PRECONCEPTION COUNSELLING AND CARE

Hello ladies, good to have you read the second part of my article on preconception care; what you should know before pregnancy and what you should do before pregnancy. It promises to be a good read. In case you have not read the first part, you can read it here; preconception care.

While waiting to have the long awaited appointment with your health care provider to discuss your intention to have a baby and allay your anxiety. I will be discussing the advice and care you should know and have before getting pregnant within this article. This advice and care is called preconception counselling and care. Even after your appointment with your health care provider, you may forget some information. You can use this article as a source of revision when you need to.

The primary objective of preconception counselling and care is to ensure you are in a state of good health before getting pregnant. Note that this clinic visit is for the couple and not just for the woman.

During your first visit a detailed history will be taken from the couple starting from the bio-data mostly interested in your age, occupation and religion. Your healthcare provider will want to know if you have any complaints, your menstrual history, history of previous deliveries if any, past medical history including operations done. Your health care provider will also want to know if you are taking any medication currently, your vaccinations and if you have any bad reaction to any drug, food or animal. He/she will also be interested to know if there is any family history of an inheritable disease condition and will also want to know if you take alcohol or tobacco.

Furthermore, the woman will have a physical examination including height, weight, blood pressure, pulse, respiration and temperature measurements. A clinical breasts examination, the chest, heart, abdomen and the vagina will be examined. From the history and examination, your health care provider will tell you if you are in a state of good health or order some tests to properly advise you. The areas to be covered during this visit will depend on if you have any complaint or underlying disease condition or not. This has been covered by the various headings within.

COMPONENTS OF WHAT YOU SHOULD KNOW BEFORE PREGNANCY.

BODY MASS

Your body mass index (BMI) calculated by dividing your weight(kg) by the square of your height(m) should be between 18.5 to 24.9kg/m² which is the optimum. Less than 18.5kg/m² is associated with premature breaking of baby’s water, premature labour. Women who are overweight with BMI 25 to 29.9kg/m² or obese with BMI ≥30kg/m² are advised to lose weight before pregnancy because they are at risk of developing diabetes, heart problems and hypertension in pregnancy. Also they are prone to having big babies, difficult delivery and more operation for delivery.

SEXUAL INTERCOURSE

It is perfectly ok to have sex while pregnant, this will not harm the baby in the womb. Sex can only be withdrawn if (1) the pregnancy is threatening to abort, (2) if later in pregnancy the placenta is found low, covering the opening into the womb, (3) advanced pregnancy is causing discomfort to the woman. Your health care provider will tell you if need be to withhold sex during the course of your antenatal visit.

EXERCISE

Exercise is good for pregnancy but has to be limited to only moderate exercise such as safe walk, swimming, stationary cycling. Avoid weight lighting, contact sport that can traumatise the abdomen.

ALCOHOL

Alcohol should be avoided if possible especially in the first 3 months of pregnancy. If you must take alcohol, it should be limited to one or two units per week as recommended by the National Institute for health and care excellence(NICE). Heavy drinking of alcohol should be avoided as it not only reduces the woman’s fertility it can also cause miscarriage, restrict the growth of the baby in the womb, after birth it can delay development and cause difficulty in learning.

TOBACCO

Smoking should be stopped as it is a risk factor for a lot of pregnancy complications like miscarriage, bleeding problem, premature delivery, low birth weight, malformation, death of baby in the womb or suddenly after delivery.

FOOD

Adequate nutrition is advised, eat food rich in carbohydrate such as rice, potatoes, pasta, ‘fufu’, yam, ‘garri’. Protein rich foods like beans, meat, fish, egg, dairy products like pasteurised milk, yoghurt, processed cheese. Use cooking oil, eat fruits and vegetables, drink enough water. If you are a vegetarian, you might be referred to a dietician for dietary advice.

FOOD TO AVOID

Caffeine intake should be reduced to 200mg daily or less (about 2cups of coffee). Avoid uncooked or under cooked meat, avoid unpasteurised milk, soft cheese, avoid mashed meat or vegetables as you can be infected by a bacterial that can cause miscarriage or a protozoan that cause deformity of the baby’s brain and spinal cord. Avoid eating shark and swordfish they contain heavy metals not good for the baby’s brain and spinal cord development.

SUPPLIMENTS

You will be commenced on folic acid supplementation either low dose or high dose. Those who might benefit from high dose folic acid include; women with personal, family history or previous delivery of a baby with neural tube defect, sickle cell disease, diabetes or obesity. Depending on the part of the world you are, vitamin D might be added, especially places with poor exposure to the sun, women with obesity, previous birth of a child with fracture at delivery, rickets or vitamin D deficiency.

RECURRENT MISCARRIAGE

This is when you have lost 2 or more consecutive pregnancies. You will be advised to withhold getting pregnant until you are properly tested to find out the cause and treated. If the losses have been in the second 3 months of the pregnancy, you will be advised to have a cerclage inserted (tying of the cervix) or a drug will be given to help maintain subsequent pregnancies.

DIABETES

This is when the blood sugar is above the normal limit because the body is lacking or insensitive to a hormone called insulin which is necessary for uptake of available blood sugar. A woman with a family history of this disease who is not diabetic can develop it while pregnant; a condition called gestational diabetes which usually resolves after delivery. A woman who had gestational diabetes can develop it in subsequent pregnancies. One who is diabetic already will be tested to check the level of the blood sugar and how effective the medication use is controlling it. If the level of control is very poor from the test results, you might be advised to withhold plans to get pregnant. Your medication might be changed if you are on medications that can negatively affect the development of the baby to safer alternatives. You might be co-managed with the diabetologists or an endocrinologist during pregnancy. Controlling blood sugar during pregnancy might be a challenge because some pregnancy hormones increase the blood sugar in the mother to make it available for the baby. Poor control can result in pregnancy loss, abnormal growth or death in the womb, babies born with malformation, big baby with difficult delivery and the mother is at risk of developing hypertension in pregnancy.

HYPERTENSION

This is when blood pressure is elevated and remains at or above 140/90mmhg taken on two different occasions at least 4 hours apart. Medications that might affect the baby will be changed to safer and effective ones. Medications in the class of ACE inhibitors like Lisinopril, ARB antagonists like valsartan will be changed because they are not good for the baby. You will be tested to check the function of your kidneys as hypertension can cause kidney problems. Hypertension can complicate pregnancy and result in early delivery.

KIDNEY DISEASE

Women with infection in the kidney or any part of the urinary system are tested and treated with antibiotics. This infection can cause pregnancy loss or premature delivery. Women with severe impairment of their kidney function may achieve good pregnancy outcome but at about 50% risk of permanent kidney damage.

SICKLE CELL DISEASE

The crisis can become more frequent with pregnancy. They could develop problems with blood supply to the baby from the placenta which could reduce the growth of the baby or even cause sudden death of the baby in the womb at any time. The woman is at risk of developing pregnancy induced hypertension. Some medications will be stopped such as deferoxamine and hydroxyurea. During pregnancy the hematologist will be part of your managing team. With proper management, most sickle cell patients will have a good pregnancy outcome.

SEIZURE DISORDERS

Could be epilepsy or any other seizure disorder, the frequency of seizure is likely to increase and the dose of your medication might be increased. Some medications might be change. The neurologist will be part of your managing team.

HEART DISEASE

Women with preexisting heart diseases will be investigated with the help of the cardiologist. Mild diseases might have a good pregnancy outcome. There are some types of heart diseases that pregnancy will not be recommended until after treatment. Normal pregnancy has been found to have some effect on the heart which might result in heart disease later in life. That is why women who have had babies are more at risk of developing heart disease than women who never had a baby.

CANCER

Women with cancer are advised to withhold pregnancy until after treatment because, some of the treatment modalities could use radiation or medications which are not good for the developing baby. Getting pregnant and withholding cancer treatment can result in advancement of the cancer, as well as early planned delivery so that the mother can start treatment or she could die.

EMPLOYMENT RIGHTS IN PREGNANCY

The labor laws on maternal right in pregnancy has slight variation in different countries. In general, you should not be fired, refused employment, demoted or treated differently because you are pregnant.

Also, it is your right to have a safe job; when your work environment is not safe for you or the baby, your employer should make adjustments. For instance, if you work where you are likely to be expose to radiation, then you need to be reassigned. If your desk can no longer accommodate you because of the baby bump, your employer should make adjustments. If your work involves standing, you should be permitted to sit.

Furthermore, parental leave such as; maternity, paternity or adoption leave varies between countries. The United states of America family and medical leave act of 1993 protect legal parent to go on unpaid maternity leave for up to 12 weeks. The 54 counties in Africa have maternity leave which ranges from 50% to 100% pay with varied duration. In Nigeria, the labor law of 2004 grants maternity leave with full pay for 12 weeks and does not give paternity leave.

I hope this article was useful to you. Follow me on my blog to get more articles on women’s health as they are published.