I love when a patient comes in for an annual exam and tells me that she is going to try to conceive soon. Truthfully, this is rare. Almost half of all U.S. pregnancies (49%) were unintended in 2011, according to the CDC.
But when it does happen, I appreciate the opportunity to discuss fertility awareness and preconception planning. Preconception counseling provides an opportunity to identify potential pre-existing risk factors and address them prior to pregnancy. This can optimize both maternal and fetal health during the pregnancy.
In a perfect world medical conditions such a hypertension, diabetes and asthma, would be well controlled and closely monitored prior to conception. These disorders, as well as underlying problems like clotting factor disorders, lupus and metabolic issues, are often not identified until they cause complications during pregnancy.
Women often wait until after they have a positive pregnancy test to stop any bad habits or medications that may not be safe for the developing baby. The problem with this is that much of the fetus’ organogenesis will occur before a woman actually knows she is pregnant.
Some medications that are slightly risky to fetal development are actually beneficial to the mother’s health during pregnancy, and are considered relatively safe. It is crucial to fully discuss medication risks, benefits and alternatives as early in the pregnancy as possible, if not preconception. Obviously, it is best if a woman stops smoking, drinking alcohol or using elicit drugs prior to pregnancy.
Maternal weight and dietary habits are also best addressed prior to conception. Some foods should be avoided in pregnancy, and if a mother’s diet is deficient in folic acid or other nutrients, she needs to begin supplementation prior to conceiving. Both obese and underweight women are at higher risk for complications in pregnancy. Exercise is generally safe and encouraged during pregnancy, but occasionally modifications are necessary.
Thankfully, preconception counseling can be done during any type of visit, if the provider has the time. I usually encourage women who are considering becoming pregnant within two to three years to come in for a preconception visit, so we can address any significant medical problems, potential genetic issues and lifestyle choices during this visit.
During preconception counseling we also discuss the timing for stopping contraception and beginning prenatal vitamins. Any woman who has the potential for a high-risk pregnancy is referred to a consultation with a perinatologist.
Healthier moms have healthier babies. Identifying potential problems before pregnancy occurs can improve outcomes and should be an integral part of health promotion education in women of childbearing age.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.