Pre-con­cep­tion coun­selling — Pre­par­ing for a healthy preg­nancy

Khaleej Times - - HEALTH MATTERS - Dr Josephine Jose, con­sul­tant ob­stet­rics/gyne­col­ogy head of depart­ment, In­ter­na­tional Mod­ern Hos­pi­tal (This ar­ti­cle has been spon­sored by the ad­ver­tiser)

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

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