Thinking About Baby?

As a follow up to my last blog post about fertility and infertility issues in professional women, I will be writing about preconception care and pregnancy over the next few months. Topics will include preconception counseling and pre-pregnancy testing, pregnancy in the advanced maternal age range, and genetic screening options.

There are many things to think about and review with your OB/gyn when planning for conception. The goal of preconception care is to reduce complications for the woman and the baby by optimizing health and knowledge prior to pregnancy. A preconception counseling appointment will allow you and your doctor to review your medical history, your prior pregnancy history, your gynecologic history, your medications, your lifestyle, and pre-pregnancy testing. As pregnancies may be unplanned, this can also be done at your annual visit.

Below are examples of what may be discussed within each topic.

Past medical history:

Pre-existing medical conditions should be optimized. For example, diabetes, hypertension, thyroid disease, and asthma need to be well controlled prior to conception.
Overweight or underweight women should work to reach a healthy body mass index (BMI 18-25) prior to pregnancy.

Pregnancy history:

Review history of prior miscarriages or fetal losses
History of c-section, pre-eclampsia, or pre-term delivery in a prior pregnancy adds risk to a future pregnancy

Gynecologic history:

Review the pattern of your periods
Review history of sexually transmitted diseases or pelvic inflammatory disease, and screen for infection if desired
Discuss other gynecologic problems like fibroids or endometriosis which may be important counseling points in regards to conception and pregnancy

Medications:

Review your medication list and stop medications that can be dangerous in pregnancy
You should take a prenatal vitamin with at least 400 mcg of folic acid
Seizure medications may need to be adjusted, and women taking seizure medications should increase folic acid dose to 4mg per day
Many psychiatric medications can be continued for treatment of anxiety or depression (SSRIs), but benzodiazepines (such as Xanax) should be tapered and stopped

Lifestyle:

Review healthy eating and exercise habits, weight management
Cessation of alcohol, tobacco, and recreational drug use
Review occupational or environmental hazards

Risk of genetic problems, family history:

Discuss family history of birth defects (heart defect, neural tube defects) or genetic problems (Down syndrome, cystic fibrosis, sickle cell disease)
Risk of genetic problems such as Down Syndrome increases with age, particularly in women greater than 35 which is considered advanced maternal age

Pre-pregnancy testing

Testing can be done to check for immunity to rubella, varicella, and determine the need for vaccination prior to pregnancy
Those of Ashkenazi Jewish descent can be tested for a panel of genetic diseases which are more prevalent in this population
Referral to a genetic counselor can be provided if desired and if there is a family history of a rare genetic disease

References:
1. American Pregnancy Association
2. U.S. Food and Drug Administration

By Dr. Loriana Soma - OB/GYN Expert