Gynecology 110: Preconception Counseling
by Ngozi Osuagwu, MD | April 9th, 2017
When I started practicing medicine a long time ago, I remember that we would never see a pregnant woman until she was about 3 months pregnant – that was the start of her prenatal care. We now realize that prenatal care should start at the time the woman is thinking of becoming pregnant. We call this preconception care. This visit is mostly a counseling visit and can sometimes be incorporated as part of your annual exam.
What typically happens is a woman comes to her gynecologist for an annual exam. The physician asks whether she wants a refill on her contraceptive pills or whether she is happy with her long acting reversible contraceptive. The patient states, no I do not need a refill, we are ready to start our family or I am ready to take out the implant or IUD, we are ready to start a family.
At this point the physician will review the following:
MEDICAL HISTORY – If the woman has any chronic diseases for example diabetes or high blood pressure, it is very important that the condition is well controlled. What is considered normal when you are not pregnant, may be abnormal for pregnancy. Diseases like asthma may get worse during pregnancy and require additional medication.
MEDICATIONS – not all medications are safe during pregnancy. It is not good for you to stop the medication without advice from your doctor. Typically, if you are on a medication that will not be safe during pregnancy, your doctor will change the medication. A good idea is that when you are a woman of reproductive age and there is a potential that you might be pregnant in the future, it is best to start on a medication safe for pregnancy – talk with your health care provider.
FAMILY HISTORY – Certain diseases and traits run in the family. For example – if you have sickle cell trait and your partner has the trait that may have severe consequence s for the baby. It is important to know your family history and have the information available to your health care provider. .
PAST PREGNANCIES – Issues that occurred with a previous pregnancy can repeat itself and in some cases we can intervene. An example is preterm delivery. If you have delivered a baby before 37 weeks, you are at risk of having another premature baby. By knowing this history, we can start you on medication called progestin to help prevent premature delivery.
DIET – This is the time to incorporate plenty of fruits and vegetables. We are learning how the environment in the uterus can have long term impact on the baby. You will also be reminded to take your folic acid daily. Folic acid helps decrease the risks of problems with the brain and spine of the baby. Folic acid should be started at least one month before becoming pregnant since the brain of the baby is formed in the first four weeks of pregnancy.
LIFESTYLE – I am always amazed how many times people want to start some crazy exercise regime when they are pregnant but prior to pregnancy they were couch potatoes. It is important to be active prior to pregnancy so that it will be easier while pregnant to maintain the activity.
Prenatal care starts before pregnancy. If you or a friend is thinking about having a baby soon, schedule the preconception counseling appointment or talk to the doctor at the annual exam.
