What is preconceptional counseling and care?
- Periconception care and counselling is the promotion of the health and wellbeing of the woman , her partner and the baby even before she gets pregnant.
- One of the main goals of periconceptional counselling is to identify medical and social conditions that may put the mother or the baby at risk, and also to implement changes that will improve pregnancy outcomes.
When should pre conceptional counseling be done?
- Periconceptional counselling should ideally be seeked by a couple at least 3-4 months before they start their journey towards parenthood.
What all does pre conceptional counseling include?
- The various aspects of periconceptional counselling include:
- Obtaining a detailed medical, family, reproductive and social history of the woman and her partner and identifying the various factors that may have an adverse effect on the pregnancy and its outcome.
- The medical history aims at identifying the risk factors like age, diabetes, hypertension, hyperthyroidism, hypothyroidism, tuberculosis, asthma, autoimmune disoders etc, as they not only affect the pregnancy but may be aggravated during pregnancy and put the mother’s life at risk.
- Also periconceptional counselling provides an excellent opportunity to identify these various ailments that may have gone undetected until now!
- Age: It is a proven scientific fact that age is an important factor in determining the fertility rate of a couple and affects not only women but also men. Oocyte number and quality decrease with advancing age. Thus, fecundity decreases as age increases, with a more rapid decline after the mid-30s. Also oxidative stress in the male reproductive tract increases with age thereby affecting the sperm production quantatively as well as qualitatively.
- Maternal age of 40 years or more is associated with medical complications and more operative deliveries. The incidence of genetic abnormalities and disorders is known to increase after 35 years of age and therefore warrants extra caution n care. Women should be informed that the risk of spontaneous pregnancy loss and chromosomal abnormalities increases with age. Women should be counselled about and offered appropriate prenatal screening once pregnancy is established.
- Diabetes: it is a metabolic disease characterized by high glucose levels over a prolonged period of time. It affects an increasingly large number of young men and women of reproductive age.
- Some evidence suggests that in men spermatogenesis is affected by diabetes and that patients have a reduced sperm motility and semen volume. Diabetic men have been found to have a significantly higher percentage of sperm with nuclear DNA damage, a factor known to be associated with compromised fertility and increased miscarriage rates.
- In women diabetes not only affects the fertility but also leads to various complication in pregnancy like increased rates of miscarriages, congenital abnormalities in the fetus, IUGR , preterm deliveries etc. Infact in some women pregnancy itself causes diabetes in previously non diabetic women known as ‘Gestational Diabetes’.
- Hypertension: Also known as ‘high BP’ is a chronic medical condition affecting a large population. It affects upto8-10% of women in pregnancy. Women with chronic hypertension are ideally counselled before pregnancy. The degree of severity, the duration of disease and current therapy must be ascertained. Women who have poorly controlled hypertension and who require multiple medications are at increased risk of pregnancy outcomes. Women who have history of episodes of myocardial infarction, cerebrovascular episodes are at a risk of recurrence or worsening of condition during pregnancy.
- Tuberculosis: Tuberculosis is a rampant disease in developing countries like India and occurs in all classes. It spreads through the blood stream, affecting the genital organs especially the fallopian tubes, resulting in blocking them either completely or partially. If there is a history of tuberculosis then eavaluation of the fallopian tubes at the time of periconceptional counselling is recommened.
- Epilepsy: Women who have epilepsy have two to three fold risk of having infants with structural abnormalities which are attributed mainly to the anti-epileptic drugs. Ideally seizure control must be optimized preconceptionally, preferably with monotherapy and less teratogenic drugs. Drugs like valporic acid are best avoided. Epileptic women should be adviced to take folic acid supplementation to avoid the malformations.
- Family history is mainly a part of genetic screening/counselling wherein a detailed health and reproductive status of each ‘blood relative’ is individually reviewed for medical illnesses, mental retardation, birth defects, infertility and pregnancy losses . It is a communication process concerning the occurrence and the risk of recurrence of genetic disorders within a family.
- The aim of such counseling is to provide the prospective parents with as complete understanding of the disorder and/or problem as possible and of all the options available. It is also aimed at helping families to cope with their problems and at assisting and supporting them in their decision making. The woman’s family history and ethnicity for genetic disorders such as cystic fibrosis, sickle cell anemia, and Tay-Sachs disease and malformations such as neural tube defects should be reviewed. The congenital conditions that largely benefit from the screening are neural tube defects, phenylketonuria and thalasemias.
- The reproductive history at the time of preconceptional counselling aims at seeking detailed information regarding infertility, miscarriages, ectopic pregnancy and recurrent pregnancy loss .Obstetric complications like preeclapsia, still births are especially important and require detailed information to determine the recurrence rate and possible prevention.
- Social history: The aim of this history is to identify medications, chemicals and recreational drugs that are potentially teratogenic before conception and to discourage their use during preconceptional and early pregnancy periods.
- The foremost thing required for prevention of drug related fetal risks is for the woman to honestly ass their use. Smoking is associated with adverse perinatal outcomes and must be screened during the preconceptional counselling. Alcohol is a potent teratogen that causes fetal growth restriction facial abnormalities and central nervous system abnormalities. Women considering pregnancy must be made aware of the drawbacks and be counselled to abstain from any alcoholic beverages.
Are there any investigations that need to be done before I plan my pregnancy?
- Yes. In fact periconceptional counselling provides an excellent opportunity for the doctor to screen the women and her partner for common diseases and genetic disorders.
- This not only helps in identifying the disorder/disease prior to conception but also ensures the timely treatment thereby preventing or limiting the maternal complications and fetal risk.
- The common conditions screened are HIV, hepatitis B, HCV, fasting sugars levels, post lunch sugar level, Complete Blood Count, Blood Group and reproductive tract infections.
- In certain medical conditions specific investigations may be advised to assess the severity of the condition, for e.g. in patient with heart disease cardiac 2D Echo is advised, in diabetic women HbA1c is done to look for sugar control over past three months etc.
- Periconceptional counselling is a good time to review fertility issues and educate the couple about optimizing fertility. It also provides an opportunity to carry out tests if fertility is an issue. For example, when the woman considering pregnancy is more than 35 year old then she requires various investigations aimed at ruling out condition that may result in infertility like AMH to check the ovarian reserve. Semen analysis of the partner may be advised.
What is the role of immunization prior to planning a baby?
- Periconceptional counseling includes assessment of immunity against common pathogens.
- Various live virus vaccines like rubella, measles, chicken pox should ideally be administered atleast one month before conception is attempted.
Do I need to change my dietary habits before planning for a baby?
- Pre conceptional counseling also includes providing specific nutritional advice and ensuring optimal weight of both the prospective parents. The nutritional status of women in the periconceptional period is not only important for the health of the mother, it is also a resource for the fetal nutrient supply. Deficiency of vitamins and minerals leads not only to poor maternal health but may also damage the fetus irreversibly.
- An adequate perinatal supply of folic acid during the first 8 weeks of pregnancy protects against neural tube defects (NTD). Iron deficiency in pregnancy increases the risk for maternal morbidity and mortality, premature birth, low birth weight and stillbirth. Low or empty iron stores before pregnancy should be replenished by iron supplements (30- 40mg/day).
- Vegetarian diets are usually protein deficient , therefore cheese and egg consumption must be encouraged .A low Vitamin B12 status, which is prevalent in vegetarians, increases the risk of abortions, preeclampsia and preterm delivery. Zinc deficiency, which is common in under nutrition and with parasitic infections must be treated to optimize the health of the mother.
- Obesity on the other hand is linked to various maternal complications during pregnancy like hypertension, gestational diabetes mellitus, labour abnormalities and operative complications. At the time of periconceptional counselling BMI should be calculated and the woman should be encouraged to achieve her ideal BMI. In some cases weight loss must be considered before conception for uneventful pregnancy.
- Excess weight in males also affects the quality of sperms indirectly by making him prone to Diabetes and hypertension
- Hence it’s very important to maintain ideal and healthy body weight prior to planning a baby.
We provide preconceptional counseling to all prospective parents and help them to achieve optimal health and fertility through our holistic approach.