Planning A Pregnancy Counts

In India, only five per cent couples seek pre-pregnancy counselling. Therefore. unfortunately, a large number of pregnancies are still unplanned. Pre-pregnancy counselling is a consultation with an obstetrician before planning for a pregnancy. But by the time some couples come to see an obstetrician, most of the foetal organs are developed and it is too late for any interventions.

Risk Group

Pre-pregnancy counselling should include all or more of the following:
Couples who are at increased risk of having babies with a genetic malformation. The counselling equips them with sufficient knowledge to make a decision.
Women over 35 years and those under 20 years of age must seek counselling.
Women who are grossly obese with a body mass index that is over 30 per cent or below 18 per cent.
Those in a consanguineous marriage.

What Counselling Should Include

Pre-pregnancy screening covers a full body check-up and detailed family and personal history of the wife and husband.
Height, weight and body mass index. Blood pressure, pulse rate, abdominal and pelvic examination should also be done.
Check for habits like smoking. alcohol, medication or drugs history or risk of exposure to hazardous substances or radiation.
History of chickenpox, shingles, hepatitis or German measles (rubella).
History of previous miscarriages.
Risk of chromosomal abnormalities or inherited genetic disorders.
Chronic health problems such as diabetes, epilepsy. chronic hypertension, thyroid. renal diseases, genetic diseases such as thalassemia, sickle cell diseases and anaemia.
Previous psychiatric illness.

Essential Factors And Their Implications

Active’ Passive Smoking
Smoking has adverse effects on the foetus. If both the husband and wife are smokers, they should give up smoking immediately.

Alcohol
A high level of alcohol consumption during pregnancy results in foetal alcohol syndrome. The babies are born with facial anomalies, growth restriction. intellectual impairment and behavioural problems.

Body Weight
Women who are overweight or obese (BMI above 30 kghn2) should lose weight before planning a pregnancy. A healthy weight reduces the risk of neural tube defects, preterm delivery. gestational diabetes, caesarean delivery and hypertension and thromboembolic diseases. Women who are underweight should gain weight before getting pregnant so as to avoid pregnancy related complications.

Medications/Drugs
It is good to avoid exposure to herbal preparations and high doses of vitamin A prior to or during pregnancy as they contain teratogen. Illicit use of drugs like cocaine and cannabis can cause miscarriages, placenta abruption, premature delivery, low birth weight babies and sudden infant death syndrome.

Environmental Risks
Consider potential risks from pet or farm animals such as cats. Pregnant women should wash the hands after gardening, avoid cleaning cat litter trays and avoid toxoplasmosis which can cause severe infection in the foetus. They should also avoid exposure to detergents, infections or radiation. Use of cell phones and microwaves should also be reduced.

Diet
Plenty of fruits and vegetables should be consumed to increase iron and calcium stores. Pregnant women should also avoid uncooked meat, fish and eggs, unpasteurised milk, soft cheeses and unwashed fruits and vegetables. Vitamin D

Vitamin D
deficiency results in impaired foetal growth. Women with a limited exposure to sunlight and with a high BMI should take vitamin D3 with multivitamin supplements. Caffeine consumption should be reduced or stopped prior to pregnancy as it may cause foetal growth restriction.

Exercise
Women who exercise regularly should continue and women who are inactive should start exercising. Saunas and hot tubs should be avoided to reduce birth defects. They should also avoid scuba diving and high impact sports.

Vaccination
Viral Infections such as rubella, chickenpox and measles cause severe foetal birth defects. It pregnant women are not immune to these viruses they should take vaccination prior to conceiving. Rubella viral infection and chicken pox in early pregnancy can cause multiple congenital defects. Vaccinations for rubella, chickenpox, varicella (shingles) should be advised if women are not immune to these infections. Also, they should be advised not to get pregnant for one month after the vaccinations.

Age
Professional and working women plan motherhood too late in their lives. Older age is associated with infertility. increased risk of miscarriage and pregnancy complications such as hypertension, gestational diabetes and certain chromosomal disorders such as Downs syndrome which increases sharply with maternal age. Also, women with a history of chronic diseases like such as diabetes, hypertension. asthma, heart disease, thyroid disease and epilepsy need to be tested before planning a pregnancy. For all the above factors, it is imperative that every woman along with her partner consult an obstetrician before planning a pregnancy, for a successful outcome.`