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.
- 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
- 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
- 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
- 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
- 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
1. American Pregnancy Association
2. U.S. Food and Drug Administration
By Dr. Loriana Soma - OB/GYN Expert