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Deborah Howell (Host): Hello and welcome to the show. You are listening to weekly dose of wellness. It is brought to you by MemorialCare Health System. I am Deborah Howell, today’s guest is Dr. Heidi Cough, a caring physician who is board certified in obstetrics and gynecology and who is affiliated with Saddleback Memorial. Dr. Cough’s interests include general obstetrics, minimally invasive gynecologic surgery, contraception, health maintenance, and adolescent medicine. Dr. Cough pursued obstetrics and gynecology, so that she could establish relationships with her patients and continue to follow them through many-many life changes. Welcome to you Dr. Cough.

Dr. Heidi Cough (Guest): Thank you very much, thanks for having me.

Deborah: Ladies, ladies, ladies, what you do before pregnancy is just as important as what you do during pregnancy. To prepare for the best pregnancy possible, preconception planning is essential. So doctor, what is preconception planning.

Dr. Cough: Well, preconception planning is where women prepare their body and their environment, the most important time of their life. What we are trying to do is optimize any health condition that women may have, identify any hazards in her environment that could be pre-pregnancy and then institute intervention before the pregnancy so as to avoid problem.

Deborah: What are some of the hazards you are talking about.

Dr. Cough: Well, some potential hazards in the home environment could be things just as simple as what we use for cleaning on surfaces of the countertops or using Windex to spray on the windows. So, it’s important when women are cleaning the home, to make sure that they are in a well ventilated area, have all the windows open. Additionally, if women have any cats at home, they should not be changing the cat litter boxes because there is a parasite called toxoplasmosis in the cat litter box that could potentially cause miscarriages, so there are some of the potential things that we may need to be paying attention, so that they don’t have problems during their pregnancy.

Deborah: Okay, well, yes, I mean well warned is forearmed, what is it forewarned is forearmed, right.

Dr. Cough: That’s correct.

Deborah: I have to dig for that one. Okay, how far in advance should couples plan.

Dr. Cough: I recommend that couples plan at least 30 days in advance because women should be taking prenatal vitamins, starting a month before they even stop their birth control to make sure that they are building up helpful vitamins and minerals in their body before they start trying to conceive. What women don’t want to do is wait until they have their positive pregnancy test to start instituting these interventions because, once the pregnancy test is positive, a woman has already been pregnant and the baby has already been developing for two to three weeks and so, if they wait until that time to start making sure that their body and their environment is healthy, the baby has already been developing, so might be too late to make some of these changes.

Deborah: Okay. So, vitamins are one thing. What other health and diet consideration should moms to be take into account, what food should she avoid for example.

Dr. Cough: Well, for example, foods to avoid, most women know that they should not be smoking or drinking alcohol, other things to be paying attention to are limiting caffeine intake to less than 200 mg a day and just as an example.

Deborah: Yeah, what is 200 mg?

Dr. Cough: Yeah! So, as an example, the average cup of home brewed cup of coffee has about 135 mg of caffeine in it, so it is safe to spell, if woman needs to have a cup of coffee, it is best to try to avoid it if possible, but some women just need their get go in the morning, so that is still O.K.

Deborah: I was thinking that’s a cup and a third, but I drink green tea, so what would that be, how much.

Dr. Cough: Green tea has about 30 mg of caffeine in it, so that has very, very minimal tea and coca cola have very little caffeine in them compared to what a cup of coffee has, so although we don’t want to push it to the limit, it is safe to have some of those beverages, so you don’t have to deprive yourself during the month that you are trying to get pregnant.

Deborah: Excellent.

Dr. Cough: Other types of food we are talking about are making sure that any meats are cooked all the way through, nothing should be eaten that is raw or undercooked, so red meats as well as fish, anything that is a dairy product have to be pasteurized, so that all the bacteria is killed off, so the milk and then soft cheeses and then women want to avoid eating any fish that has high mercury in it, so its like shark, swordfish and king mackerel, they are not commonly consumed, actually tuna is okay, tuna is not one of the fish that has a high level of mercury in it, so it is safe to eat and it is recommended that women have two servings of fish in a week, because it has healthy DHA or omega 3 fatty acids in them and those help with the brain and eye development of the baby, so if women want to consume tuna, white fish like halibut, salmon, shrimp, those are all safe to consume.

Deborah: But, no sushi ladies for nine months, sorry. I know that for me would be like the hugest thing, you know, because everybody…

Dr. Cough: I think so a lot of women, if they ask about caffeine for them, but I try to reassure them that the cup of coffee is okay, but a lot of women need more than one cup of coffee to get through the day, so we try to limit them.

Deborah: I understand, may be coffee in the morning and then a little cup tea later in the afternoon.

Dr. Cough: Yeah! Just something a little extra in the afternoon.

Deborah: Okay, so what exams and lab tests should moms to be complete before conception and immunizations as well.

Dr. Cough: Sure. Women should have a complete physical examination that has been done within the year and that would include doing a Pap smear if it’s indicated for her. It is also really important that women are up to date with their dental care interestingly because oral caries and periodontal disease has been associated with a higher chance of having preterm labor and so if a woman can get her dental cleaning done out of the way, you know, they always want to do an x-ray, just get that stuff done before your pregnancy, so you make sure that, that’s all up to date. For vaccinations, if women have received their childhood vaccinations when they were younger, they should be up to date, a couple ones in particular that would have to be given at least 30 days before pregnancy are the live vaccines and those are the ones for rubella or varicella which is chicken pox and some women are not sure if they had chicken pox, but they might have been exposed to it as a child, never had any lesions, but do have immunity to it, so we can do blood testing to check for immunity against varicella and rubella if a woman is not sure if she was vaccinated.

Deborah: So, clearly, I want to do all that beforehand.

Dr. Cough: Yeah because those vaccines, like I said, have to be given 30 days before a pregnancy, so you don’t want to wait until you are pregnant to find out that you are not immune, these are things that you want to plan before the pregnancy.

Deborah: Good, good, good. Especially measles now, we had a little outbreak of that and you know, so we got to take care that these incidents don’t.

Dr. Cough: It is, yeah, yes, it’s very important to make sure that those vaccinations are up to date. You don’t want to risk anything during this important time in your life.

Deborah: All right, that’s for moms to be, now what tips and considerations can Dad do to help give the baby the best start possible.

Dr. Cough: Well, men want to make sure they are healthy just as the women do to help improve mostly for their fertility. Men should also have a physical exam, they should have a normal body, like a normal weight to make them a normal body mass index, so they should make sure that they are exercising and eating nutritiously and also as like a woman to avoid tobacco and alcohol, men should too during the months that they are trying to get pregnant, because excess tobacco and alcohol has been linked with lower fertility rates and also to help men’s fertility, they should avoid hot environments like saunas, hot tubs, or laptops on the lap because all of that can lower their fertility rate.

Deborah: My brother-in-law is a pilot and he used to fly fighter jets and cockpits got so warm, and they couldn’t figure out why they couldn’t conceive and as since he got out of the cockpit of course, boom, and the baby started to fly, so those warm environments are really important to avoid.

Dr. Cough: It really makes a difference and men’s fertility, kind of renews itself about every month, so if something has happened to damage their fertility, if they wait a month, a lot of those damages will reverse themselves and they will go back to normal fertility. So, it’s fortunate for men in that regard.

Deborah: That is terrific news, I had not heard that, that’s very fast.

Dr. Cough: Yeah! Women are born with all eggs they will ever have in their life and the age with the women, we don’t get them renewed. So…

Deborah: That’s a bad system, we need to change.

Dr. Cough: I wish we could. A lot of women wish that we could.

Deborah: Where could couples go to learn more?

Dr. Cough: They can start by going to startingmyfamily.com or they can sign up to attend the free preconception planning event with their spouse. It is taught by an OB-GYN and it includes one on one question and answer session with the hospital tour or finally, they can contact their OB GYN to schedule a preconception planning visit.

Deborah: Okay, very good advice. It’s such a good time to have a baby, I mean, when I look at the hospital facilities and how they have changed and how they now nurture both, you know, the husband and the wife, it’s just, it is a lovely thing.

Dr. Cough: It is always a wonderful thing.

Deborah: Well, thank you so much Dr. Cough, it has been great to have you on the program today to talk to us about what we need to know about giving our families the best start possible. We really appreciate your time today.

Dr. Cough: You are welcome and thank you for having me.

Deborah: And everybody, if you would like to listen to our podcast or for more information, what you can do is visit MemorialCare.org. I am Deborah Howell, join us again next time as we explore another weekly dose of wellness. Brought to you by MemorialCare Health System. Have a fantastic and healthy day.