Doctors frequently emphasize healthy behavior during pregnancy and suggest expectant mothers avoid certain foods, products, and environmental factors — ranging from sushi dinners to Retin-A. But according to the American Congress of Gynecologists, it can be just as important for a woman to practice healthy behavior as she is trying to get pregnant. The ACOG recommends that women who are trying to get pregnant meet with their doctors for a “preconception care checkup.”

To get a sense of the specific products you should avoid to ensure a healthy pregnancy, we called Dr. Kelly Culwell, an OB-GYN and former medical officer at the World Health Organization. Here’s what she told us.

Drugs, alcohol and tobacco

Although many women know they should eliminate alcohol, tobacco, and drugs when they’re pregnant, the American Congress of Gynecologists encourages parents to stop these behaviors before conception as the overall health of parents can have direct impact on the health of a baby. The fetus is also most vulnerable to the effects of drugs, alcohol, and tobacco during the first trimester of pregnancy, so avoiding harmful behavior during the first months of pregnancy can help prevent birth defects.

Certain prescription medications
Dr. Culwell recommends that women speak to their doctors when they’re thinking of becoming pregnant to review their current medications and any possible side effects. “There are definitely medications that can cause birth defects, even before you know you’re pregnant,” Culwell says. “Certain antiepileptic, psych, and blood thinner medications are known to cause problems.”

Select over-the-counter medications
Women are also encouraged to check with their doctors before taking vitamins and mineral supplements. Calcium and iron taken in large quantities can have adverse effects, and according to the ACOG, certain herbal remedies should also be taken with caution while you’re pregnant.

Environmental chemicals
Certain everyday chemicals have been shown to affect a woman’s fertility, and Dr. Culwell says women who are trying to get pregnant should be extra cautious of the chemicals they come in contact with. Exposure to lead, mercury, chemicals such as pesticides or solvents, and radiation can all impact fertility, and could harm the fetus, the ACOG warns. However, the research around whether chemicals such as BPA and phthalates — often found in plastics — impact fertility isn’t as clear. “There’s not terrific evidence on how much BPA exposure, for example, would be safe or what we need to avoid,” Culwell says. “So right now, that comes down to your personal feelings and comfort level.”

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