Nutritional Needs for Pre-Pregnancy

Start off with these positive steps for a healthy diet to make your pregnancy healthy, active and happy:

Stay Healthy
A healthy diet will nourish you and your soon-to-be baby. It should be balanced in calories, carbohydrates, protein and fibre, and provide certain nutrients.

Do: Eat these foods for these beneficial nutrients:

  • Dark green vegetables like spinach and asparagus, citrus fruits and juices for folate (or folic acid) to prevent neural tube defects.
  • Red meat, chicken, fish, egg yolk and green leafy vegetables as sources of iron, which prevents anaemia and helps to form red blood cells.
  • Coldwater deep-sea fish like tuna, salmon and sardines for DHA, an omega-3 fatty acid for 
    healthy development of your baby’s eyes and brain.
  • Milk, hard cheese, yoghurt, sardines, beancurd and foods like tauhu or tau kwa for bone strengthening calcium and Vitamin D for better calcium absorption.

Take Folic Acid

Folic acid or folate is a type of vitamin B that reduces the risk of brain and spinal cord defects developing in your baby.

Do: Take a folic acid supplement of at least 400 to 800mcg at least three months before trying for pregnancy, and for the first 12 weeks of pregnancy. Some women might require up to 5mg. Do speak to your doctor for more advice on the appropriate dosage.

Good Habits to Encourage Pregnancy

Keep in mind these tips when trying to conceive.

Start Young
Fertility declines sharply from 35 years of age. The chances of genetic abnormalities and pregnancy complications also increase.

Do: Start young when you're in your prime – between 20 to 24 years of age! But not to worry if you're older, just see an obstetrician early.

Quit High-risk Activities
Babies born to smokers tend to have lower birth weight, slower growth, higher risk of asthma and breathing problems. Your pregnancy will also have an increased risk of complications. This applies for passive smoking too!

Do: Quit smoking. Encourage your partner and family members to stop smoking as well.

Go for a Pre-conception Check-up
It's important to keep prior medical conditions like diabetes, hypertension, epilepsy, anaemia and others under control to ensure a healthy pregnancy.

Do: Visit a gynaecologist early on to discuss your chance of conception and assess your pregnancy risks, if any. It would be helpful to bring your and your partner's medical and immunisation history during the consultation as well.

Pre-Pregnancy Vaccinations

Getting the right vaccinations before you conceive is crucial to protecting you and your future baby during pregnancy. Make sure you're protected against these three vaccine-preventable illnesses at least three months before you conceive:

Rubella (German measles)
This contagious virus can be passed on to your baby. Your baby may be at risk of heart damage and hearing loss. Your pregnancy will be at risk of a miscarriage or stillbirth.

Chicken Pox
Although this extremely infectious disease is uncommon in pregnancy and does not cause serious harm to you, your baby may be affected by skin blisters, scarring and organ damage.

Hepatitis B
An infection can be acute or chronic. If you're a chronic carrier, you can pass hepatitis B to your baby, which puts them at risk of liver-related diseases and infections like cirrhosis and liver cancer later in life. Tell your doctor about your medical history before conceiving.
There is no evidence that vaccinating pregnant women will cause any risk to the baby. Rest assured that vaccinations are safe when you're breastfeeding too.

Can I Choose My Baby's Gender?

Is it a boy or a girl? Gender selection is not allowed in assisted reproductive techniques in Singapore. However, there are natural gender selection techniques that are popular but do note that these methods are not scientifically proven:

How your baby's sex is determined
Your egg will carry an X chromosome while your partner's sperm carries either an X or Y chromosome. If an X-carrying sperm fertilises the egg, you will have a girl (XX)! If a Y-carrying sperm fertilises the egg instead, a boy will be conceived (XY).

A breakdown of natural gender selection methods
Shettles method (for a boy):
This method involves timing sexual intercourse as close to your ovulation as possible, preferably within 24 hours of ovulation. Both of you should also abstain from sex for three to four days.
Penetration and ejaculation should be as deep as possible, so adopt the position where your partner enters you from the rear. This increases the chance of male sperm surviving and fertilising the egg faster than female or X-carrying sperm.

Shettles method (for a girl):
Do the opposite to the above. Time your sexual intercourse two days before ovulation. Shallow penetration is needed. Have your partner on top of you to ejaculate at the mouth of the cervix. This increases the likelihood of female sperms fertilising the egg.

Gender selection kits:
You may come across these kits on the Internet. They aim to guide couples to select the gender of their baby over one ovulation cycle. However, they are also based on the Shettles method of using ovulation prediction to determine the sex of the baby — and can be quite costly.

Am I Pregnant?

Use these pointers to find out if you're carrying a baby:

How do pregnancy test kits work?
If you're pregnant, your body will produce a hormone called human chorionic gonadotrophin (hCG). This hormone will be present in your blood and urine. The pregnancy test kit will detect the presence of hCG in your urine and be able to tell you if you're pregnant if you're between the 
fourth and fifth week of your pregnancy. If you normally have regular periods, the test should be positive if your period is a few days overdue.

How accurate are pregnancy test kits?
Pregnancy tests are rarely wrong. In fact, they are more than 99 percent accurate. However, if you do the test too early, your body may not have enough hCG and your test will come back negative.  Repeat the test again a few days later to be sure.
There are instances where the hCG levels are raised temporarily and drop to zero. Your test kit may give you a false positive at first. Ovarian tumours may also secrete hCG and create an inaccurate result. To be certain, check in with a gynaecologist after you perform a kit test.

When should I do the pregnancy test?
You can test any time of the day but your first morning urine will be the most concentrated with pregnancy hormones. Testing a few days after your missed period is recommended for the greatest accuracy, although you may test positive as early as six days after ovulation.

Commonly Asked Questions About Pre-Pregnancy

The overload of information on how to conceive may confuse you! Here's a handy list of frequently asked questions and answers to help you conceive:

When should I seek medical attention if I'm unable to conceive?
An average couple in their 30s will conceive approximately after 12 months of trying. If you are not pregnant after one year of regular sexual intercourse (two to three times a week), it's a good idea to seek medical attention. Fertility rates are lower for older women, who may find it harder 
to conceive, so do seek medical attention if the mum-to-be is older than 35.

Why can't I conceive?
Always remember that not being able to get pregnant is not your nor your partner's fault. There are many different reasons for not being able to conceive, such as male and female subfertility or sexual dysfunction.
Female subfertility happens when the sperm is unable to reach and fertilise the egg. It could be due to your ovaries not being able to produce an egg, Fallopian tube blockage or abnormalities in 
your womb. Male subfertility, on the other hand, includes low sperm count, abnormal sperm shape, problems in the testicles and testes ducts and others.
Don't forget that you and your partner are not alone. Twenty percent of subfertile couples will not be able to find the cause of their subfertility.

What can I do to get pregnant?
Various tests can be carried out to investigate underlying causes for subfertility. There are also treatments depending on the cause of subfertility, such as medication and assisted reproductive 
techniques like intrauterine insemination and in-vitro fertilisation. These treatments will only be suggested after much counselling and investigation by your doctors.

How do I know if an obstetrician is right for me?
Word-of-mouth recommendations by friends or relatives may be useful but what works for one mum may not work for another! One good way to start thinking about this is if you prefer to be taken care of by an obstetrician in a restructured maternity hospital or in a private maternity hospital.

What foods should I avoid when trying to conceive?
Raw sushi or sashimi and unprocessed dairy products: these may result in gastrointestinal infections, which may affect your baby.
Fattening and sugary foods: these will make you gain weight. Being overweight before conceiving may increase pregnancy complications.
Certain types of fish: shark, king mackerel and swordfish can contain high amounts of mercury, which is dangerous in pregnancy.

By Associate Professor TAN Thiam Chye Head & Senior Consultant, Dr TAN Shu Qi Senior O&G Resident, Department
of Obstetrics and Gynaecology, KK Women's and Children's Hospital
Copyright © 2016 All rights reserved.
The New Art and Science of Pregnancy and Childbirth 2008, World Scientific
Healthy Start for your Pregnancy 2012, Health Promotion Board Singapore