So, you’ve decided to have a child. However, war imposes its limitations, and it may seem impossible to plan at such a time. In fact, it’s not that true, so in my new article, I will answer the questions about women’s pregnancy planning for those who are in Ukraine and abroad.
“Life goes on, and I don’t wish to waste my time.”
“War is war, but I have no desire to postpone motherhood.”
“How to get pregnant when your husband is going to fight?”
“I want to get pregnant in time before my beloved is taken to the Armed Forces”
Without any doubts, the number of requests for pregnancy planning has increased in my practice now. During wartime, it may slightly differ from the peaceful time, but not that much.
What does “pregnancy planning” mean?
The term “pregnancy planning” is a complex of actions which increases the chances of conceiving a healthy child and at the same time reduces the risks of complications during pregnancy and childbirth. It also helps to give a birth to a healthy child and preserve the health of the woman.
Of course, some of you may say: “women used to give a birth in the field or got pregnant during earthquakes, famines, wars and other natural or supernatural disasters without any planning”.
It’s 100% true. But in certain regions, the mortality from the childbirth and pregnancy had reached 25-50%. The level of premature birth and women’s health disorders due to pregnancy was high, and women’s quality of life was not a point at all.
I have gone through pregnancy, childbirth and the first year of a child’s life four times. Therefore, for me personally, as a doctor and a woman, it is important so that every woman understands: her mental and physical health during pregnancy and after childbirth depends on the quality of her pregnancy planning. And it also affects the health of the newborn baby.
When and how to start pregnancy planning
You should start planning your pregnancy three months before conception. This is the time needed for a man’s sperm to completely renew. When it comes to women, it is believed, that the follicle which will become the main one in the cycle begins to “grow up” during the three cycles before.
Firstly, in the wartime I would recommend getting re-vaccination against rubella, or initial vaccination if it was not done in the childhood. It is also significant to get vaccinated against hepatitis B.
The things you have to discuss with your family doctor:
- booster against COVID-19
- vaccination against smallpox and chickenpox
- re-vaccination against tetanus and diphtheria
Medical checkups you have to take with your partner
Blood type and rhesus (Rh) factor test
If you have the Rh negative factor, and the future father has positive, it could cause a rhesus conflict. The option is to either determine the Rh factor of the unborn baby, or inject anti-rhesus globulin at 28-30 weeks of pregnancy to prevent the development of complications for the fetus.
Blood for HIV, syphilis and hepatitis B and C
If the mother infected with HIV, syphilis or hepatitis, it can cause intrauterine infection of the baby. But if you find out about these infections in advance, it is possible to start treatment and reduce the risks for your child. For example, a woman who takes antiretroviral therapy (medications against HIV) has less than a 1% risk of intrauterine infection of the baby.
PCR test for sexually transmitted infections
You need to exclude chlamydias, gonorrhea, trichomoniasis. Why is this so essential? For example, chlamydia infection can cause rupture of the membranes and premature birth.
Additionally, if possible, I recommend visiting a geneticist. If needed, take a test for SMA (Spinal Muscular Atrophy) together with your partner. If both of you have these genes, there are bigger chances to have a child with such disease, and the treatment cost a lot. I am sure lots of you have seen social media stories about parents collecting thousands of dollars for an injection against the SMA.
Medical checkup that a woman should do
PAP Smear and oncogenic HPV screening
It is important to treat severe precancerous conditions of the cervix before pregnancy. During pregnancy, they have a risk of progressing to cervical cancer.
Level of sugar, hemoglobin, platelets, level of vitamin D3 and ferritin
It is critical to control the level of glucose before pregnancy, since the deviations are associated with the complications during pregnancy. A lack of vitamin D may lead to an early and severe form of preeclampsia (high blood pressure). That may cause intrauterine death of the baby, premature detachment of the placenta, and even the lethality.
Iron deficiency and low hemoglobin may cause premature birth and fetal growth retardation.
Thyroid hormones
It is necessary to check the level of thyroid hormones. For example, a decrease in the work of the thyroid gland (hypothyroidism) leads to a delay in mental development in an unborn baby.
Therefore, I recommend, regardless of the day of the menstrual cycle, to do the blood test with an empty stomach for:
- thyroid-stimulating hormone (TSH)
- free thyroxine (free T4)
- free triiodothyronine (free T3)
- glucose
- ferritin
- a general blood test for vitamin D 25-OH
I would recommend that some women also include homocysteine in the list of tests.
To measure your blood pressure two to three times a day during two or three weeks
Make sure to consult your family doctor if your pressure is higher than 125/85. She/he may suggest undergoing 48 hours Holter monitor recording, i.e., portable electrocardiogram (HM ECG). This help to detect hidden hypertension, which can complicate the course of pregnancy.
Weight and pregnancy planning
Weight is something what modern Woman doesn’t want to talk about. Both factors, obesity and underweight, are dangerous for the pregnancy and for the baby.
Unfortunately, obesity leads to all possible complications during pregnancy, including:
- preeclampsia
- congenital defects for the fetus
- gestational diabetes
- large baby (8,5-10 lb)
- traumatic childbirth because of the size of the child
- pregnancy depressions and anxiety disorder
Women with the body mass index (BMI) of 30 and above should start taking folic acid at a dose of 5 mg (5000 mcg) at least one month before they start their pregnancy planning. Healthy women, who didn’t have pregnancy losses in the past, should consume 400 mcg of folic acid per day.
How to measure your BMI?
The BMI calculation are calculated through dividing an adult’s weight in kilos to their height in meters². For example, let’s take an adult with the weight of 150 lb (ca. 68 kg) and 5.7 ft (1.74 m) tall.
BMI=68/1.74×1,74=22.5
Then we compare the obtained indicators in the table:
| Indicator, kg/м² | Result |
| Less than 18.5 | Underweight |
| 18,5-24,9 | Normal weight |
| 25,0-29,9 | Overweight |
| Over 30 | Obesity |
Dear readers of my Blog, you may ask me : “But you have always emphasized that the body mass index is not so important as a waist size”.
But in the case of pregnancy planning, it is essential to have BMI 18.5-25.
If the BMI is 29 or higher, it is crucial to be under observation of the gynecologist. This specialist has to be experienced in managing pregnant women with perinatal risks. You should definitely give birth in a perinatal center as well.
Bad Habits
Alcohol
Once you have started planning your baby, you and your husband have to follow a healthy lifestyle and keep to a healthy diet. But this is another topic, answer to which I give in this article. And surely I have to answer to one very common question: “Does alcohol have to be excluded?”
It is significant to remember that beer and “heavy” alcohol deteriorates the quality of sperm. One or two glasses of dry, high quality wine a week is totally “safe”. But experts who deal with fetal alcohol syndrome and its spectrum disorders in children recommend refraining from drinking any doses of alcohol at least three months before the planned conception.
Smoking
It is critical to stop smoking before pregnancy. Otherwise, there is a high risk of premature birth, clefts of the upper jaw in the child, fetal growth retardation and sudden newborn’s death.
Vitamins during pregnancy planning
The next question I receive from my patients and readers is: “Do I need any multivitamin complex for pregnants?”
For those who are planning pregnancy or are already pregnant, it is very important to get enough of those vitamins daily:
- Folic Acid
- Iron
- Calcium
- Vitamin D
- Docosahexaenoic acid (DHA): a polyunsaturated fatty acid (PUFA) from the Omega-3
- Iodine
How to plan pregnancy if your loved one is going to join Armed Forces of Ukraine or is already there?
There is such a technique as sperm cryopreservation.
A man donates sperm using manual masturbation, then an embryologist washes it of leukocytes and freezes it. After that, the woman undergoes an insemination procedure.
What if you and your Beloved one do not have the opportunity to have sex every two to three days? Then the insemination with your partner’s sperm is the best option.
Learn how often you need to have sex during pregnancy planning in my article and get rid of myths.
If you want to dive deeper into the preparation for pregnancy and the birth of a healthy baby, I recommend watching my four webinars devoted to this topic. My personal position is that the partner should also prepare for the pregnancy and the birth of a child. Therefore, the online course on preparation for pregnancy includes this webinar for men with recommendations of urologist-andrologist.
You can always find your doctor at the Lior Medical Center.
Be happy and healthy! May we and our beloved Ukraine have peace 💛💙
Natalia Silina 💗
Gynecologist-endocrinologist
Senior doctor of the Lior Medical Center
