Preconceptional Care: Being Good to the Baby Before Conception

Maintain Health

The best time to see a woman for prenatal care is before pregnancy. Prenatal care is really ten months with the first month being the period of time before a woman becomes pregnant. We have now reached a level in prenatal care where the best time to assess, manage and treat many pregnancy complications and conditions is before pregnancy occurs. The ideal time to see a woman for prenatal care is, therefore, when she is first considering or planning pregnancy. She should not wait until she gets pregnant to see her caregiver.

This concept has been popularized as preconceptional care. During this period of time, her risk for pregnancy can be assessed and determined. Her history, physical, and pertinent laboratory tests can be evaluated. During the preconceptional visit, the woman interested in pregnancy can discuss her history, such as drug or medication exposure, family history of any fetal abnormalities, her age-related risk, any medical problems she has at the present time, and her previous pregnancies, including previous cesarean delivery.

Information can be obtained from family members and records sought from providers of her previous obstetrical care. Laboratory tests, such as a rubella titer, can be obtained and the patient appropriately immunized and followed. The preconceptional period is a time when the patient can be screened for genetic disease disorders, such as sickle cell disease, Tay-Sachs disease, or other abnormal blood conditions.

Discussing a woman’s health and risks for pregnancy during the preconceptional period is preferred, rather than waiting for pregnancy. Discussion before pregnancy can be more thorough, less rushed and more informative than during pregnancy. Certain medical conditions can be treated, or at least stabilized. This could be most important in having a healthy baby, such as the patient who has diabetes or epilepsy and desires pregnancy. Other conditions, such as urinary tract infection, thyroid disease, anemia, or heart disease can be fully evaluated and the woman treated medically before pregnancy. Their risks during pregnancy can be discussed. Weight reduction may be prescribed, if the patient is obese, since this condition also increases a patient’s risk during pregnancy. Patients who have more severe risks may need to be seen in consultation by specialists or subspecialists. Maternal-fetal medicine specialists, specialists in taking care of high risk pregnancies, can be very helpful to the woman’s physician or midwife and the woman in discussing her risks for pregnancy and optimizing her health before pregnancy. Preconceptional care allows for the identification of risk factors, which then can be treated or managed so that the woman’s risk during pregnancy is decreased.

Preconceptional Care: Being Good to the Baby Before Conception

We now know that preconceptional care must not only be a part of obstetric care, but a part of all women’s healthcare. It is important for all providers who see women of reproductive age to discuss with them pregnancy, contraception, their medications, and their illness. Women with diabetes, thyroid disease, systemic Lupus erythematosus, hypertension, heart disease, or other medical disorders should seek evaluation and counseling by their healthcare provider prior to pregnancy.

Pregnancy outcome can be affected positively by appropriate preconceptional care of patients with diabetes mellitus, seizure disorders, or taking a variety of medications. Before conception, patients need to be aware of the risks that their health may impose on a pregnancy and how to decrease that risk before conception. Preconceptional vitamins can reduce the incidence of spina bifida and other defects. The woman anticipating pregnancy should use her preconceptional visit to review not only her health, but drug usage and other social practices, such as drinking and smoking. She can be counseled regarding not using medications during the first trimester. Information can be given regarding occupational exposures, medications, drugs, diet, exercise and potential complications of pregnancy.

The preconceptional visit can also include a discussion regarding keeping accurate records of the woman’s last menstrual period, so that gestational age dating will be more accurate. It has been suggested that women on oral birth control pills may wish to stop their pills at least one month before attempting pregnancy to help ascertain her normal cycle length.

When seeing a provider for preconceptional care, a woman might want to ask:

Should I gain or lose weight before pregnancy?
Do I have any special dietary needs?
Does my use of alcohol, tobacco, or drugs interfere with my chance of having a healthy pregnancy?
Could any of the over-the-counter medications I’m taking be harmful to my baby?
Should I start an exercise program? Can I continue my present exercise program?
Does my work expose me to things that could be harmful during pregnancy?
Do I need to be vaccinated for any infectious diseases before I try to conceive?
Should I be tested for any sexually transmitted diseases?

As a result of the answers to these questions, a woman may be referred for specialized counseling, medications discontinued, medical conditions stabilized, or genetic counseling obtained.