Pre-conceptual dos and dont's

Many pregnancies are unplanned, and most couples do not seek pre-pregnancy advice. In an ideal situation, all pregnancies should be planned, with pre-conceptual advice being part of routine care.

Pre-conceptual care is distinct from antenatal care and includes information about health issues that may affect conception and pregnancy. Pre-conceptual health is discussed, and couples with increased risks in pregnancy are identified and specific measures put in place. Chances of a healthy pregnancy and a healthy baby are thus optimized.

Couples planning a pregnancy should be as healthy as possible. This applies to both the man and the woman. Weight should be optimized, women with a high body mass index (BMI) have more complications that include: delayed conception, gestational diabetes, pre-eclampsia and higher risks of clotting disorders. Diet and exercise both contribute to BMI optimisation. Specific dietary advice includes: balanced diet, fruits and vegetables, and dairy products rich in vitamins, calcium and iron. Foods to avoid include uncooked meats and eggs; unpasteurized milk and soft cheese. Caffeine drinks should be taken in moderation.

Smoking and other recreational drugs should be stopped before conception as they are associated with delayed conception, miscarriages, low birth weight babies and other complications. It’s best to stop taking alcohol as well, though scientific evidence is conflicting about untoward effects of small amounts of alcohol during pregnancy. Certainly, high alcohol levels must be avoided as this causes growth retardation, mental retardation and behavioral problems.

Environmental risks are uncommon, but include couples working with chemicals, radiation exposure or with infectious material. Such couples should have their duties re-assigned to minimize harmful exposure.

Couples with chronic conditions like hypertension, diabetes, kidney and heart diseases have specific risks in pregnancy. Such couples need optimal pre-pregnancy control of their conditions. They may also be on medications harmful to a growing fetus, which must be substituted prior to conception. These couples need combined antenatal care with other specialists, and this must be planned pre-conceptually. In addition, screening for other disease conditions and specific interventions before conceiving can be done.

Pregnancy risks increase with age, especially above 40 years. Such risks must be discussed pre-conceptually, coupled with associated genetic counseling for increased risks such as Downs Syndrome. Couples are then able to make informed choices.

Pre-conceptual Folic acid supplementation is one of the most important preventive interventions. It reduces the risk of birth defects notably spina bifida. Diet alone does not give adequate levels, and some women require higher doses especially if epileptic, diabetic or have family history of spina bifida. Any other supplements will be advised by your Gynecologist.

The next time you plan a pregnancy, there are plenty of reasons to make a preconception appointment with your Gynecologist.