Dr. Richa Sharma & Dr Samit Sekhar
Despite continuing efforts to improve antenatal care, the incidence of a number of adverse pregnancy outcomes, including low birth weight, preterm delivery and birth defects, has not diminished in recent years.
Reasons-This may in part be attributed to
* an increased number of women of advanced age at the time of their first pregnancy
* an increased number of multiple pregnancies
* a relatively increased number of high-risk pregnancies among women with a chronic medical condition.
Prevention-“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.
Ways followed-
* Promoting healthy habits
* Education of women on pregnancy planning and the need for antenatal care
* Identification and reduction of (modifiable) risk factors before conception
* Preconception care should not be restricted to women; their partners should also be involvedfor the evaluation of paternal risk factors for adverse pregnancy outcome
OUT-PATIENT CLINIC FOR PRECONCEPTION CARE- Own initiative or referral externally or from within hospital
First visit-
* Medical history
* Description of specific problem
* To gain additional information from doctors involved Consultation of other specialities
* Additional diagnostic procedures
Second visit-
* To draw up to a multidisciplinary preconceptional, ante- and postnatal plan of management
* Written report (for referring specialist, own files and couple)
COMPONENTS OF PRECONCEPTION CARE
Preconception care should encompass the following four components:
(1) Risk assessment: the systematic evaluation and identification of risk factors for adverse pregnancy outcome. This may require additional screening, diagnostic tests and consultation with other specialists.
(2) Health promotion: 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.
(3) Intervention in order to modify or eliminate risk factors.
(4) Counseling: adequate information and counseling allow couples to make an informed choice on whether to refrain from child-bearing or opt for pregnancy.
Preconceptional screening questionnaire-
Medical history-Diabetes, Thyroiddisease, Asthma, Heartdisease, High blood pressure,Deep venous thrombosis, Kidneydisease, SLE, Epilepsy, Sickle cell anemia, Cancer, Reproductivehistory, 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
Nutritional history-Vegetarianism/veganism,Frequent consumption ofsnacks/pica, History of bulimia/anorexia nervosa, Specialdiet, Vitamin supplement use, Intolerance for milk
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
Social history/behavior 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
Medication history- Use of prescription medication,Use of over-the-counter(OTC)Medication
Counseling-
Couples should be counseled on the specific risks of pregnancy based on the presence of other risk factors, which may include genetic issues or the recurrence risk of previous obstetric complications. In recent years, more and more women who have previously been told or who have assumed that they could never bear a child because of a (severe) congenital anomaly, or chronic disease (and medication use) or organ transplantation, are opting for pregnancy. Preconception care in women with chronic medical conditions requires special knowledge, training and organization . This deals with the optimal timing of pregnancy and balancing of maternal and fetal/neonatal well-being and prognosis.
The authors are Senior IVF consultant Gurgaon Fertility Centre, GFC and Executive Director GFC)
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