and Well team on 0800 22 84 83 or visit their website.  

Women who have experience of mental illness, have had mental illness during or following a previous pregnancy, or who are currently managing mental illness, have a higher chance than other women of developing mental illness during or following pregnancy.  

What you need to do if you’re thinking about getting pregnant

If possible, it is best to plan pregnancies and speak with your GP, psychiatrist, mental health nurse or other health professional helping with your care before you get pregnant. Some medications are not ideal in pregnancy, and you may need to plan to change medications to suit you beforehand.

• Make a plan with your health professionals as to how and where the best care for you would happen.
• Once you are pregnant, it is important to find a midwife as early as possible in your pregnancy who you are relaxed and comfortable with, so you can discuss your mental health with her right from the start.
• Your midwife will work with your mental health team to provide the best care for you.

Waikato DHB has a specialist Perinatal Mental Health Team. Involving this team in your care may be helpful, either with hands on support and follow up, or in a consultation capacity to other professionals.

There are also lots of resources available online.  

• New Zealand Health Navigator mental illness page
• depression.org.nz
• depression.org.nz/maori/ (for Māori)
• depression.org.nz/pasifika/ (for Pasifika)
• Mental Health Foundation of New Zealand

If you live with type 1 or 2 diabetes mellitus then you will probably be an expert at managing it well. 

If you are planning to get pregnant you should ideally speak with your GP, diabetes physician and/or diabetes nurse before trying to get pregnant, and get personalised advice and guidance to ensure optimal blood glucose control and health prior to conceiving.

Diabetes can mean a higher chance of your baby having birth defects, miscarriage and stillbirth so it is really important to plan your pregnancy as much as you are able and make sure you are as well as possible, with excellent blood glucose levels.

It is also really important to manage your blood sugar levels well throughout your pregnancy to reduce the likelihood of developing complications during your pregnancy. The Diabetes in Pregnancy team will support and assist you to do this.

You can find more information on the Diabetes New Zealand website and Ministry of Health website.

If you have had severe complications in a previous pregnancy or currently have severe or complex health conditions, and you’re planning to get pregnant, talk to your GP about what you will need to consider.

It is best to arrange to have this appointment 3-6 months before trying to conceive.

Previous severe pregnancy complications include:

• history suggestive of cervical insufficiency such as preterm prelabour rupture of membranes (PPROM) or premature births
• spontaneous preterm birth at less than 32 weeks of pregnancy
• miscarriage in the second trimester
• stillbirth or your baby passed away following birth.

If you currently have a complex health condition it could significantly affect your pregnancy, your health during pregnancy, or the health of your baby.

After a discussion with your GP, they may refer you to Waikato Hospital maternity services to be reviewed by an obstetrician (a doctor who specialises in pregnancy care). Your GP may receive advice to discuss or action with you, or you may be offered a preconception care appointment at the high risk pregnancy clinic.

High risk pregnancy clinic

At the clinic you will have an appointment with an obstetrician, or with an obstetric physician (general medicine physician with an interest in how pregnancy may affect a medical condition, or vice versa).

They will review the possible implications of your specific background and discuss how to improve the chance of having a successful pregnancy and birth. This may include the need for further testing and interventions prior to a future pregnancy and the discussion of a management plan for your pregnancy and birth.

A total of 2 doses of the MMR vaccine are recommended for all children and adults born on or after I January 1969. When 2 doses of MMR are required, they can be given a minimum of 4 weeks apart. Just 1 dose of MMR gives you a 95% chance of being protected against measles. The reason for a second dose is to make sure the 5% who need this second vaccine get immunity.

Measles, Mumps and Rubella (MMR) and pregnancy

The MMR (Measles Mumps Rubella) vaccine is a live weakened vaccine, so it is advised that you DO NOT GET PREGNANT for at least 4 weeks after having an MMR vaccination. Pregnant women are advised to wait until post-delivery to get their vaccination.

Why is vaccination against measles, mumps and rubella important?

Vaccination with the MMR vaccine is the best way to protect against measles, mumps and rubella. While these infections may be mild in some people, they can cause serious complications in others.

Measles: The infection can be serious, with 1 in 10 needing to go to hospital. If you catch measles while you are pregnant it can lead to increased risk of miscarriage, premature labour, or a low birthweight baby. Complications include diarrhoea (which can lead to dehydration), ear infections (which can cause hearing loss), pneumonia (which is the most common cause of death) and encephalitis (brain inflammation), which can cause brain damage. Read more about measles.

Mumps: The symptoms of mumps are usually mild, such as swollen salivary glands (at the side of your face), headache and fever, but it can cause serious complications such as deafness, swollen testicles or ovaries, and meningitis. Read more about mumps.

Rubella (also called German measles): This is usually a mild infection that gets better within about 7–10 days, but it becomes a serious concern if a pregnant woman catches the infection during the first 20 weeks of pregnancy. This is because the rubella virus can affect the development of the baby and cause severe health problems such as eye problems, deafness, heart abnormalities and brain damage. Read more about rubella.

Coming into contact with measles or rubella while pregnant

If you’re pregnant and think you have come into contact with someone with measles or rubella, and aren’t sure if you’re immune, you should speak to your midwife and see your general practitioner (GP) as soon as possible.

If a pregnant woman is not immune, and contracts measles during pregnancy, she may be at increased risk of miscarriage, premature labour, or a low birthweight baby. These effects are not common however it is important to be aware of this.

 If you contract measles or rubella during pregnancy, you will be provided with additional care to monitor you and your baby’s wellbeing, and to ensure follow up care for your baby after he or she is born. It is very important to avoid contact with others while you are infectious with the measles. Please make contact with healthcare providers by telephone in the first instance.

For more information go here.

You can get your MMR vaccinations from GPs, some pharmacies and other healthcare providers and from Waikato DHB community mobile vaccination clinics.