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Preconceptional counseling : Must read for a safe and healthy pregnancy!!

Preconceptional counseling is an informative session with a specialist done before planning for pregnancy. It's a very important but least implemented and understood topic. All the pregnancies need to be planned to prevent health problems to mother and newborn.

The main aim of this session is to identify risk factors and address them before becoming pregnant to decrease complications in mother and baby. See your doctor at least 3 months before planning for pregnancy.

When you go for a preconceptional counseling, your doctor will take a detailed history first. That will include your menstrual and obstetric history. Marital history like of consanguineous (within blood relation) marriage. History of abortions or bad obstetric history, number and age of kids. History of any contraception use. Any history of sexually transmitted diseases or vaginal infections.

Past history of any medical illness like high blood pressure, diabetes, kidney disease, thyroid disease, mental illness, asthama, epilepsy etc.

Any surgical history? Any recent or on going medicine intake?

Family history of any genetic diseases. Personal history of any addictions like smoking, partner smoking,tobacco in any form, alcohol intake or substance abuse like drugs. Your work history and type of job.

He/she will then do a physical examination. Look for signs of pallor. Record weight and height. Calculate BMI. Note vitals like blood pressure and auscultation. Do a breast examination and check for thyroid swelling. Do a per abdomen and if indicated internal examination.

Some routine blood tests will be ordered for both partners like complete blood count, blood group, blood sugar, triple H markers, hemoglobin electrophoresis, rubella IgG, other special tests specific to disease conditions as indicated. He may also ask for a physician reference or other specialist reference for specific chronic illnesses.

Specific counseling

Folic acid tablets should be advised to all women trying for pregnancy, to be started 1-2 months before planning and continued till at least 12 weeks to decrease neural tube defects in the baby.

Advice on healthy lifestyle including nutritious diet and exercise before pregnancy will be given by the doctor. Some yoga, pranayam and meditation can relieve stress in this period and good for physical and mental health.

Doctor will also talk about planned relations and fertile period.

He will advise against taking any unnecessary medication without asking your doctor in the planning period.

When couples approach for second or subsequent pregnancy, good spacing should be stressed according to history and maternal health to ensure safe motherhood.

In families with genetic conditions like previous child with down's syndrome, metabolic disorders, blindness, birth defects etc needs genetic counselling with an expert.

Patients with any chronic disease like Diabetes, high blood pressure, mental illness, anemia, kidney disease, thyroid disorder, epilepsy, tuberculosis,Thalassemia minor, chronic infections like HIV, Hbsag, Hcv, etc. The list is exhaustive.

  1. They need a medication review to switch to a safer alternative before pregnancy or stop that drug or reduce dose.

  2. They also need to discuss with their physician about the progression of disease in pregnancy and. any complications in pregnancy due to that. In some severe conditions pregnancy may be contraindicated or can be planned only after things are under control.

  3. To discuss the effects of disease or medicines on the unborn child.

  4. Doctor should ask at every visit about the couple's views on planning for pregnancy in such patients and explain effective contraception.

  5. Explain beforehand the consequences if accidental pregnancy occurs and necessary precautions.

  6. To make sure that the disease is well under control before planning.

For example.

If Patients with very Uncontrolled diabetes mellitus conceive, there are high chances of complications like miscarriages, heart and other anomalies in fetus, big baby, increased chances of c section delivery, shoulder dystocia, preterm labour, high blood pressure in pregnancy, hypoglycaemia in newborn etc.

Other Individual cases need detailed discussion and plan which is out of scope of this article and not discussed here.

Smoking by to-be mom can cause fetal growth restriction, low birth weight, preterm labour etc

Even passive smoking or second hand smoke inhalation is dangerous. Quitting smoking before planning is must.

Alcohol intake can cause Fetal alcohol syndrome. As not much data is available on safe limit, best is that the woman should avoid alcohol intake if trying for pregnancy.

Substance abuse if any should be stopped and should be referred to the expert.

Occupational exposure or toxin exposure

Doctor should ask about any exposure to toxic agents in work environment.

Obesity can cause Gestational diabetes, high blood pressure in pregnancy, difficult delivery, increasing c section delivery, complications in delivery, big baby etc

Dietician refrence should be done and ideal weight loss aimed.

Underweight mothers can have Low birth weight babies, Preterm labour etc.

Wishing everyone a Safe and healthy pregnancy!!!

For useful articles on early pregnancy, click here

Disclaimer - These are the views of a qualified doctor and author. These are general suggestions and do not replace actual check up by a doctor. Any resemblance to anybody is coincidental. Medical science is a ever-changing field. We try to update our articles from time to time. Please follow current guidelines where necessary.

Author information - Dr Harita N Kothia, Obstetrician and gynecologist, Mumbai.

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