Ask a WHT Doctor About Preconception Counseling
Kathryn Holloway, M.D. FACOG with the Institute for Women’s Health covers how a preconception visit to your ObGyn can help optimize conception and pregnancy outcomes. At this appointment a discussion about cycle regularity, prior conception and pregnancy outcomes, any new medical diagnosis or medications as well as overall health assessment can occur. The goal of the visit is to establish care and reduce the risk of adverse health eﬀects for the patient and future child. Changes can be made to lifestyle and medications prior to conception is recommended. Contraception options can also be reviewed at this time to allow the patient to time her conception.
Which chronic diseases may impact pregnancy?
It is important to discuss any new or chronic diagnoses with your ObGyn. Examples of diseases that may negatively eﬀect pregnancy outcome include:
- psychiatric illness
- thyroid diseases – both hyper- and hypothyroidism
Some medications are contraindicated in pregnancy or recommended to be avoided during certain parts of pregnancy. All medications should be reviewed with your physician and adjustments made if needed.
Always let your doctor know if you are taking any additional herbal or nutritional supplements as these may eﬀect the ability to conceive and pregnancy.
What testing/treatments should be performed prior to conception?
In addition to a routine screening and annual exam, preconception counseling should include evaluation for conditions that may eﬀect getting pregnant and pregnancy outcome. If a condition is identified, it allows time for preparation and changes prior to conception.
If you are a woman with regular, monthly and predictable menstrual cycles, you are likely ovulating. Timed intercourse during the 3-4 days before ovulation increases the chances of conception. A couple who has been trying to conceive for over 12 months, should be referred for fertility evaluation.
A thorough family history can identify risk for genetic diseases and allow time for testing, patient education, and counseling.
Important vaccinations prior to pregnancy include:
- Hepatitis B
All women should receive the yearly influenza vaccine.
What lifestyle changes should occur prior to pregnancy?
Smoking during pregnancy can lead to poor fetal growth, ectopic pregnancy, hypothyroidism, and eﬀects on the placenta. Children born to women who smoked during pregnancy have higher rates of asthma, childhood obesity, and colic.
Alcohol consumption can have fetal eﬀects at any stage and can lead to childhood behavioral and cognitive deficits.
The closer we are to ideal body weight; pregnancy risks are reduced. Obesity in pregnancy can lead to miscarriage, birth defects, preterm delivery, gestational diabetes, hypertension, cesarean section, and blood clots. Starting moderate exercise for 30 minutes, most days of the week prior to pregnancy can mitigate these risks. Exercise is also safe to start and continue once pregnant.