Pre-pregnancy is a vital to assess and identify the various risk that could lead to the adverse outcome for moms and fetus.
WHO defines it as the “provision of biomedical behavioral and social health interventions, to woman and couples before pregnancy occurs”.
Pre-pregnancy care focusses on long-term as well as short-term improvement in women and child health through counseling and interventions. It is a targeted at management and reduction of underlying risk factors responsible for poor maternal and neonatal outcomes.
Unplanned pregnancy, maternal age, undernutrition, iron deficiency anemia, vaccine-preventable diseases, epilepsy are the main cause of poor pregnancy outcomes.
There is an emphasis on planned and timely motherhood.
An intensive health care approach is basically desirable to reduce the adverse pregnancy outcome, in order to obtain a paramount mother and child health.
Lack of healthcare precautionary measures in adolescence and delayed antenatal care are the gaps to be fulfilled in pre-pregnancy care.
Pre-pregnancy care warranting health promotion and timely intervention, so that women start with a healthy pregnancy and better outcome.
There is a recent focus on pre-pregnancy care as a tool for promoting the health of prospective parent and to reduce maternal and perinatal mortality and morbidity in India.
- Towards a planned pregnancy – Avoiding unplanned and unwanted pregnancy is an integral part of pregnancy outcomes.
- Nutrition – Supplementation of folic acid with recommended strengths depending on the history is asserted part.
- Treating (or) screening for anemia is essential because there is a high incidence of anemia in India.
Optimal body weight management
It is advisable to attain normal BMI prior to pregnancy. You should have ideal BMI as both overweight or underweight can cause unwanted complications during pregnancy.
Overweight and obesity:
If there is overweight and obesity in the pre-pregnancy period there is an increased risk of adverse effects on mother and fetus in the form of neurological problem macrosomia, preterm delivery, stillborn, gestational diabetes (diabetes in pregnancy), HTN and thromboembolic disorder (clot formation).
Even underweight increases the risk of adverse outcomes like preterm birth, low birth weight and increased risk of birth defects like gastroschisis (stomach problem).
A thorough personal (or) family history need to be asserted to identify couple requiring genetic counseling.
- Presence of birth defect (NTD/ heart defect/ ovarian defects)
- Advanced parental age during a pregnancy which can predispose to chromosomal abnormalities like down syndrome.
- Recurrent pregnancy loss
- The family history of early onset cancer genetic testing can be offered during the pre-pregnancy period for various disorders to quantify the risk and provide suggestions for modifying the outcome.
Some of the common indication for which prenatal testing can be offered are:
- Advanced age of mother(>35years)
- Previous child with a) chromosomal abnormality
- b) any other congenital abnormality
Chronic medical conditions
In the pre-pregnancy period, all women should be screened for diabetes.
Women with pre-existing diabetes mellitus should be advised to achieve the optimum glucose level before pregnancy.
Screening for thyroid dysfunction with TSH is desirable considering the high incidence of thyroid disorder in India.
In untreated hypothyroidism, there is an adverse effect on the mother (like abortion, HIV in pregnancy, pre-eclampsia, preterm delivery and post-term bleeding) on the fetus and newly born like (impairment in IQ score, neuropsychological development and being abilities).
Disease condition should be optimized before pregnancy by the best modality of treatment.
(Drugs used to treat hypothyroidism might cause embryopathy)
All women should have at least basic clinical cardiac assessment in the pre-pregnancy period.
Genetic counseling is essential to women with congenital heart disease.
All women in the pre-pregnancy period should be screened for hypertension disorder especially those with a history of hypertensive disorders in previous pregnancy, kidney disease.
In women with pre-existing hypertension disorder should need counseling about the possible need to change the antihypertensive treatment before planning a pregnancy.
Epilepsy (or) Seizure disorder:
Women suffering from epilepsy should be counseled about the need to properly plan their pregnancies considering the risk of increased epileptic seizure frequency in pregnancy, the potential side effect of epilepsy and anticonvulsant drug a pregnancy outcome.
Most of the commonly used conventional anticonvulsant have known teratogenic effect (major malformation).
Folic acid supplementation should be started prior to pregnancy after consultation with a doctor.
Cancer survivor should be counseled on the potential reproductive effect of cancer treatment and the resultant effect on fertility and prospective pregnancy outcomes.
Breast cancer survivor should need counseling before planning their pregnancy.
Symptoms of an autoimmune disease systemic lupus erythematosus (SLE) and rheumatoid arthritis(RA)
Could improve women or remain unaffected when a woman becomes pregnant.
The medication is used for RA/SLE should be reviewed before and during pregnancy.
Asthmatic women who are planning for conception should be advised about the probable asthma aggravation with pregnancy and used for achieving asthma control prior to pregnancy with suitable medication.
There is an increased risk to herself and her fetus resulting from the disease and the medication such a preterm birth, low birth weight, very small and small for gestational age and congenital malformation.
Pregnancy should be avoided during treatment with oral steroids.
Infection screening protocol:
Universal pregnancy screening should be offered for HIV, symphysis and hepatitis B.
All couples planning pregnancy should be offered HIV screening and counseling.
Gestational Diabetes Mellitus (diabetes in pregnancy) :
The woman had a risk of 25.8% of developing diabetes within 15years of GDM and GDM increases cardiovascular risk as well.
Pregnancy-induced hypertension and preeclampsia:
Women who had pre-eclampsia and preterm delivery had an 8.12 fold increase in death from cardiovascular causes. Continued monitoring of women with HTN during pregnancy even after pregnancy help in the prevention of CVD.
Polycystic ovarian syndrome:
Polycystic ovarian syndrome (PCOS) is estimated to affect nearly 10% of women at reproductive age is characterized by
- Irregular periods
- Excessive hair growth
- Weight gain or obesity
- Women with PCOS are at high risk for diabetes
Women with PCOS may have several cardiovascular risk factors such as
- Insulin resistance and diabetes
- Central obesity
Awareness is particularly important since women with PCOs are typically young.
Risk assessment is in the form of
- Waist circumference to know about central obesity.
- Fasting lipid profile
To reduce this risk for cardiovascular disease in these women lifestyle modification is the first line therapy.
Even modern weight loss can have multiple benefits for women with PCOs and should be strongly encouraged.
This is an important correctable risk factor to decrease cardiovascular risk.