*Updated 9/2024
Why Optimizing Your Health is Essential
Whether or not pregnancy is planned within the next year, every person should be thinking about their health because about 50% of all pregnancies are unplanned. In addition, despite our modern-day medical advances, about 1 in 8 babies are born prematurely. While physicians and researchers are still working to find the cause of and develop preventive strategies for preterm birth, experts agree that people need to be healthier before becoming pregnant. By addressing health issues and risks before pregnancy, problems that could affect the pregnancy can be prevented or mitigated.
What is Preconception Counseling?
Seeing a Maternal-Fetal Medicine Specialist, or high-risk pregnancy specialist or perinatologist, before pregnancy, ie a preconception counseling consult, is a good way for people with pre-existing medical conditions to assess their health and potential for a healthy pregnancy. The goals of preconception counseling are to improve maternal, fetal, and neonatal outcomes by optimizing health, address modifiable risk factors, and providing education about pregnancy relative to an individual's pre-existing medical conditions, complications experienced in prior pregnancies, or other factors. The MFM partners with the expectant parent, their family and medical team to navigate the these medical conditions in order to attain the best possible pregnancy outcomes. In a preconception consultation with an MFM, the patient’s medical and pregnancy histories will be reviewed to help create an optimal strategy for the next pregnancy.
According the the SMFM, counseling should include information regarding maternal health implications of pregnancy, ways to optimize maternal health and pregnancy outcomes through preventative care or treatment before pregnancy, and strategies to prevent or plan pregnancy through the use of contraception. This information may be provided either by a maternal-fetal medicine (MFM) subspecialist. Other healthcare practitioners or subspecialists may be brought in to the patient's care team as needed to review available strategies to reduce risks before pregnancy. If the patient is already under the care of a practitioner for an existing medical condition, this practitioner should be involved with their care as well.
Tips for all people considering pregnancy include:
- Take 400 – 800 micrograms (or 0.4 – 0.8 mg) of folic acid daily to lower your risk of birth defects of the brain and spine, i.e. spina bifida.
- Stop tobacco, alcohol, and other illicit drug intake.
- Review over-the-counter and prescription medications you are using with your obstetrical care provider to ensure they are compatible with and ideal for pregnancy.
- Make sure your vaccinations are up to date; MMR and varicella vaccinations should be given prior to pregnancy if needed.
- Avoid contact with toxic substances or materials: lead, mercury, solvents, pesticides, paint thinners, radiation, cat and rodent feces, etc.
- Maintain a nutritious and well-rounded diet.
- Develop a consistent, sustainable exercise routine.
Reasons why people may be referred to an MFM for preconception counseling:
Known genetic conditions or at risk for chromosomal problems
- Canavan disease
-Familial dysautonomia
-Fragile X
-Spinal muscular atrophy
-Tay-Sachs disease
-Age over 35
Prior fetal complications
-Growth disorders: intrauterine growth restriction (IUGR) or macrosomia
-Infections (CMV, Toxoplasmosis, Parvovirus, Herpes, Varicella)
-Prior stillbirth
-Alloimmunization: maternal antibodies (Anti-D, anti-Kell, etc) that can cross the placenta and cause fetal anemia
-Neonatal Alloimmune Thrombocytopenia (NAIT): maternal antibodies that attack fetal platelets and can cause fetal bleeding
-Non-immune hydrops: swelling or excess fluid in the heart, lungs, and abdomen
Prior children with birth defects
-Spina bifida or central nervous system abnormalities
-Congenital heart disorders or lung/chest disorders
-Gastroschisis or omphalocele
-Urological (kidney / bladder) problems
-Chromosomal differences (Trisomy 13, 18, or 21) or syndromes
Prior pregnancy problems
-Recurrent pregnancy loss or multiple miscarriages
-Preterm birth due to spontaneous preterm labor or the spontaneous breaking of water too early (PPROM)
-History of shortened cervix or prior need for a cerclage (surgical stitch placed to strengthen the cervix and sew it closed)
-Anomalies of the uterus
-A prior history of preeclampsia, HELLP, or eclampsia
Maternal health problems
-Immune system conditions and/or infections: non-specific immune function is enhanced while specific immune functions are decreased so that the body does not attack the developing fetus. This can increase risk of some infections and may also affect autoimmune disorders.
-Infectious diseases:
-Hepatitis A, B, C
-HIV
-Gonorrhea, chlamydia, syphilis, trichomonas
-Rare infections
-Autoimmune disorders
-Lupus (SLE)
-Antiphospholipid syndrome
-Cancers: pregnancy may affect organs previously stressed by chemotherapy. Sometimes people are diagnosed with cancer while attempting to become pregnant.
-Brain: the increased blood volume in pregnancy can worsen or improve neurologic problems. The stresses and hormonal effects of pregnancy can also complicate psychiatric disorders.
-Neurological:
-Seizure disorders / epilepsy
-Chronic / migraine headaches
-Berry aneurysms / AV malformations
-Multiple sclerosis
-Pseudotumor cerebri
-Spinal cord injury
-Psychiatric and psychosocial:
-Smoking and/or drugs use disorder
-Depression / anxiety
-Other psychiatric disorders
-Domestic violence
-Kidney disorders: renal function is increased as the mother has to filter wastes for the pregnant person and fetus; people with kidney disease are also at increased risk of blood pressure disorders during pregnancy.
-Nephropathy or chronic renal insufficiency
-History of kidney transplant
-Blood conditions: pregnancy increases blood volume by 50% but increases the chance of blood clots and anemia.
-Iron-deficiency anemia and hemoglobinopathies
-Sickle cell disease
-Von Willebrand disease
-Thrombotic thrombocytopenia purpura / hemolytic uremic syndrome(TTP/HUS)
-History of blood clots on anticoagulant therapy
-Inherited thrombophilia
-Gastrointestinal conditions: digestion slows during pregnancy, contributing to nausea and vomiting, heartburn, and potentially worsening gallstones.
-Hyperemesis gravidarum
-Intrahepatic cholestasis of pregnancy
-Ulcerative colitis and Crohn’s disease
-Gallstones and gallbladder infections
-Pancreatitis
-Wilson’s disease
-History of liver transplant
-Endocrine conditions: the placenta and body changes of pregnancy change how the body regulates blood sugar, responds to physiologic stress, and utilizes vitamins.
-Diabetes mellitus
-Addison’s disease
-Thyroid disorders
-Parathyroid diseases
-Lung conditions: In pregnancy, people breathe more quickly and more deeply to take in more oxygen for the developing fetus, which may prove difficult for women with chronic lung conditions.
-Asthma and other restrictive lung diseases
-Lung infections: pneumonia, influenza, or tuberculosis
-Cystic fibrosis
-Heart conditions: the requirements of the heart function increase by about 50% in pregnancy, which can create problems for those with underlying heart conditions. Patients with heart disease should be counseled about the risk of mortality based on their modified World Health Organization classification; those with class III or IV are at a substantially higher risk than those with class I or II heart disease. These can include:
-Congenital heart disease
-Arrhythmias: abnormal heart rhythms with or without pacemakers
-Disease of the heart valves or history of valve replacement
-Pulmonary hypertension
-Coronary artery disease or history of a heart attack
-History of a heart transplant
-Obesity: extra body fat increases the risk of the pregnancy complications of gestational diabetes, high blood pressure disorders, birth defects, stillbirth, and labor abnormalities and the need for a cesarean delivery. In addition, evaluation and monitoring of the fetus is technically more difficult and may warrant different techniques to be utilized.
In summary, MFMs offer expert guidance on multiple aspects of pregnancy, including recommendations on optimizing health before the journey of pregnancy begins. They can suggest medications that can be safely used in pregnancy to manage medical and psychiatric conditions with minimal risk to the developing fetus so that the ideal outcome can ultimately be achieved. A healthy parent and a healthy fetus and baby (or babies) is the best outcome for everyone!!
For more information on MFMs and what issues can be addressed with preconception counseling, please see: