Pre Conception check
Before attempting to conceive it is desirable that all women have a pre-conception check to ensure that cautions are taken to improve the chances for a successful outcome of pregnancy. Usually 3 months before attempting to conceive is adequate, but women with PCOS or endometriosis may need to increase this time because help may be required in achieving a pregnancy.
Either a GP who is interested in women’s health or an Obstetrician Gynaecologist can perform the assessment at this stage.
The rationale behind this consultation is to discuss lifestyle factors that can have an impact on the pregnancy and also ensure that the appropriate pre-pregnancy investigations have been performed.
Smoking should definitely be discontinued before a pregnancy. Smoking is associated with an increased risk of fetal mortality, pre-term labour and small growth retarded babies. It also increases the risk of infertility, placental separation, premature rupture of membranes and placenta previa. Of course there are the long term maternal risks such as heart disease, lung disease and an increase in numerous cancers.
It is also known that children who inhale smoke have a higher incidence of SIDS, chronic respiratory conditions, including asthma, Atherosclerosis and middle ear disease. Essentially they grow into unhealthy adults.
Nicotine patches are not recommended during pregnancy but are probably safer than smoking during pregnancy. Ideally smoking should be ceased before the pregnancy is conceived.
It is known that excessive alcohol intake can produce fetal abnormalities, but the exact safe level of alcohol intake during pregnancy has not been determined. Binge drinking has a higher risk than a small amount of alcohol on a regular basis. It is important that women, once they start attempting to conceive, avoid the possibility of binge drinking, especially over the Christmas period, when this seems most likely to happen.
The occasional glass of alcohol, however, is unlikely to cause any problems to the baby, but this can not be guaranteed. I will add that 1 standard drink is 100mls of wine.
There is no exact dose response relationship between the amount of alcohol consumed during the prenatal period and the extent of damage caused by the alcohol and the infant, abstinence is recommended.
Obviously a healthy diet will help grow a healthy baby. It is recommended that women taken pregnancy vitamins for 3 months prior to conception. There are a range of these on the market and it is important to choose 1 with Iodine. For example: Elevit with Iodine, Blackmores Gold with Iodine, Pregnacare with Iodine.
Folic acid deficiency has been shown to increase the risk of Spina Bifida and related abnormalities, and the addition of folic acid either by folic acid tablets alone or in the multi vitamins, can significantly reduce this risk.
The makers of Elevit claim a reduced risk of miscarriage.
Another issue to be concerned about is ones BMI.
Underweight women who have a BMI of less than 18.5 have an increased risk of spontaneous preterm birth. Small babies (less than 2500 grams), and have increased risk of perineal tearing during labour. Women who have a raised BMI, however, have an increased risk of gestational diabetes, hypertension during pregnancy, the need for induction of labour, caesarian section and large babies. There is also an increased risk of fertility issues, often because a raised BMI is associated with the presence of PCOS.
A sensible eating plan should be commenced before conceiving and should be incorporated with exercise. It is possible, of course, to continue this eating program during a pregnancy to help minimise the risks.
Medical conditions such as Thyroid Disease, Auto Immune Diseases, Hypertension and Heart Disease need to be discussed and medications evaluated before conception occurs. It is vital to ensure that these drugs are safe during pregnancy and, if the preconception assessment occurs in time, there is time to change to safer medications if necessary.
Some blood tests are best performed before pregnancy. These include Rubella (German Measles) and Varicella (Chicken Pox). An infection with German Measles during the first 12 weeks of pregnancy can produce significant fetal abnormalities including deafness and blindness. A Chicken Pox infection during pregnancy can cause the mother to become very unwell with the risk to the baby being significantly less.
There are vaccinations for both of these viral infections but they need to be given 3 months before conception occurs.
It is also good to know your blood group before conceiving in the event of an early miscarriage. If the woman is rhesus negative she may require an Anti-D injection to protect against future pregnancy problems.
Another test that we are now doing is for Cystic Fibrosis. Cystic Fibrosis is a genetic condition that occurs in approximately 1/25 people in the community who are carriers of the abnormal gene. There is a 1/625 chance of 2 carriers conceiving together and that couple has a ¼ chance of having an infected baby.
Cystic Fibrosis causes major lung problems, malabsorption and pancreatic damage and is often associated with a shortened life span.
There is a test available to check the presence of the carrier state so that appropriate advice can be provided if necessary. This is a test that only needs to be performed on the mother in one pregnancy in most circumstances.
It is always advisable to check on a pap smear during a preconception check. If a pap smear is taken during pregnancy it often shows low grade changes that can be worrying but are usually not significant and therefore it is desirable to avoid taking a pap smear when pregnant.
The preconception check is also a time to discuss period regularity, whether there are signs of ovulation, period pain or other symptoms that could suggest that there may be factors that could hinder conception. A preconception check is one way of making sure that everything is in order before a baby is conceived.