Pre-conception counselling — Preparing for a healthy pregnancy
The dictum ‘prevention is better than cure’ is never more appropriate than when a woman is preparing for pregnancy. More than one-third of women have an unplanned pregnancy.
Pre-conception care can ensure healthy mother and healthy baby. It helps to identify factors that can affect the health of both the mother and baby. Women do not realise the implications of ensuring optimum health when planning a pregnancy.
The ideal time for prenatal counseling is at least three to six to months prior to pregnancy. It gives her sufficient time to prepare her body for conception and pregnancy. It also allows her to reduce any health risks.
At this visit, the woman can be screened for risk factors; recommendations can be made for risk reduction interventions and advice for healthy lifestyle given.
Prenatal advice is important for reducing pregnancy complications like pre-term births, having low birth weight babies and maternal complications which are among the third leading cause of infant deaths.
The critical period of fetal development is from the time of the missed period up to the third month of pregnancy. At this time prenatal vitamins like folic acid helps in the brain and neural growth, and is proven to reduce incidence of neural tube defects.
Infections like Rubella (German measles) and chicken pox at this stage of pregnancy can seriously damage the fetal organs. Vaccine against Rubella and chicken pox can be given prior to pregnancy, after checking immune status by blood tests.
Other infections that need to be screened for include HIV, Hepatitis B and syphilis and appropriate advice given. Other factors that can influence pregnancy outcomes include age, weight, lifestyle factors like exercise, smoking history and alcohol intake.
Optimum biological age for pregnancy is from 20-35 years. Women now tend to delay pregnancy due to career choices. Pregnancy at an older age increases chances for fibroids, infertility, miscarriages, and fetal chromosomal abnormalities like Downs’s Syndrome, twins and pregnancy complications like diabetes, hypertension and pre-term births.
Risk of Down’s syndrome can range from 1:350 at 35 years to 1:100 at 40 years. Being overweight increases risk for infertility, miscarriages, neural tube defects, pre-term delivery, diabetes, hypertension, thrombosis and Caesarian delivery. Weight reduction can thus lead to normal pregnancy, uncomplicated labour and healthy baby.
Chronic illnesses like diabetes can worsen with age, and if uncontrolled, can increase the risk of abnormalities, large babies with difficult delivery, pre-term delivery and caesarian section. Pregnancy outcome can be improved by ensuring normal blood sugar levels when planning a pregnancy.
Hypertension history increases a woman’s risks when pregnant. The blood pressure levels can increase and affect her kidney functions, as well as there is a risk of effects on the baby like growth restriction and pre-term delivery.
Thyroid disease prior to pregnancy warrants close monitoring and optimising the dose of medication before pregnancy. The source of thyroid hormone in the developing fetus is from the mother, and it is essential for normal brain development.
Hence the mother should be taking appropriate doses of thyroid hormone prior to and in the first three months of pregnancy if she suffers from thyroid deficiency, also called as hypothyroidism. Medications used in hyperthyroidism (excess levels of thyroid hormones) can affect the fetus especially in the first three months of pregnancy.
Epilepsy and the medication used to control fits can have effects on the developing fetus in the early period. Hence it is important to consult the neurologist, to modify drugs used and their doses or to change to safer alternatives, to reduce the risk. Medications used in epilepsy should never be discontinued without medical advice.
Genetic counselling may be required in case of a positive history of previous abnormal baby or a strong family history of genetic disorder.
Smoking and alcohol intake can adversely affect pregnancy by increasing the risk of miscarriage, fetal growth restriction, pre-term delivery and stillbirths. Women planning pregnancy should adopt a healthy lifestyle with regular exercises, weight reduction, and correction of anemia if present, stop smoking and take prenatal folic acid. These simple lifestyle changes can ensure good health for women and the health of the future generation.
Dr Josephine Jose