Preconception counselling involves meeting with a doctor who is experienced in this specialty, before pregnancy and consists of an assessment of the health of both potential parents.
It provides an opportunity to inform women about fertility or pregnancy issues, identify some of risks of pregnancy for mother and fetus, and educate them about these risks and institute appropriate interventions before conception.
Optimizing the heath of mother before conception is important for improving pregnancy outcome. Several aims of the preconception counselling are-
- To help a couple to achieve pregnancy
- Decreasing the risk of a pregnancy loss.
- Decreasing the chance of birth defects.
- Improving health and identifying medical conditions that might affect pregnancy
- Decreasing any negative effects of pre-existing medical conditions.
- Identifying medications that might possibly affect the fetus and changing them to safer ones.
Ideally all women should go for preconception counselling. However it must be offered for reasons like-
- Family history of a genetic condition
- If women has chronic illness like diabetes and hypertension
- Nutritional deficiencies e.g folate
- Exposure to toxins and teratogens
- It helps to understand the potential risks of her disease and medication over the developing baby.
- Thorough medical, personal and family history of both the partners
- History of previous pregnancy and pregnancy related problem
- Physical examination of mother like Pap smear and mammography when age of mother is more than 35 years.
- Folic acid supplementation: Folic acid supplementation is important for all women of reproductive age because 1:1000 pregnancies are affected by a NTD (neural tube defects). All women of childbearing age should be encouraged to take a folic acid supplement, even those with a healthy diet, because most women do not get enough folate in their diet. Cooking reduces folate in many foods. Low carbohydrate diets may reduce folic acid intake.
- Stopping smoking before pregnancy will improve your chance of getting pregnant and decrease certain adverse effects on the fetus.
- Blood sugar testing to exclude diabetes.Improved control of diabetes in diabetics can reduce the risk for birth defects.
- In hypertensive patients changing certain pills to safer ones.
- Aspirin before and early in pregnancy might prevent miscarriages in women with certain conditions.
- Hypothyroidism management – the requirement for thyroid replacement therapy increases during pregnancy and early intervention promotes healthy neuro logic development in children.
- Oral anticoagulant– Warfarin is associated with an increased risk for birth defects and hemorrhage in pregnancy if at all, women should stop or change treatment before pregnancy.
- Anticonvulsants- Most of the oral antiepileptic drugs are harmful to the baby, so medication should be changed to safer ones before pregnancy.
- Male partners should be advised to stop smoking and alcohol before planning pregnancy. Smoking and alcohol decreases fertility potential of males by reducing number and quality of sperms.
- Rubella antibody status- All women should have their antibody titers measured .If Ig G is positive means woman is immune to rubella no further vaccination is required. However if she is non-immune meaning Ig G is negative she should be given vaccination against rubella. Vaccinated women are advised to avoid pregnancy for four weeks after vaccination. Rubella can cause serious and lethal abnormalities in baby.
- Obesity- Obesity reduces the fertility potential in women. Weight loss improves their ovulation and chances of becoming pregnant
- Stress management- stress relief in many ways like exercise, change of job can be helpful in conception.
- Fertile period- A couple should know about fertile period when chances of conception are maximum.
- Women should also be aware that fertility potential decreases with increasing age as number of eggs go on decreasing with age so pregnancy should not be delayed for too long.
Pelvic ultrasound scan and vaginal examination (for women), which details the exact status of the uterus and ovaries, and gives you a fair idea of whether your womb is strong enough to host a baby within.
Semen analysis, which is done after 2 -3 days of abstinence, to gauge the male’s ability to fertilize an egg .
Hormonal assay is done for both men and women, to test all the hormonal levels necessary for normal follicular stimulation, sperm production, implantation of the fertilised egg, to sustain the baby and induce labour. This is the most crucial set of tests, and is done for women on the 2nd day of her ovulation cycle.