3 Tests You Should Ask Your Doctor to Run Before PregnancyNov 09, 2021
If you’re like me, you may not be pregnant yet, but you know the importance of preparing your body for pregnancy. You understand that being proactive and getting labs ahead of pregnancy can help prevent avoidable pregnancy complications.
In my experience, I see these labs that I’m recommending, either not being run at all, or the doctor not explaining to the patient why these labs are important and what implications they can have on your pregnancy.
Labs may sound scary and expensive but they give us important information that can inform where we need to optimize your health ahead of pregnancy. This can make your pregnancy smoother, more enjoyable, and in some cases prevent irreversible negative outcomes.
Now I don’t want to be a negative Nancy over here, but I do want you to be informed and understand the stakes.
The stakes of not running these labs and having underlying deficiencies, an under-active thyroid, or insulin resistance can lead to adverse outcomes for your baby like:
- Cognitive delays i.e. lower IQ, smaller brain volume, worse motor skills, higher chance of autism etc.
- Unfavorable changes in DNA and genetic expression
- Long term metabolic issues like childhood diabetes and obesity
- Compromised immune system and gut health
- Birth defects
- Preterm birth & low birth weight
- Fetal macrosomia (large baby/delivery complications)
The stakes are high for you too and can lead to pregnancy complications like:
- Gestational diabetes which can lead to insulin resistance, type 2 diabetes, obesity
- Chronic fatigue & brain fog
- Unhealthy weight gain & stretch marks
- Weakened immune health
- Postnatal depression
- Compromised fertility (our approach combats this ahead of time)
Having a baby takes a serious toll on our bodies and it’s in our best interest to make sure we’re as healthy as possible going into pregnancy so we can increase the likelihood of a beautiful, enjoyable, healthy pregnancy and baby.
The problem is the healthcare system’s model is set up to wait until someone is actually sick or there is a problem, like multiple miscarriages or diabetes, to diagnose and treat.
Why wait until something is a problem when you can prevent it by running the right labs and then putting the right interventions into practice?
Not only will taking a preventative approach to your health support fertility and chances of having a healthy pregnancy, but it will also help to stack the deck for your child's future health and success.
Here are three labs you should ask your doctor for ahead of pregnancy:
1. Hemoglobin A1c (HbA1c)
This test shows your average blood sugar levels over the past 3 months. It’s one of the most accurate indicators of metabolic health and risk for developing gestational diabetes. In fact, one study found 98.4% of women that have an A1c of 5.9 or higher go on to develop gestational diabetes. Most experts agree that an A1c of 5.5 or lower is a healthy normal range, but 5.0 or lower may be optimal. Falling between 5.7 and 6.4 means you have prediabetes which increases your chances of developing GD by almost 3x compared to women who fall below 5.7. By being proactive and bringing this number down before pregnancy you can prevent a future gestational diabetes diagnosis and increase your chances of conceiving!
Why else does blood sugar matter? Your blood sugar and insulin sensitivity are essentially the key components of your overall metabolic health. 88% of Americans have at least 1 biomarker of metabolic dysfunction and many of them aren’t even aware of it. During pregnancy, having metabolic conditions is associated with autism, neurodevelopmental problems and developmental delays in children. The great news is that you can improve your metabolic health! It’s not a fixed genetic state. It can be positively affected through food and lifestyle which is a big part of what my approach to prenatal nutrition covers. If you’re not sure where to start to bring your A1c down then I recommend taking our course. We approach blood sugar balance through real food and lifestyle habits that will balance your blood sugar naturally. Being healthy metabolically is such an important piece of the pie. I always recommend getting your blood sugar in check before trying to conceive.
Keep in mind, HbA1c only gives us part of the picture, as it does not provide data on variability. This is a limitation of the test, which is why I also suggest my clients have a full metabolic panel (fasting insulin, fasting glucose etc.) done with their doctor and consider tracking their blood sugar with a continuous glucose monitor (CGM). Using a CGM once or twice before pregnancy, and then also during pregnancy, can help you understand how your typical meals may be affecting your blood sugar throughout the day and how insulin sensitivity will change throughout your pregnancy. There are other factors that could throw off your A1c reading, like hypoglycemia or your unique red blood cell longevity. Red blood cell turnover increases during pregnancy which means you will most likely get a more accurate reading before pregnancy.
My recommendation to clients is to get this test done ahead of pregnancy every year. If your number is creeping up to 5.5 or higher, following the nutrition guidelines of the course for a few months will greatly decrease chances of high blood sugar and gestational diabetes during pregnancy.
2. Full Thyroid Panel
Undiagnosed hypothyroidism is one of the most common reasons for infertility and miscarriage. One study concluded that 60% of pregnant women with untreated overt hypothyroidism experienced miscarriage. For the better half of your pregnancy your baby does not make their own thyroid hormones and are completely dependent on your thyroid hormones for proper development. Although many doctors don’t test for thyroid disorders until you’re symptomatic, I believe it's a test worth investing in to avoid preventable pregnancy complications.
I recommend running a full thyroid panel (TSH, free T4, free T3, reverse T3, TPOAb, TgAB) before conception. If you do have a thyroid diagnosis, you will likely need thyroid replacement hormones which will support your thyroid, a healthy pregnancy, and your baby's brain development and thyroid function. This is one case where medication is often necessary and it's best to be proactive about it and continue to monitor with your endocrinologist or doctor.
Given the rates of thyroid disorders are on the rise, and the irreversible damages an under-active thyroid can have on your baby's health, I recommend just getting tested and eliminating any doubts. You likely will have a perfectly healthy thyroid, with nothing to worry about, but in the off chance your thyroid is not functioning normally, take comfort in the ability to correct it before it's a problem during pregnancy.
3. Nutrient Panel
A big part of my approach to prenatal nutrition is optimizing your nutrient status so you can have a positive impact on your baby's future intelligence, gut health, metabolism, motor skills, communication skills, social skills, genetic expression etc. The cool thing is your body actually stores nutrients now for your future baby that you haven’t even conceived yet! That’s why I always say there is so much we can do ahead of pregnancy to prepare our bodies for a healthy pregnancy. During the first trimester you may not be able to eat foods like vegetables and animal proteins without experiencing nausea so now is the perfect time to build your nutrient stores.
Allow me to provide a few examples where nutrient status really makes a difference during pregnancy.
You’ve probably heard how important folate is during pregnancy, but I bet you didn’t know what I’m about to share with you.
Folate specifically is crucial during the first 28 days of pregnancy in order to form your baby's neural tube, which later becomes their brain and spinal cord. Many women don’t even know they’re pregnant until after the first 28 days, which means it’s important to build your folate stores ahead of time and take a quality prenatal for a few months leading up to conception. One important thing to note is regarding the MTHFR gene mutation, which affects up to 60% of women. If you have this specific gene, it means that you don’t convert folic acid to its usable form which is super problematic if you’re relying on a prenatal supplement that uses folic acid. If you have MTHFR gene mutation you will want to avoid foods and prenatals with synthetic folic acid, and instead include a methylated folate supplement, and lean on foods rich in choline, glycine and b9 which will support the methylation process. Either way, I’d opt for a prenatal that includes b9/folate in its usable form which is L-methylfolate. Folate deficiency can cause serious birth defects, which is why I recommend a comprehensive nutrient profile to understand where your levels are at.
Another nutrient to consider is vitamin D. Vitamin D deficiency is linked to many unfavorable pregnancy outcomes like gestational diabetes, autism, preeclampsia, postnatal depression, preterm labor and more. Vitamin D is also crucial for your baby's healthy development.
Taking too much vitamin D at one time could be toxic for you and your baby, which is why I recommend getting ahead of it and slowly building up your vitamin D to healthy levels ahead of pregnancy. I recommend getting your vitamin D levels checked before pregnancy and at every trimester and modifying your supplementation as necessary. You want to be aiming for closer to 50ng/ml and definitely over the minimum of 30 ng/ml (75nmol/l - 125nmol/l).
To bring it full circle, the Position Paper of the Academy of Nutrition and Dietetics states, “Inadequate levels of key nutrients during crucial periods of fetal development may lead to reprogramming within fetal tissues, predisposing the infant to chronic conditions in later life. Those conditions include obesity, cardiovascular disease, bone health, cognition, immune function, and diabetes.”
To check your nutrient status I recommend the Genova NutrEval which is the most comprehensive nutrient panel on the market. Remember your body can store nutrients now in preparation for pregnancy so now is the time to start building up those nutrient stores through real foods and proper supplementation.
If any of your lab results fall outside of normal ranges, take comfort in addressing it now before you get pregnant! Once you’re pregnant you will want to work with your doctor and retest throughout pregnancy to monitor.
If you’re interested in other labs I recommend, check out the Hello Baby Prenatal Nutrition Course where we have a whole module about fertility and setting your body up for a healthy pregnancy!
https://www.tandfonline.com/doi/abs/10.3109/00498254.2013.845705?journalCode=ixen20 https://pubmed.ncbi.nlm.nih.gov/31737547/ https://moh-it.pure.elsevier.com/en/publications/folic-acid-versus-5-methyl-tetrahydrofolate-supplementation-in-pr https://jamanetwork.com/journals/jamapediatrics/fullarticle/1919923 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250974/ https://pubmed.ncbi.nlm.nih.gov/18709885/ https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/