Pre-pregnancy Counselling

If You Are Planning To Become Pregnant; You Should Know This!!

Bringing new life to this earth, what an exciting feeling it is!! Becoming a new mother is very rewarding but you to remember that your baby’s health is dependent upon your health.

That’s why I advised all women planning a pregnancy to consult their General Practitioner or obstetrician to assess any specific health conditions which can be managed adequately before pregnancy and to minimize the impact of the problem on the overall health on the baby. It is also necessary to have general advice to daily routine and lifestyle with pregnancy.

The medical practitioner will ask about detailed medical history and will carry thorough clinical examination to assess any medical problems and have a discussion of how they may affect a pregnancy. Many medical conditions need to be well stabilized before pregnancy as it may go worse during pregnancy or medication used for these diseases can adversely affect the unborn baby.

Assessment of mental health status prior to a pregnancy is necessary to optimize pregnancy outcomes. In case serious medical conditions exist, multidisciplinary pre-pregnancy planning and team is needed and it can be well coordinated by GP/ obstetrician.

History of previous pregnancies (e.g. pregnancy loss, preterm birth, birth defects, gestational diabetes) is very important as it helps in determining any measures needed to reduce the future risk. Pre-pregnancy genetic testing and counselling may be needed if there is family history of genetic disorder like-Down Syndrome or other inherited disorders. In that cases Pre-implantation, genetic diagnosis (PIGD) may be considered.

It is important to review all the medications including over the counter medicines with your obstetrician. Certain medications may not be appropriate to take during pregnancy or may have teratogenic effect on unborn baby. Sometime medications need to be altered or changed to get the adequate control of disease and to reduce its teratogenic impact on the baby.

Any infection during pregnancy may be dangerous and may have serious impact on the mother and baby health. So, vaccination status of all women should be assessed. Vaccination history for measles, mumps, Rubella, Varicella Zoster, Diphtheria, Tetanus and Pertussis should be checked and maintained as per recommendations published by the relevant Australian and New Zealand Government bodies. Women who have no or incomplete immunity to Rubella and Varicella, should have rubella and Varicella vaccination. All the live vaccination are generally avoided during pregnancy. Pregnant women should be immunized against influenza. dTpa vaccine for Pertussis is recommended as a single dose during the third trimester of each pregnancy. The optimal time for vaccination is early in the third trimester between 28 and 32 weeks.

A healthy, well balanced diet is strongly recommended before, during and after pregnancy. All women should have discussion with medical practitioners about the impact of over-weight and under-weight on the pregnancy and its outcome. Obesity is becoming an increasingly common health issue in Australia and it is most important risk factor for adverse pregnancy outcomes. It is one of the causes of infertility and may interfere with conception leading to infertility. Obesity can increase the risk of miscarriage, stillbirth and fetal abnormality. Furthermore, obesity increase risk of diabetes, high blood pressure, large size baby leading to difficult deliveries. In addition, obesity also increases anesthetic complications. It is important to take proactive action to correct obesity prior to pregnancy. Dietary advice and exercise prior to a pregnancy are worthwhile considerations. Intensity of exercise and dietary advice should be under supervision of the specialist.

Folic acid is recommended to be started at least one month before conception and should be continued at least for first 3 months of pregnancy. The recommended dose of folic acid is at least 400mcg daily to the prevent neural tube defects (NTD). There are certain conditions where the risk of NTD is increased like anti-convulsant medications, pre-pregnancy diabetes mellitus, previous child or family history of NTD. In these condition, high dose of folic acid – a 5mg daily dose should be used. It is recommended to take dietary supplementation of 150mcg of iodine prior to a planned pregnancy or as soon as possible after finding out you are pregnant.

If your pregnancy is proceeding normally, you can have sex as often as you like. However, hormonal fluctuations, fatigue, nausea and breast tenderness early in pregnancy might lower your sexual desire. As your pregnancy progresses, weight gain, back pain and other symptoms might dampen your enthusiasm for sex.

Your emotions can take a toll on your sex drive, too. Concerns about how pregnancy or the baby will change your relationship with your partner might weigh heavily on your mind — even while you’re eagerly anticipating the addition to your family. Although many couples worry that sex during pregnancy will cause a miscarriage, sex isn’t generally a concern. Most miscarriages occur because the fetus isn’t developing normally. Most studies have shown that sex during pregnancy is not associated with an increased risk of preterm labour or premature birth. However, if you’re at risk of preterm labour your health care provider will recommend avoiding sex. Similarly, sex isn’t likely to trigger labour even as your due date approaches.

Illicit drug use and Cigarette smoking during pregnancy can have serious consequences for an unbornbaby and should be stopped before conception. It can increase risk of preterm delivery, growth restriction of the baby, premature separation of placenta leading to adverse outcome to mother and baby. It is important to have counselling from appropriate health professionals.

There is no safe level of alcohol intake during pregnancy. There it is better to avoid alcohol consumption during whole of the pregnancy.

Further assessment may be needed based on the findings on history and examination.

Written By,

Dr Preeti Khillan

Senior Consultant Obstetrician & Gynecologist, Sunshine Hospital

Director; Western Specialist Centre, Werribee & St Albans

Director; MyOBG , Werribee

Tel; 9367 8626, 936441542

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