before planning pregnancy Archives

Reena is a new age, smart, educated, working professional. She is particular about everything, from her dress… to her make- up… to her exercise schedule ….to her career plan. This agile, young, healthy girl, Reena is now pregnant. And she is so happy! As she discloses the news to her near and dear ones, she is suddenly bombarded with so many inputs about do’s and don’ts.
Reena believes that being pregnant is a natural event. Then why should her lifestyle go upside down suddenly? Why should there be restrictions on things that she always liked to do for so many years? On the other hand she is a perfectionist…wanting to keep no stone unturned to achieve the “best results”!
She has so many questions and no one can convincingly answer them… neither her Mom or Mom in law not even Google!
Finally, Reena comes to me and she asks:
Is it safe to have coffee during pregnancy?
Here is the answer:
Coffee contains caffeine. While making coffee most people add sugar to the drink. Excessive sugar again is not good. However this article deals with caffeine.
Caffeine is naturally available in coffee beans, tea leaves, some seeds and fruits.
What does caffeine do to my body?
Caffeine is a natural stimulant. It improves alertness. It also increases the heart rate and blood pressure slightly. It makes you pass more urine. It can also increase the heart burn. Alertness in the later part of the day may not allow you to sleep well.
Does excessive consumption harm the baby?
High intake of caffeine can cause pregnancy loss, miscarriages and still births. (1) With every 100 mg of caffeine, the risk of pregnancy loss increases by 7% and that of low birth weight increases by 13%. (4). There is convincing evidence that if you are consuming more than eight cups of coffee per day, it can harm the baby in the womb.
How much caffeine is “OK” for a healthy non pregnant person?
400 mg /day of caffeine is ok. Higher amounts may lead to side effects.
Why should pregnant women consume less caffeine?
During pregnancy the body digests (metabolises) caffeine slowly. The caffeine passes directly to the baby through the placenta. The baby doesn’t have the enzyme to digest (metabolise) the caffeine so it accumulates in the body. This may lead to bad effects on the baby in the womb
How much caffeine is “OK” during pregnancy?
Reputed medical bodies recommend that pregnant women should consume less caffeine. The National health services of the United Kingdom suggest that pregnant woman should consume less than 200 mg of caffeine every day. (1)
The World health Organization recommends that it is advisable to reduce the intake to below 300 mg per day (2)

Is tea better than coffee?
Tea contains less caffeine than coffee.
Here is a comparison:
Coffee: (per cup)
Filter coffee: 100 mg
Instant coffee: 60-100 mg
Decaf: 2 mg
Tea:(per cup)
Black Tea: 50mg
Green Tea: 25mg
Even energy drinks contain caffeine. Cola contains around 25 mg of caffeine.

How to reduce the intake of caffeine?
First estimate the amount of caffeine that you take in a day. Is it really high? If yes, think what is it that attracts you to the cuppa? Is it the smell, the feel, the taste? Is it the few leisure moments or the hot temperature of the drink. Try to replace coffee by other drink. Still not possible?
Here are few tips that can help:
• Use decaf and trick your body.
• Use small cups or take half cup every time.
• Avoid coffee in the later part of the day.
• Consume a lot of water or juices during the day

Conclusion:
Caffeine is not a poison. Medicines used for common cold also have caffeine. Caffeine is used to treat apnoea (when breathing stops) in premature babies.
Most of the reputed medical organizations recommend that use of moderate amounts of coffee (upto 200- 300 mgs) of caffeine is safe during pregnancy.

References:

1. Int J Gynaecol Obstet. 2015 Aug;130(2):116-22. doi: 10.1016/j.ijgo.2015.03.033. Epub 2015 May 14.
2. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0174-6. [Online]
3. https://www.nhs.uk/common-health-questions/pregnancy/should-i-limit-caffeine-during-pregnancy/. [Online] [Cited: 2020 april 10.]
4. https://www.who.int/elena/titles/caffeine-pregnancy/en/. [Online] [Cited: 10 april 2020.]

Akshay has come home … frustrated from the office. In fact he has been sacked from the job. Pranoti is his wife. She is on treatment for PCOS ( polycystic ovarian syndrome). She is taking treatment from her gynaec for becoming pregnant. She has been told by the doctor that today is “an important day” . The couple must have sex. Pranoti is trying to get her husband to the bed. Akshay is in no mood… It is the stress in his life… added to it is the performance anxiety which is hovering over him. He is unable to perform on the day… leading to further frustration and stress in the couple.
All this was being staged in a Marathi play “Don’t worry, Be Happy” written by Mihir Rajda. The Marathi play is doing well on box office and received lots of appreciation from audience as well as critics. It was the sixtieth show. My wife Dr Smita had given some technical medical inputs to the script. Thus we were invited for the play. The script was brilliant… dialogues sharp… and acting fantabulous. Umesh Kamat ( Akshy) & Spruha Joshi ( Pranoti) were cracking mind blowing humor on stage in this so called serious scene and audience was laughing… At the same time a serious message of how the stress has now creeped in the delicate relationships and into the bedroom was getting registered by the people. The spectators gave a standing ovation at the end of the play and they deserved it.
Being a gynaecologist I hear this every day from my patients. Today I was seeing it in a very hilarious way on the stage. The heroine Pranoti represented the modern age career oriented woman. She had postponed the pregnancy till now… in spite of the her mother’s and mother in law’s advice. The hero is working in corporate sector and burdened with targets. The couple has to kind of struggle to maintain the existing lifestyle. Pranoti is a perfectionist and wants her house to be well kept. She loves her pet dog too. On the other hand, Akshay typically represents “male” upbringing, he can’t cope up with Pranoti’s basic expectations nor does he like the dog. The couple although loves each other and cares for each other they also want their own space. I think it is a perfect setting… Today this is a story of this new generation…
Many couples come to me with a typical problem. In order to prioritize the careers they postpone the pregnancy. At around 30 or above, it is usually the woman who suddenly realizes that they have to now plan a baby. They want everything pre-planned. They expect quick results. They do not mind starting treatment, spending money but want immediate solutions. I distinctly remember one of my patients… The girl wanted to become pregnant in a particular month so that the child will be born in a certain month so that the school admission will not be difficult!

So here are some tips for those planning to be pregnant.
• The couple must have open ended discussion time to time after marriage about pregnancy. It is usually common to see that males want to post pone the pregnancy. A realistic thought must be given to this. Just delaying pregnancy for the sake of nothing may not be a great idea.
• Planned pregnancy is better than unplanned pregnancy.
• Adopt healthy life style. Quit smoking, exercise regularly, eat healthy diet, lose weight (if obese).
• Meet the gynaecologist and get pre-pregnancy investigations done.
• Understand that the egg formation (ovulation) occurs only once in the month. If pregnancy has to occur it will occur around that time. Intercourse before and after cannot lead to pregnancy. But that does not mean that couple should not have intercourse for pleasure and satisfaction.
• Understand that the chance of pregnancy occurring per month is low in human beings. The chance is considered to be just around 15% or so per month. It means out of 100 so to say normal couples only 15 will achieve pregnancy in that month.
• Do not lose the spontaneity in the sex life. The sex has to start from the mind. Do not get mechanical. Accept that performance anxiety is a real and genuine issue. Do not behave as if heavens have fallen if you miss the important day.
• Do not start medical treatment unnecessarily. Going to the doctor and starting the treatment can also cause stress. So first allow your body to work. Only if needed medical treatment should be started.
• Although pregnancy can be planned, it cannot be planned so accurately. Accept that nature and body takes time to work. Take things as they come.
• And lastly the most important thing: “ Don’t worry,be happy”

P.S:
I request the team of “Don’t worry Be happy” to upload the hilarious bedroom scene on You Tube… of course after a while. It can serve as an educational material for those who are planning their pregnancy.