PreConception Care

The Ultimate Preventive Medicine

Taking a Step Back to Before the Beginning

Sarah Irving, MD, Family Practice/Obstetrics

05/10/2007

A shift in our medical paradigm has occurred over the past generation. The focus of primary care medicine has broadened to not only include diagnosis and treatment of illness, but also prevention. As we celebrate Mother’s Day on May 13^th and National Woman’s Health Care Week May 13^th through the 19^th, I want to share with you the concept of preconception care; care prior to pregnancy. I believe pre-conception care to be the ultimate form of preventive medicine. Establishing good health in a mother prior to pregnancy improves outcomes of pregnancy and benefits both mother and child.

The reality is that over 50% of pregnancies in the United States are unplanned. As a consequence, many women do not realize that they are pregnant. The average time for a woman’s first prenatal visit to her physician is at 12 weeks gestation. However, the critical time-period for fetal organ development is during the first 10 weeks of a pregnancy. In other words, the first prenatal visit is simply too late…

So what is preconception care??? Preconception care involves a woman seeking care from her provider prior to pregnancy. The goal of this care is to maximize maternal health and reduce or eliminate possible risks to the pregnancy. This involves education and sometimes medical or psychosocial interventions. A preconception care assessment involves a review of a woman’s medical history, family or genetic history, medications, and nutritional status as well as a physical exam and possibly blood work or other studies, if indicated. As a physician conducts this assessment, he or she is thinking about ways in which to help a woman with numerous issues that have the potential to impact a pregnancy.

Optimally, a woman should be of normal body weight at the time that she conceives a pregnancy. Women who are overweight have greater risk of developing gestational diabetes, pre-eclampsia (toxemia), or having a large baby which could lead to delivery complications and increase the rate of cesarean section delivery. At the other end of the spectrum, women who are underweight have greater risk of delivering an infant with low birth weight, or impaired neurologic development. By helping a woman to achieve a normal and healthy body weight prior to pregnancy, these risks are substantially reduced.

Many women have chronic medical illnesses that may directly impact the pregnancy or as a consequence of medications used in the treatment of a chronic medical illness harm a pregnancy. Such medical illnesses including high blood pressure, diabetes or thyroid problems are common examples. Appropriate treatment of these problems improves the prognosis of a pregnancy. Even over the counter medications such as ibuprofen have the potential to impact a pregnancy and it is important for women to possess this knowledge.

The use of tobacco, alcohol or drugs during pregnancy presents obvious harm to both mom and baby. For many women the decision to begin a family provides strong incentive to quit. A physician is able to provide a woman with numerous resources to aid the process of quitting and optimally improve the outcome of the pregnancy. Smoking is the leading preventable cause of low birth weight and is associated with additional risks such as placental abruption (when the placenta separates from the wall of the uterus), preterm delivery, and miscarriage. In addition, smoking in the household of an infant is associated with SIDS, childhood respiratory illness, asthma, and ear infections. Alcohol is the most common teratogen (a factor that causes deformities) in pregnancy, and is the leading preventable cause of mental retardation (fetal alcohol syndrome). It is important to remember that the effects of alcohol occur at all stages of pregnancy. Finally, the use of illegal substances such as heroin and even prescription narcotics presents substantial risk and requires medical attention to treat both mom’s addiction and the withdrawal that the newborn infant is likely to experience.

Immunizations should be up to date prior to pregnancy and women should be educated about the potential impact on a pregnancy of very common infections such as chicken pox, shingles, and fifth’s disease. In addition, due to concerns about potential for infection, a pregnant woman should never change a cat’s litter box nor eat certain foods such as sushi, blue cheese, or uncooked meats.

There is emerging evidence that periodontal disease may have an association with pre-term delivery and so it is very important for women to have good dental care prior to pregnancy.

Finally, folic acid has been shown to prevent up to 70% of neural tube defects (spina bifida), but it is critical that a woman be taking folic acid prior to pregnancy to achieve this benefit. Prior to conception women should take at least 400 mcg of folic acid daily. During pregnancy, this should be increased to 800mcg daily. Most prenatal vitamins contain 800-1000 mcg of folic acid. While there are folic acid supplements in numerous of the food products on the market including breads, cereals etc, and this amount is inadequate.

Motherhood is undoubtedly the most important role in many women’s lives. It makes sense to take the time to plan and optimize the health of pregnancy as it represents the beginning of everything... a healthy Mom and healthy Baby.