Most women who get pregnant see their gynecologists only after they have missed their periods. They take it for granted that they are healthy enough to carry on with a nine-month journey, safely. They also take for granted that they have no problem which could potentially harm their growing baby. Now let me ask you this: don’t we plan and don’t we organise ourselves for any long trip we make? Then why this casual attitude towards such an important event in our lives, when the lives of both, the mother and the baby could be at stake?
Planning your pregnancy can help you make wise choices that will benefit, both you and your baby. As soon as you decided to start a family, you should see your gynecologist who will help you determine what steps you may need, to become physically and medically ready for a pregnancy.
Preconceptional care refers to the care prior to conception. This preventive care is one of the most cost-effective and benefi cial interventions which can dramatically improve the chances of a successful pregnancy.
There are various factors, which if addressed preconceptionally, can result in a healthy successful pregnancy.
Adolescent pregnancies, or conception among young women less than 19 years of age, are more likely to result in low birth weight babies. On the other hand, older women are at greater risk for genetic abnormalities and miscarriages. Information about problems associated with age and the necessary intervention, along with management of any existing medical problems, are among the mainstays of treatment of women advanced in age.
Medical history and medications
Women with certain medical conditions may benefit from advice before becoming pregnant. Drugs taken during pregnancy, especially during the first three months, could harm the baby. Hence in conditions like epilepsy, for example, the medications may possibly harm the pregnancy or the unborn child. Hence, the neurologist needs to be consulted when you are planning a pregnancy so that he could prescribe the safest drugs possible to ensure you have a safe and healthy pregnancy. Women with diabetes need to control their sugar strictly because the chances of abnormal babies increases eight times if the sugar is uncontrolled in the first trimester of pregnancy. Medications being taken for skin conditions, for example, retinoic acid, need to be stopped before planning a pregnancy, since it can cause nervous system abnormalities in the baby.
If you have a family history of babies born with any congenital abnormalites or you have history of babies born with any development disabilities, you need to inform your doctor so that mentally he can carry out appropriate screening tests as soon as you get pregnant.
Women with recurrent miscarriages, those with advanced age and those with abnormal pregnancies in the past, can benefit by testing their embryos prior to the transfer to the uterus. For example, if the embryo has a genetic disease, it is not transferred to her womb, thus preventing the creation of an abnormal pregnancy. This can improve the chance for the birth of a child without the affected condition.
Women who are obese have a greater chance of problems during pregnancy. Obesity poses risks for the baby, as well as the mother. The babies are also at an increased risk of being born with a condition called macrosomia, in which a foetus grows too large, causing complications during labour. A woman who is slightly underweight should gain a few pounds to prepare for her pregnancy.
Psychiatric disease warrants good quality pre-pregnancy care and counseling. The estimate is that there is a 10 to 15 per cent risk of schizophrenia in offspring. Risks of instability and potential plans for withdrawing medication must be thoroughly discussed before planning a pregnancy.
It is advisable to take folic acid tablets at least three months before you become pregnant, even if you are healthy and eat a well-balanced diet. This may reduce the risk of having a baby born with a spine problem such as spina bifi da. After conceiving, you need to be cautious of what you eat. Too much Vitamin A or undercooked meats can cause toxoplasmosis or other parasitic diseases.
Alcohol: Heavy drinking can cause an increased risk of miscarriage and it may cause serious harm to the baby’s growth and brain development.
Smoking: It is strongly recommended that women stop smoking when trying to get pregnant. Tobacco smoke can slow the baby’s growth. The risks of having a miscarriage, premature birth or still birth are higher in women who smoke.
Recent studies have indicated hat gum disease increases the risk of preterm delivery. This is precisely why every woman should have dental care and treatment prior to pregnancy, if possible.
Drug abuse can be hazardous to the baby. Women who consume heroin can be prescribed methadone to avoid symptoms of withdrawal in the baby.
Infections can harm both the mother and the baby. Some infections in pregnancy can cause birth defects or illnesses in the foetus. Vaccinations can prevent some of these infections. It is important to be vaccinated before becoming pregnant, because some vaccines are not safe to use during pregnancy. All women considering pregnancy should get tested for immunity to rubella, and if not immune, should be offered a rubella vaccination. A rubella infection in pregnancy can lead to devastating effects on the developing foetus. Vaccinations for women susceptible to chicken pox also can be offered, so as to avoid maternal and foetal infections.
Sexually transmitted diseases come in all types and forms. These diseases not only affect the ability to conceive, but can also infect and harm the baby. For example, HIV. AIDS in pregnant women bears special attention since treatment with antiretroviral or anti HIV drugs, has been shown to reduce the transmission of infection from mother to child. Screening for syphilis can also be done to avoid complications, both maternal and foetal. Gonorrhoea can lead to adverse pregnancy outcomes and infertility, if left untreated. Treatment of both partners prior to pregnancy is preferred, as it prevents unnecessary exposure of to the foetus. The preconception period is optimal to provide immunisation to women who have not received the hepatitis B vaccine, especially if they are at risk of blood exposure or sexually transmitted diseases.
Women with a family history of hemophilia, sickle cell anemia, thalassaemia, muscular dystrophy, etc., can be offered genetic screening to detect any of these hereditary disorders. If the pregnancy is found to be affected, then the patient is counselled for termination of pregnancy.
Conditions in which pregnancy is contraindicated
There are some medical conditions like some cardiac conditions (pulmonary hypertension), respiratory conditions (cystic fibrosis), kidney conditions (severe compromise of kidney function), etc., wherein the woman should be deterred from getting pregnant since these conditions can threaten the mother’s life.
Male periconception care
There is expanding scientific evidence of an association between male-associated health issues and pregnancy outcomes. A couple should attend the periconception visit together and the woman’s partner should be encouraged to be included in periconception counseling and care. Paternal smoking, as well as alcohol consumption, have been associated with decreased fertility and increased frequency of malformations in the baby. It takes an average 10 to 11 weeks for sperm to be produced. This is why, abstaining from alcohol and tobacco is advised three months prior to conception. Sperm production in the testicles requires a temperature that is lower than the core body temperature. Men should refrain from staying too long in saunas or hot tubs, and prevent overheating of testes. They’re also advised to wear loose underwear so as to maximize sperm production. The use of certain lubricants during sex can decrease fertility, and hence they should be avoided.
Pregnancy puts special demands on a woman’s body. As a quality of any crop will depend upon the quality of seeds, the soil and the environment, a healthy baby can only result from the union of a healthy sperm and ova, in the mother’s healthy environment. Always remember, a pregnancy should be by choice and not by chance. Becoming a parent is filled with many challenges, rewards and choices. Making healthy choices before you become pregnant is an important step to a healthy and happy pregnancy. | MB