Pre Conceptional Planning

Dr Richa Sharma, Dr Amit Basnotra
Science is gettimg advanced day by day but still in many places even basics may be lacking or not reachable and even after continuing efforts to improve antenatal care, the incidence of a number of adverse pregnancy outcomes, including low birth weight, preterm delivery and birth defects still not under check so really need to be worked upon
There can be various attributing factors for such lags and gaps some of which can be managed
There is a delay in the child bearing age of female so more of women of advanced age at the time of their first pregnancy
Rise in ART procedures for infertility may be a reason of an increased number of multiple pregnancies
a relatively increased number of high-risk pregnancies among women with a chronic medical condition.
“Prevention is Better than cure”
So if we are fully prepared prior only we can curb down such incidences
Here we will give some tips to our readers-
The first antenatal visit usually takes place after baby formation process have been completed and, therefore, is too late to have a substantial impact on reproductive outcome. Hence, risk factors for adverse pregnancy outcome should be addressed before conception.
The opportunity for primary prevention, to address and reduce risk factors for adverse pregnancy outcome before conception, has led many to believe that a shift from antenatal care to preconception care could be the most effective strategy to improve maternal and fetal outcome.
What can be done ?
Healthy habits should be followed not only on papers but in life also
Education of women on pregnancy planning and the need for antenatal care
Identification and reduction of risk factors ,which can be modified, before conception
Preconception care involves focus on both husband wife like Thalassemia is one such example as its right of baby to be born to be healthy so all due precautions to be taken with in linitations and ability of science and scientific techniques so far
Components Of Stepwise Care Of The Pregnant Female In Antenatal Clinic-
First Antenatal visit-
Medical history
Description of specific problem
To gain additional information from doctors involved Consultation of other specialities
Additional diagnostic procedures
Second Antenatal visit-
To draw up to a multidisciplinary preconceptional, ante- and postnatal plan of management
Written report (for referring specialist, own files and couple)
Four Steps To Safety –
Preconception care should encompass the following four components:
Assessment Of Risk- the systematic evaluation and identification of risk factors for adverse pregnancy outcome. This may require additional screening, diagnostic tests and consultation with other specialists.
Patient Awareness-couples are informed and educated on a variety of health-promotion issues, including periconceptional folic acid supplement use, avoidance of alcohol, tobacco and other drugs, and proper nutrition.
Execute on time- in order to modify or eliminate risk factors.
Counseling- adequate information and counseling allow couples to make an informed choice on whether to refrain from child-bearing or opt for pregnancy.
Do Rule Out Whats Mandatory –
Medical and Surgical history-Diabetes, Thyroiddisease, Asthma, Heartdisease, High blood pressure, Deep venous thrombosis, Kidneydisease, SLE, Epilepsy, Sickle cell anemia, Cancer, Reproductive history, Uterine or cervical abnormalities, Two or more first-trimestermiscarriages,Preterm delivery, One or more intrauterine death (s), Prior infant < 2750 g at birth,Prior infant admitted to neonatalICU,Prior infant with birth defect, Operative delivery
Dietary history-Vegetarianism/veganism,Frequent consumption ofsnacks/pica,History of bulimia/anorexia nervosa, Specialdiet, Vitamin supplement use, Intolerance for milk
Infectionor Disease history- STD, Herpessimplex, Chlamydiainfection,Humanpapillomavirus,Viral hepatitis (or risk behavior), HIV (or risk behavior), Occupational exposure to blood,Blood transfusion, Own/work with cats,Immunity to rubella
Family history- Birth defects/genetic diseases, Related to partner, Race
Any addictions or Behaviour risks- Alcohol use (per day),Tobacco use (per day), Marijuana, cocaine or other druguse, Chemical use at home/work,Exposure to radiation at work, Participation in sports, Age ? 34 years
Drug history- Use of prescription medication,Use of over-the-counter Medication
Pregnancy prepartion done ahead of time pre conceptionally helps save both lives and take care of any expected challenges in the journey of parenthood.Its the responsibility of both the patient and the treating Doctor to be well versed, informed and aware and make aware so that timely any medical ailments in due course can be handled in a safe manner.Ignorance cannot be an excuse for the damage done.So be more informed,aware and prepared than repenting later.
(The authors are Senior IVF consultant Delhi NCR and Senior Gastroentrologist)