“A woman’s health prior to conception is critical to the outcome of her pregnancy and may have a lifelong impact on her baby’s health. There is a lot that women can do prior to pregnancy to optimise their health including lifestyle changes such as a healthy diet and appropriate supplementation. Pre-pregnancy care helps find issues that may affect a woman’s pregnancy, so that steps can be taken to manage potential problems prior to pregnancy.”
RANZCOG Guideline Pre-Pregnancy Counselling”C-Obs 3(a) (July 2017)
For each of the following pre-pregnancy considerations, your GP is key to providing advice, guidance and is the link to future pregnancy care.
Medical Conditions and Medications
Some medical conditions may impact on your fertility, your health during pregnancy and the well-being of your baby during and after birth. Before you consider trying to fall pregnant it is important to visit your GP to discuss how your medical conditions and medications may affect your pregnancy, and vica versa, how any pregnancy may affect your medical conditions.
Medications may need changing, stopping, increasing or decreasing. Some medications may be risky to the baby, others innocuous, and some extremely important to continue and perhaps increase once a pregnancy is conceived.
It may be important to delay conception so that a medical condition can be optimised, in which case contraception is paramount as part of a healthy and safe short to medium-term plan to prepare for pregnancy.
Prior to pregnancy you may need to consider vaccinations that protect you and your baby during the pregnancy period. These include the measles, mumps and rubella (MMR) vaccine, the chicken pox vaccine and hepatitis A/B vaccine. If you have had chicken pox in the past, you will be protected. However, if you have had a vaccination in the past for the above viruses, your immunity status should be checked, and a vaccination recommended if this is sub-optimal.
There are other vaccines important for your general health that should not be administered during pregnancy, but may be considered prior to pregnancy, including the meningococcal vaccine, and the HPV vaccine. A recently released vaccine protects you against nine of the most common HPV viruses that cause 90% of cervical cancers and genital warts. Your GP can advise you of your suitability for these vaccines.
Genetic Carrier Screening
You, your partner, children or relatives may have a heritable condition, or come from a racial background where particular conditions are common and can be passed from one generation to the next. Some genetically heritable conditions can also skip generations. It is reasonable to discuss the susceptibility of your unborn children to heritable conditions with your practitioner prior to pregnancy. You can expect to be provided advice about screening for conditions for which your children may be at increased risk, and the potential implications of conceiving a pregnancy and having a baby with the condition in question. In some cases referral to a genetic counselor may be required.
Lifestyle, diet and weight
A healthy weight is important not just from a general health point of view, but can have an important impact on the health of a woman and her baby in pregnancy, at delivery and for the lifetime of the child. Infants born to women of a healthy weight have a reduced risk of high blood pressure, metabolic, vascular and weight problems later in life.
A long-term plan for healthy eating and exercise can help contribute to a healthy pre-pregnancy weight and reduce risks of infertility, early pregnancy failure, blood pressure problems, diabetes in pregnancy, and birthing risks. There are a multitude of treatments for weight loss, and your GP is in a good position to discuss these with you.
Early review where there may be concerns about body weight or other risks for diabetes in pregnancy can make a huge difference to the health of your pregnancy. Your GP will discuss screening for diabetes earlier in your pregnancy and healthy eating and exercise to optimize the health of your pregnancy.
Alcohol, smoking and other illicit drugs have a negative impact on your baby during pregnancy and later in life. It is recommended to raise these concerns with your doctor before pregnancy so that you give yourself and any future children the best chance of good outcomes. There are many effective support and treatment programs available to help deal with addictions. Your GP is the best first person of contact to help point you in the right direction.
0.4mg of folic acid, daily, at least four weeks prior to conception and during the first trimester of pregnancy has been proven to reduce the incidence of neural tube defects in early pregnancy. The neural tube is the structure that develops into the babies brain and spinal cord and is highly dependent on folate for normal development.
Some women will require a much larger supplement of folic acid. Nutritional deficiencies, some medical conditions and some medications can impair your folate levels. Furthermore a personal history of previous pregnancies affected by neural tube defects increases the risks in future pregnancies. In such cases women are recommended to increase this supplementation to 5mg of folic acid per day for one to three months prior to conception and for the entire pregnancy.
Your doctor can help to guide you where such an increase in the dose of folic acid is appropriate.
Women should consider taking a 150mcg daily of iodine supplementation in order to ensure there are the building blocks for adequate thyroid function in early pregnancy.
A reputable multivitamin for pregnancy will have the above constituents. Where an increase in folic acid supplementation is required, an additional preparation is needed.
Routine cervical screening is considered good practice for the early detection of cervical disease to reduce the risk of cervical cancer. Unfortunately 80% of all cervical cancers in Australia are diagnosed in women who do not participate in, or have fallen out of, the cervical screening program.
For the majority of people, current recommendations for cervical cancer screening have recently changed from a 2-yearly PAP smear test where cervical cells are examined under a microscope, to a 5-yearly cervical screening test based on the detection of cancer-causing HPV viruses collected by using a cervical brush. Abnormal screening tests may require an earlier repeat cervical screening test or may need a colposcopy, where their cervix is examined under a microscope.
Women who have abnormal symptoms, such as abnormal vaginal bleeding or discharge, should see their doctor immediately and not wait for their next screening test.