By Steven Gelber, MD
The decision to have a child, whether it’s your first baby or your last, is one of the most significant decisions you will make. That’s why planning ahead for pregnancy is a good idea, and one of the people who can help you plan is your obstetrician.
We have known for some time that women have the best pregnancy outcomes when the mothers-to-be are at their healthiest. Preconceptual counseling—when couples and their doctors meet prior to pregnancy—is a direct outgrowth of sound prenatal care. Since the first six to eight weeks of pregnancy are the most critical in terms of fetal development (when the baby’s organs form), it is important during that period of time for women to be in optimal physical condition. That can require preparation, which in some cases means lifestyle changes like quitting smoking and alcohol.
In the best of all worlds every women would see her doctor before becoming pregnant, but this is especially important for women who have had previous problems with pregnancy. Women who have experienced pregnancy loss related to early miscarriage, or who have had pre-term labor or high blood pressure should review their pregnancy history with a trained caregiver before becoming pregnant again. This allows the physician to review these risks and determine if there are preventive measures that can be taken to reduce the chances of complications occurring during another pregnancy.
During preconceptual counseling, the woman and her obstetrician will review previous pregnancies and gynecologic history. The woman’s medical history is also extremely important to explore, particularly if she has diabetes, high blood pressure, seizure disorder, a history of blood clots, or connective tissue disease such as lupus. Chronic conditions like diabetes should be well in control prior to getting pregnant. Patients who have had kidney transplants need to be stable and at least two years should have elapsed from the time of their transplant surgery.
The family history of each partner is an important part of preconceptual counseling. Certain groups of people are at higher risk for potentially serious problems if parents carry the gene in question. European Jews, for example, are at higher risk for having babies with Tay-Sachs disease, which causes mental and physical retardation. The gene for sickle cell anemia is relatively common in African-Americans, and children of families from the Mediterranean and Southeast Asia are at risk for thalassemia, a hereditary anemia. Huntington chorea and cystic fibrosis are also inherited and can be screened for if necessary.
Couples at risk for passing these conditions on to their children may benefit from genetic testing as part of their preconceptual counseling. Blood samples from both parents are drawn in the doctor’s office and sent to a reference laboratory where they are analyzed. When the results come back, the obstetrician can counsel the couple on likely outcomes should they decide to pursue pregnancy.
One of the most common situations we deal with in this region is women who choose to start their families after the age of 35. As women age, the risk for chromosome abnormality rises (which increases the risk of birth defects like Down syndrome) as does the risk for maternal complications during pregnancy. Nevertheless, the majority of women over 35 who are healthy and whose family history does not increase their risks for bad outcomes can and do deliver perfectly healthy babies. Preconceptual counseling gives the doctor an opportunity to check the woman’s rubella status before pregnancy, and to counsel her on the importance of adequate folic acid in her diet (400 mcg each day helps to prevent spina bifida).
If you are planning to begin—or add to—your family, think about seeing your obstetrician before getting pregnant. He or she can help you with everything from proper nutrition to sorting out risk factors for you and your baby. If previous pregnancies ended in miscarriage, your doctor may be able to figure out why and treat you to prevent it from happening again.
Dr. Gelber is board certified in obstetrics and gynecology and serves on the medical staff at Cayuga Medical Center. He is in practice with OB-GYN Associates of Ithaca and can be reached at (607) 266-7800.