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Thinking About Baby?

March 03, 2017 by Beauty Refined MD in Women's Health

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

            

March 03, 2017 /Beauty Refined MD
women's health, preconception care, pregnancy, OBGYN, obstetrician, gynecologist
Women's Health
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