A healthy pregnancy is best achieved by optimising your health prior to falling pregnant. The aim of pre-conception care is to identify and modify any biomedical or social risks to a woman’s health and, potentially, to her pregnancy. Preconception care can be offered by your GP, or by an obstetrician and gynaecologist, and can be a good way to meet the person you might have in mind to care for your pregnancy.
During a pre-conception assessment, your medical, surgical, gynaecological and obstetric history will be assessed, along with your family medical history, mental health history and social history (including nutrition, exercise, smoking, alcohol intake, and use of other drugs). Your doctor will also be interested to know of your immunisation history, and a panel of blood tests can be ordered to check your immunity to diseases that can cause problems if contracted in pregnancy, such as rubella and chickenpox. Based on these results, your doctor may recommend you update some vaccinations prior to falling pregnant.
For women with pre-existing medical conditions, your medical and medication history will be assessed. Some medications will need to be changed due to potential pregnancy complications, and those that are safe to use may need to have doses adjusted prior to or during pregnancy. The possible effects of your medical condition on your pregnancy, and your pregnancy on your medical condition, will be discussed with you, so that you have an idea of what to expect during pregnancy, and of what changes may need to be made to “routine” pregnancy care for your individual needs. Rest assured that most women with well-managed pre-existing medical conditions can have healthy pregnancies and normal deliveries. The doctor or midwife who looks after your pregnancy can always liaise with the specialist who looks after your medical condition, to make sure your care is optimal.
General advice for all couples who are planning pregnancy include eating a healthy, well-balanced diet, exercising according to the Department of Health’s guidelines (150-300 minutes of moderate intensity activity per week), achieving and maintaining a healthy weight, and avoiding cigarettes, alcohol and other drugs. For women, folate supplementation should start 3 months before trying for pregnancy – some women should take higher doses of folate than the general recommendation of 400 micrograms/day, so check with your doctor. In addition, women should take iodine supplements when planning pregnancy (150 micrograms/day). Blood tests may indicate that you need other supplements such as iron or vitamin D.
Your doctor should discuss genetic carrier screening with you. These are tests that can be done for both yourself and your partner to determine whether you carry any genetic mutations which don’t affect you but, if both parents carry the same mutation, can result in disease in a child. The basic version of these tests assess for genetic mutations causing the diseases cystic fibrosis, spinal muscular atrophy and fragile X syndrome. The expanded versions of these tests assess for hundreds of different genetic mutations, causing diseases of varying impact on a child’s life. Family history is not always helpful here, as people who carry a genetic mutation may not have any medical issues themselves – it’s the combination of yourself and your partner’s genetics which is important.
Of course, even the best laid plans can sometimes go astray…and sometimes you are pregnant without much planning happening at all! Don’t worry, these assessments can also be done in early pregnancy, and a healthy lifestyle can be achieved at any time of life. If you need help with making these positive changes, referrals can be made to the appropriate allied health specialists to get you on the right track. I look forward to seeing you to help you plan your pregnancy, and to looking after your pregnancy when it happens!