Preconception Health

Add The New Jersey Women's News to myHome page Written by The New Jersey Women's News on Nov 19

By All Women's Healthcare

Optimizing the health of the mother prior to conception is important for improving pregnancy outcome. Preconception counseling offers an opportunity to identify fertility or pregnancy issues, identify some risks to mother and fetus with the goal of educating about these risks and instituting appropriate intervention when possible.

A complete medical history is helpful in identifying potential health risks to mother and fetus. Discussion of how medical conditions may be affected by pregnancy and how current medications may be changed or discontinued should follow. Seizure history, Diabetes, Heart disease, Asthma, Hypertension and Anxiety/Depression are a few conditions that may require change of medicines to those that may be used during pregnancy. Over-the-counter medicines and dietary supplements, whatever the reason for use, may be “natural” but may not be indicated for use during pregnancy. The latest trend of using “energy drinks” or supplements to increase metabolism is of particular concern. These supplements have excessive levels of caffeine and consumption may be associated with decreased fertility, increased risk of miscarriage, and increased risk of stillbirth.

Advanced maternal age is associated with increased pregnancy risk and women should be aware of the risk of delaying conception until over 35 years of age. A reproductive history with attention to past pregnancy complications and outcomes is important in assessing risk for future pregnancies. Family history screen for inherited risks should be identified and evaluated. Use of alcohol, tobacco and any illicit drugs should be discussed. Alcohol consumption in young women is increasing with moderate to heavy use of alcohol being associated with birth defects and behavioral effects. It is estimated that more than half of women of childbearing age who do not use contraception consume alcohol frequently and may engage in binge drinking. Mental health concerns, domestic abuse and work related stresses/hazards need early identification and intervention.

Nutritional assessment and vitamin supplement is an important part of the preconception discussion. A prenatal vitamin with at least 400 mcg of folic acid (preferably 1 mg) is recommended to maximally reduce the risk of neural tube defects such as Spina Bifida. Avoidance of methyl mercury exposure in certain fish and shellfish is recommended during preconception, pregnancy and lactation. Any shark, swordfish, king mackerel, and tilefish should be avoided. Limiting intake of salmon, flounder, sole, cod and catfish to no more abut 12 ounces per week is advised. Canned tuna should be no more than 6 ounces per week and large tuna steaks should be avoided because of potentially higher mercury levels. Dietary habits in the United States are not high in essential fatty acids and supplementing diet with omega-3 fatty acids or flaxseed may be beneficial. Some prenatal vitamins are now formulated with these specific fatty acids.

The physical evaluation should be a complete examination with cervical cancer screening and screen for sexually transmitted diseases. If indicated, a referral to a dentist may be appropriate for evaluation of dental caries and oral diseases. Poor oral health is a risk factor for preterm delivery. Identification of certain familial/genetic risks and environmental exposures may necessitate pre-pregnancy laboratory examination; otherwise a routine set of laboratory tests is performed during early pregnancy.

Only a few genetic diseases have the possibility of prenatal diagnosis. Recent advances allow early (first trimester) and non-invasive prenatal screening with good accuracy for Down syndrome and certain genetic conditions. Down syndrome may not be “treatable” but other findings that are associated (such as cardiovascular malformations) may require surgical intervention soon after delivery. Knowledge of the presence of Down syndrome allows coordination of obstetric and neonatal care providers prior to delivery.

An assessment of potential risks, thorough evaluation and communication of concerns is significant in assuring the best possible outcome during pregnancy. Preconception care is an important part of preventative care and should be a part of a woman’s non-emergency health care encounter regardless of her immediate pregnancy plans.