Add folic acid to your diet. If you're of childbearing age, it's important to take folic acid supplements ”especially if you have stopped using contraception. Folic acid is a B vitamin that reduces the risk of neural tube defects like spina bifida. Few women get enough folic acid in their diet alone, so talk with your physician about supplementation. Get vaccinated. Make sure that all of your vaccinations are up to date, including immunization against rubella (also called German measles) and chickenpox. It's also important to be up to date on your tetanus shot (every 10 years). Kick bad habits. No one should smoke while trying to get pregnant or during pregnancy. Smoking can lead to higher risk for miscarriage as well as low-birth-weight babies. Drinking alcohol is OK, but in moderation only. If you think you might be pregnant, it's better to abstain. Maintain a healthy weight. Being overweight can increase your risk of gestational diabetes and other pregnancy-related complications. Keep exercising. Exercise will help you maintain or lose weight and it helps manage stress. If you think you might already be pregnant, check with your doctor about the kinds of exercise that are safe to continue. Ask about chronic health problems. Discuss with your physician the health risks of pregnancy if you have a chronic medical condition and which prescription medications are safe to continue. It's also important to talk about a family history of any heredity disorder prior to planning a pregnancy. Wait a month after stopping contraception. Dr. Coulter-Smith recommends waiting for one spontaneous menstrual cycle before trying to conceive. A normal menstrual cycle is the signal that the endometrium, the lining of the uterus, is healthy enough to support new life. What about the dad-to-be? Prior to conception, the important consideration is sperm count. Avoid hot tubs and saunas. Smoking and alcohol also can affect sperm count. Advancing age does not affect fertility in men as much as it does in women.

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In an accompanying editorial, Cornelia M. Ulrich, M.S., Ph.D., and John D. Potter, M.D., Ph.D., of the Fred Hutchinson Cancer Research Center, Seattle, discuss the findings of Cole and colleagues.

"How should the unexpected results of this study be interpreted? The most likely explanation for the increased risk of advanced and multiple adenomas in the intervention group is that undetected early precursor lesions were present in the mucosa [a type of membrane] of these patients (who are at increased adenoma risk), and that folic acid promoted growth of these lesions. This hypothesis is consistent with experimental studies showing increased colorectal neoplasia when folic acid is administered after lesions are present."

"Nonetheless, by the nature of the design, the results do not provide information on primary prevention by folic acid (the potential for folic acid to reduce the incidence of first adenomas). The question of efficacy of folate in cancer prevention is not resolved, and animal experiments showing chemopreventive effects of folate, as well as the strong observational epidemiological evidence, speak to the potential of folate as a chemopreventive agent, if taken early. Unfortunately, primary prevention trials that start in childhood would be lengthy, expensive, and logistically nearly impossible."

"The results of the clinical trial by Cole et al illustrate, yet again, the principle that chemoprevention with single agents is problematic. Similar to the increased risk of lung cancer observed with beta carotene supplementation, selection of resistant clones is as plausible an outcome of the use of single-agent chemoprevention as it is of single-agent chemotherapy," they write. "It is time to be as thoughtful about the need for multiagent chemoprevention, not forgetting that diet is one version of this, as about the use of multiagent chemotherapy."

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