On the eve of my teaching a seminar in Albuquerque in 2002, a nurse asked if I could find time to speak about nutritional requirements during pregnancy. I thought about the request that night and realized that I certainly was not qualified to give definitive information in that area. Moreover, there are already volumes of information available on the subject, and I was certain she had more training and experience than me. However, I always try to be a good resource of information for seminar attendees and, after careful thought, I found time the next day to end the seminar with an outline of "The Five Stages of Pregnancy."

Since that seminar I have found, much to my surprise, that there is considerable interest in the topic. So I have decided to take the outline I used in Albuquerque, expand on it, and present it to you here.

The comedian George Carlin has used oxymorons, such as "jumbo shrimp" and "12-ounce pound cake," as a part of his stand-up act for years. As another example of this seeming self-contradiction, I have always thought it strange to give prenatal vitamins and minerals to a woman AFTER she becomes pregnant. If at all possible, prenatal nutrition should start several months before conception, getting the bodies of both parents ready for a baby. In other words, if a nutrient deficiency exists in either parent, it will be an influence before and after conception.

Think of it this way. If a deficiency already exists in the mother when she becomes pregnant and nutritional support (prenatal vitamins) will not arrive for roughly another month after conception, it will be difficult, if not impossible, to play catch-up. This is because some of the most important fetal development happens within the first month.

Additionally, what tends to be forgotten is that the father's nutritional status is just as important as the mother's for the health of the baby. Before I married, I learned this concept from my mother and paternal grandmother, both of whom were R.N.s. They felt very strongly about both mother and father being in the best possible health before attempting to have a child. I remember being under-impressed with the concept at the time, believing I was young and in my prime and not wishing to change my lifestyle for several weeks or months. But at least I remembered their advice and put it into practice when the time came.

I vaguely remember studying prenatal nutrition in college. What I now remember from that course is this:

-- A woman's nutritional requirements are greatly increased during pregnancy.

-- She needs prenatal vitamins and minerals as early as possible.

-- Some nutrients can prevent birth defects.

-- I wouldn't have to worry about it, that was the job of the obstetrician.

When I look back at that list, I realize how incredibly naive, incomplete, and even inaccurate some of that information is. I know better now and will relay what I have learned about the subject without trying to restate what the experts have written.

Three months prior to attempting to start a family, the parents-to-be should begin the following routine:

*** Get plenty of sleep, at least 7-8 hours per night. Five hours just won't cut it. If more sleep isn't possible, rest!

*** Drink lots of water. This is incredibly important to cleanse the body. I'll revisit this when discussing morning sickness in subsequent columns.

*** Exercise. Do what you can. At the very least, go for walks.

*** Eat a healthy and balanced diet. I know that many people believe they are eating well, except for some minor cravings from time-to-time. Sometimes, this just isn't the case.

*** Stop smoking and drinking.

How many future mothers and fathers come close to meeting the above recommendations? Every one of your patients tells you they eat a good diet. Well, if that is true, how do they develop vitamin and mineral deficiencies?

The average American diet is not deficient in nutrients. It may not be balanced but seldom is it deficient. The overwhelming problem in nutrition today is nutrient excess, not deficiency. The 1988 "Surgeon General's Report on Health and Nutrition" stated this opinion emphatically. So, if the problem is not dietary deficiency, it must be nutrient assimilation, and that begins with digestion and absorption.

This viewpoint will come as no surprise to regular readers of this column. Next month, I'll begin to summarize the incredibly important role of lipid digestion and assimilation for both males and females as it concerns not only conception but also development of the fetus.