Whether or not pregnancy is planned within the next year, every woman should be thinking about her 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 physician and researchers are still working to find the cause of and develop preventive strategies for preterm birth, experts agree that women need to be healthier before becoming pregnant. By addressing health issues and risks before pregnancy, problems that could affect the health of mom or baby may be prevented. The goals of preconception counseling are to improve maternal, fetal, and neonatal outcomes by optimizing health, address modifiable risk factors, and provide education about pregnancy.
Tips for all women considering pregnancy in the foreseeable future (or at least 3 months prior to attempting conception) 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
- Complete tobacco, alcohol, and street drug cessation
- Review over-the-counter and prescription medications you are using with your obstetrical care provider and 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 and develop a consistent, sustainable exercise routine
Sometimes, due to pre-existing medical conditions, complications experienced in prior pregnancies, or other factors, a woman is considered high-risk even prior to pregnancy and may be referred to a high-risk pregnancy doctor for preconception counseling. An MFM, Maternal-Fetal Medicine Specialist or “perinatologist”, is a high-risk pregnancy specialist who partners with the expectant mother, her family, and her medical team to navigate the out-of-the-ordinary and attain the best possible pregnancy outcomes for both mother and child. Before pregnancy, MFMs can provide guidance for women with chronic medical conditions or those who have experienced pregnancy complications in the past. In a preconception consultation with an MFM, the patient’s medical and pregnancy histories will be reviewed to help create an optimal strategy for her next pregnancy.
Below are some reasons why women may be referred to an MFM for preconception counseling:
-Known genetic conditions or at risk for chromosomal problems
-Spinal muscular atrophy
-Women over the age of 35
-People related by blood who want to have children together
-Prior fetal complications
-Growth disorders: intrauterine growth restriction (IUGR) or macrosomia
-Infections (CMV, Toxoplasmosis, Parvovirus, Herpes, Varicella)
-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 disorders (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 her 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)
-Mullerian anomalies or a misshapen 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 a woman’s body does not attack her developing baby. This can increase her risk of some infections and may also affect autoimmune disorders.
-Hepatitis A, B, C
-Gonorrhea, chlamydia, syphilis, trichomonas
-Cancers: pregnancy may affect organs previously stressed by chemotherapy. Sometimes mothers 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.
-Seizure disorders / epilepsy
-Chronic / migraine headaches
-Berry aneurysms / AV malformations
-Spinal cord injury
-Smoking and/or drugs of abuse
-Depression / anxiety
-Other psychiatric disorders
-Kidney disorders: renal function is increased as the mother has to filter wastes for herself and her baby; women 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
-Gastrointestinal conditions: digestion slows during pregnancy, contributing to nausea and vomiting, heartburn, and potentially worsening gallstones.
-Intrahepatic cholestasis of pregnancy
-Ulcerative colitis and Crohn’s disease
-Gallstones and gallbladder infections
-History of liver transplant
-Endocrine conditions: the placenta and body changes of pregnancy change how a woman’s body regulates blood sugar, responds to physiologic stress, and utilizes vitamins.
-Lung conditions: In pregnancy, women 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
-Heart conditions: the requirements of the heart function increase by about 50% in pregnancy, which can create problems for women with underlying heart conditions. These can include:
-Congenital heart disease
-Arrhythmias: abnormal heart rhythms with or without pacemakers
-Disease of the heart valves or history of valve replacement
-Coronary artery disease or history of a heart attack
-History of a heart transplant
-Obesity: extra body fat increases a woman’s 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 her 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 a woman’s health before she embarks on the journey of becoming a mother. They can suggest medications that can be safely used in pregnancy to manage the mother’s medical and psychiatric conditions with minimal risk to the developing fetus so that the ideal outcome can ultimately be achieved. A healthy mom and a healthy 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:
- The Society for Maternal Fetal Medicine
- American College of Obstetrics and Gynecology (ACOG) Committee Opinion on Preconception Counseling
- US Department of Health and Human Services Preconception Health Page