Your Pre-Pregnancy Checkup: 7 Things to Know Before You ConceiveCynthia Ramnarace
In your heart and mind, you may be ready to start the journey toward motherhood—but is your body ready? Find out by scheduling a preconception checkup with your OB-GYN. Dr. Mark Chames, MD, an obstetrician specializing in high-risk pregnancies at the University of Michigan Health System in Ann Arbor says he’d love for every woman to talk to her doctor before conceiving. That’s because many of the complications of pregnancy sow their seeds in the earliest weeks and months, before a woman is even aware she is pregnant.
During a preconception visit, Dr. Chames says most doctors will review a woman’s medical history and address a lot of things related to pregnancy, such as genetic history. For example, if there’s a neural tube defect in the family, your doctor will discuss the importance of taking folic acid before getting pregnant, and so on.
Those first few weeks are so vital to development that the US Centers for Disease Control and Prevention hosted a Preconception Summit in June 2005 to focus on better educating women about preparing their bodies for pregnancy. According to the CDC, nearly 28 percent of pregnant women in the United States suffer complications during their pregnancies each year. Many of those complications, from gestational diabetes to low birth weight, can be avoided with good preconception care, CDC experts say.
“We want to make sure that women are healthy before they get pregnant,” says Dr. Hani Atrash, MD, medical director for the CDC’s National Center on Birth Defects and Developmental Disabilities. “There is solid scientific evidence that interventions work. Things like taking folic acid, stopping smoking, stopping alcohol. We have been successful in preventing the causes of infant mortality that are preventable.”
During your preconception visit, expect to do a lot of talking, says Dr. Chames. It is a chance for your doctor to educate you on staying healthy, and for you to ask questions. Your OB-GYN will recommend several tests and talk to you about the lifestyle changes you should make to ensure a healthy pregnancy. Here are seven areas you should discuss with your doctor.
Although you rarely hear about rubella, sometimes called “German measles,” the virus still exists, and if a woman were to contract it while pregnant her baby could develop serious birth defects. The CDC reports that seven percent of all women are not immune to rubella. Varicella, or chicken pox, is another disease that raises concern, says Dr. Chames. A blood test can confirm whether you are immune and if vaccination will be recommended. Recently, mothers-to-be have been offered the Tdap vaccine to boost their immunity to whooping cough, a major source of infant illness.
It is possible to be sick and not know it? Diabetes can go undiagnosed, as can syphilis, hepatitis, and HIV. Your doctor will likely recommend you be tested for all these diseases. “Most of the blood work at the first prenatal visit—a CBC, the rubella status, hepatitis status, blood type, and antibody screen—should be done prior to conception so if there are issues they can be dealt with,” says Dr. Chames. “The other thing I recommend is HIV testing. I would recommend all pregnant women have that test because there is a subset of women who don’t know they are HIV-positive.”
Your doctor should inform you of the risks of drinking alcohol, doing drugs, and smoking during pregnancy. If you smoke, don’t wait until you are pregnant to give up the habit. Babies born to women who smoke are more likely to be born too early and have low birth weight, reports the March of Dimes. They are also at greater risk for sudden infant death syndrome (SIDS) and attention deficit disorder (ADD), adds Dr. Chames. For the mothers, there is a greater risk of placental abruption, placenta previa (where the placenta implants itself in the wrong place, blocking the cervix), and miscarriage.
Drinking and drug use also need to stop before conception. By the time you register a positive pregnancy test, your baby’s central nervous system is already forming. Alcohol use during pregnancy can lead to fetal alcohol system, a leading preventable cause of mental retardation, says the March of Dimes. Use of street drugs such as heroin and cocaine can result in low birth weight and congenital abnormalities. Any risky behavior increases your chance of miscarriage.
If you are overweight, you might have trouble conceiving; the same is true if you are underweight. Achieving a healthy weight will benefit your baby once you conceive. If you’re too thin, you risk having a low birth weight baby. If you are too heavy, you run the risk of diabetes, blood clots, and labor complications that could lead to a C-section. Your baby is also at higher risk of a neural tube defect such as spina bifida.
Women with diabetes are strongly advised to talk with their doctors before conceiving. Getting glucose levels in check is crucial to a healthy pregnancy, says the March of Dimes. Also, those who take oral medications to regulate blood sugar might need to switch to injections, as medication from some pills can pass the placenta and possibly cause birth defects. Birth defects are three times more common in babies whose mothers have diabetes, says the CDC. Controlling the disease limits that risk.
Hypothyroidism also needs special attention. Thyroid hormone requirements increase during pregnancy, and so the CDC recommends medication levels be adjusted to ensure proper neurological development.
Any on-going medical problem requires “tuning up” before conception. This is especially true of seizure disorders, asthma, and auto-immune conditions like lupus.
“Women taking antidepressants should never stop taking them without a doctor’s recommendation,” Dr. Chames says. Instead, talk with your physicians about the medication, the dosage, and what risk, if any, there is to the fetus. “Generally (antidepressants) are mostly safe,” explains Dr. Chames. “If there is a link to birth defects, it is generally low. For a lot of women, when you consider the risks of the drug versus the benefits of the drug, we will say continue the medication.”
Certain medications definitely need to be stopped during pregnancy, including warfarin (Coumadin), certain anti-epilepsy drugs, and the acne drug Accutane. All have been linked to birth defects.
Are You Ready?
Visiting your doctor for a preconception visit is the first step in mothering the child you are hoping to soon conceive. Other simple steps include getting into the daily habit of taking a multivitamin with folic acid. And if there is the slightest chance you might be pregnant, abstain from alcohol, smoking, and drug use. But most of all, ask questions. ‘The more educated a woman is, the better her chances of having a healthy pregnancy,” says Dr. Chames.