A Common Sense Secret to a Safer Pregnancy and a Healthier Baby
A pregnancy with peace of mind. A baby born free of birth defects,
diseases, or other disorders. They are every woman's dream.
While no one can promise you perfection, a wide range of medical
advances can give you a precious degree of control over your child's
future and your own health during pregnancy. The secret is
preconceptional care. A valuable form of preventive medicine,
preconceptional care simply means seeing your doctor or midwife for
an exam—before you conceive
During your preconceptional visit, your practitioner can point out any
special hazards you and your future baby may face. He or she can offer
you testing, immunizations, counseling, nutritional therapy, or other
treatment to help ward off problems before they happen.
Among the women most likely to benefit from preconceptional care are
those with diabetes, phenylketonuria (PKU), and certain infectious or
hereditary diseases. However, because spontaneous miscarriages
occur in about 25% of all pregnancies, it makes sense to schedule a
pre-pregnancy exam even if you do not fall into any high-risk
categories. Don't be surprised if your health care provider offers you
preconceptional care on a routine gynecologic visit. Unintended
pregnancies do happen. Staying healthy and informed "just in case"
while you are in your reproductive years can be a big benefit. In
addition, your healthcare provider can offer you valuable general or
pre-pregnancy contraceptive advice during your preconceptional visit.
Why Preconceptional Care Can Be Vital
Before you realize you've even missed a menstrual period—as early as
17 days after sperm and ovum meet—the cells of the rapidly growing
life within you are starting to differentiate into tissue that will form your
baby's heart and other organs. Most fetal development, in fact, occurs
within the three months after conception. The baby's heart begins to
beat after 4 weeks. By 8 weeks your child's eyes, ears, nose, mouth,
fingers, and toes are recognizable. And by 12 weeks most major
organs have developed.
It is during this very early time of organ formation that your fetus is
most vulnerable to teratogenic (birth-defect-inducing) drugs, viruses,
chemicals, and other agents. By working with your doctor, nurse
practitioner or midwife, you can guard against these toxins before you
conceive and remove many serious threats to your baby.
Additionally, your family medical history may make you—or your
partner—a carrier of certain serious genetic diseases. If so, you are
well advised to obtain preconceptional counseling to reduce the risk of
passing these disorders on to your child. Again, planning ahead
before your start your pregnancy is the key. Once conception
occurs, the genetic material is in place and it is too late for preventive
measures.
Your Reproductive History Offers Important Clues and Insights
Even if you have had previous miscarriages, premature births,
difficulties conceiving, or other obstetrical or gynecological problems,
your physician may be able to help you avoid problems in a future
pregnancy. During a preconceptional exam, he or she will perform a
pelvic exam. Based on your medical history and physical findings, your
practitioner will order any special tests that may be necessary. By
obtaining an accurate diagnosis and medical treatment before you
attempt to conceive, you can significantly improve your chances of
having a healthy baby.
Genetic Detective Work and Counseling Can Help You Protect Your Child
Genetic testing and, if necessary, counseling are among the most
critical preconceptional services you can obtain. If your practitioner
suspects you could be a carrier of a hereditary disorder, he or she can
help you obtain genetic screening through blood tests. Once a
pregnancy has begun, genetic testing of the fetus can be done through
amniocentesis and chorionic villus sampling (CVS).
Depending on the outcome of the tests, your doctor can counsel you
on a range of available options. In light of the severity of many of these
diseases, it is easy to see why prevention is so important. In some
cases, screening for certain diseases is based on your race or
ethnicity. Persons of African, Mediterranean, Middle Eastern,
Caribbean, and Latin American heritage are in a risk group for
sickle-cell anemia, an abnormality of the red blood cells.
Beta-thalassemia, a type of anemia that is related to sickle-cell
anemia, tends to occur in persons of Mediterranean origin (especially
Italians), Southeast Asians, Indians, Pakistanis, and Africans. Another
form of thalassemia affects Southeast Asians and Africans. Persons
affected by these painful diseases run an increased risk of dying as
young adults.
Yet another ethnically related genetic disorder, Tay-Sachs disease,
affects persons of Eastern European Jewish and French-Canadian
origin. Tay-Sachs affects the central nervous system and leads to
death in early childhood.
Other genetic diseases, though not ethnically related, may run in
families. These include cystic fibrosis, fragile X, and Down syndromes.
Older mothers are at additional risk for having a baby with Down
syndrome, a condition that involves moderate to severe mental
retardation in addition to facial and other abnormalities.
Phenylketonuria (PKU) is another genetic disorder that can result in
mental retardation. Effective interventions are available to minimize the
risks of PKU.
With Pre-Pregnancy Precautions and Immunizations, You Can
Avoid a Number of Problems and Gain Peace of Mind
Do you have insulin-dependent (Type I) diabetes? If so, you will want to
see your doctor to achieve the best possible control of your blood sugar
before you conceive… as well as throughout your pregnancy. That's
because maintaining excellent blood glucose control significantly
reduces your risk of having a baby with congenital malformations. Also
by maintaining tight control of your glucose, you will protect yourself
from complications during pregnancy. A number of other diseases can
make pregnancy risky for you. Your practitioner can help you
understand and meet these challenges. Your preconceptional exam is
a critical first step.
During pregnancy, both rubella (German measles) and hepatitis B virus
can harm your developing fetus. You can, however, obtain
immunizations against both of these infectious diseases as part of your
preconceptional care. If contracted early in pregnancy, rubella may
affect your baby's eyes, ears, and heart. Hepatitis B virus, which is
often sexually transmitted, can also be passed from mother to baby.
Women with hepatitis B virus can give birth to infants who are likely to
become carriers of the disease and to suffer serious liver-related
effects. If you are a health worker or if you may have had sexual
contact with another hepatitis B carrier, you may be at risk for hepatitis
B virus. Your doctor or midwife can help you avoid these dangers
through pre-pregnancy treatment.
You can obtain preconceptional testing for a number of other infectious
diseases that could put your fetus at risk. These include toxoplasmosis
(found among cat owners and people who handle raw meat),
tuberculosis and cytomegalovirus (health workers in neonatal intensive
care units, child care centers, or dialysis units are in this risk group). In
addition, your doctor or midwife should offer you confidential AIDS
testing and appropriate counseling…as well as testing and treatment
for any sexually transmitted diseases to which you may have been
exposed. These may include gonorrhea, chlamydia, and syphilis.
Diet and Medication Changes for a Healthier Start
The prescription and non-prescription medications you take can effect
your pregnancy, even from its earliest moments. For example, if you
are taking Accutane® for severe acne, your obstetrician or midwife will
counsel you to halt the drug as it is linked to a high incidence of birth
defects. Depending on what medication you are taking for any
pre-existing illness or condition, your doctor may be able to switch you
to a drug that provides the therapy you need—without possible
birth-defect-inducing side effects.
In some cases your doctor or midwife will recommend you gain or lose
weight before starting a pregnancy. If you are a vegetarian, he or she
may suggest modifications to your diet to ensure that your developing
child receives adequate nutrients. Be sure to discuss any food cravings
you may have and which vitamin supplements you take. Megadoses of
vitamins A, B6, C, D, E, K, or too much iron, zinc, or selenium can be
harmful during pregnancy. Again, see your physician or other provider
for guidance.
Finally, if you have phenylketonuria (PKU), a disorder that prevents the
liver from metabolizing a certain amino acid called phenylalanine, you
will need to observe special dietary restrictions. Your doctor will
strongly advise you to stop using the artificial sweetener
Aspartame—sometimes sold as NutraSweet, Equal or under other
brand names—and foods or beverages that contain Aspartame.
Women with PKU who have high blood levels of phenylalanine during
pregnancy are likely to give birth to children with mental retardation and
other congenital abnormalities. By lowering phenylalanine levels during
early pregnancy you can reduce these risks.
Folic Acid Supplements: The Newest Way to Protect Your Future Baby's Nervous System
One of the most promising new pre-conceptional recommendations is a
daily dose of folic acid. Folic acid is one of the vitamins in the
B-complex. It has been shown to dramatically reduce the risk of
abnormalities of the spinal column, such as spina bifida, particularly
when taken from the earliest days of pregnancy. Your health care
provider will prescribe the dosage and course that's best for you. While
all women who may become pregnant can benefit from folic acid
supplementation, the therapy is especially recommended to women
with a history of fetal neural tube defects.
Avoiding Alcohol, Tobacco, and Other Addictive Drugs
Some of the most common neonatal problems are also the most
preventable. While smoking and taking addictive drugs are always bad
for your health, you should take special measures to kick these habits
as you plan a pregnancy. These substances can cause your baby to
be born both prematurely and at a low birth weight. Alcohol, too, can
interfere with fetal growth. In addition, it can cause a tragic set of
symptoms known as fetal alcohol syndrome. This can involve mental
retardation, facial deformities and other defects. Even though drinking is
very much a part of our culture, there is no known "safe" level of alcohol
intake during pregnancy. That is why you should abstain from beer,
wine, or hard liquor in anticipation of a pregnancy. Should you need
help breaking any alcohol, tobacco, or other drug habits, do not
hesitate to ask your health care provider for guidance.
Pre-Pregnancy Contraception Strategies
Depending on what form of birth-control you are now using, your doctor
or midwife may recommend a pre-pregnancy change. For example,
your doctor may advise you to stop the Pill and switch to another form
of contraception for a few months before you attempt a pregnancy.
Women should not take oral contraceptives if they know or suspect
that they might be pregnant.
Looking Ahead with Confidence
Think of preconceptional care as a vital introduction to your later
prenatal care. In many cases, a woman's preconceptional exam will
reveal no problems at all. Your doctor may suggest something as
simple as a temporary change in your pre-pregnancy birth control
methods and daily folic acid. Also keep in mind that, on average, it
takes couples having unprotected intercourse from nine months to one
year to achieve a pregnancy. If you do not get pregnant after trying for
one year, do consult your doctor for guidance.
Most babies are born healthy. Still, it makes sense to take basic
preconceptional precautions, especially if you fall into a risk group.
Remember, accepting your health care provider's interventions is up to
you. You may choose to work with your provider to lessen your specific
hazards… accept the risks…or explore other alternatives. If you are in
your reproductive years now, consider a preconceptional visit to give
your future child a healthy and loving start.
Your Preconceptional Exam Checklist
The ideas in this article are based on information provided in ACOG Technical Bulletin Number 205, "Preconceptional Care."