Tuesday, September 1, 2009
Preconception Counseling: Part I
Last week I took a two-day training on Preconception Health with the Office of Minority Health. It was a good way to supplement the obstetrics class I took in the spring. I wanted to share some of what I learned from this course:
Why is Preconception Counseling important?
Because 50% of all pregnancies are unplanned.
Women can go weeks- even months, without knowing they are pregnant. Just think of all the things you might not do if you knew you were pregnant right now! Hopefully you wouldn't smoke or drink alcohol. Hopefully you'd start to eat better and take folic acid and multivitamins.
But if a woman has gone say, two months without knowing she is pregnant, she's already missed an important window of time for her baby's development. Most birth defects begin in the first eight weeks after conception. A prenatal visit isn't going to be able to prevent or correct any problems that occured in those first two weeks.
That's why women need to think about their preconception health. Who is in the preconception phase of their life? Anyone who is sexually active and not pregnant. It doesn't work to say "I don't need folic acid right now, I'm not getting pregnant anytime soon." If 50% of all pregnancies are unplanned, we should at least encourage women to be healthy when the surprise comes.
Obviously it would be better if pregnancies were not surprises. That's where the above Reproductive Life Plans come in. These should be passed out in all high schools tomorrow! We should ask people at a young age, right around the time they start thinking about having sex, what they see for themselves in the future in terms of parenthood.
Everyone should ask themselves:
Do I want to be a parent? When do I want to be a parent?
How will I control when I become a parent?
How many children do I want? What will I do to determine the number of children I have?
What do I need to do before I have children?
This should be thought about and decided before the first sexual experience. But still, surprises do happen. For this reason all women should be encouraged to maintain their health.
What is good preconception advice?
All preconception-phase women should take folic acid to prevent certain birth defects like spina bifida.
Women should be sure they have up-to-date vaccinations before they become pregnant. Certain diseases like rubella and chickenpox can cause birth defects. Because those vaccines contain live virus, you should not be vaccinated while pregnant. Do it before you get pregnant!
Women should be tested for high blood pressure and diabetes before pregnancy as these conditions can cause complications.
Women should be tested for STIs. Many STIs can cause birth defects and/or can be passed along to the baby. It is very important to know the status of your sexual health before becoming pregnant.
Women should stop smoking and drinking alcohol before getting pregnant. (This is why it's so important to know you are pregnant early on!) Tobacco and alcohol can cause preterm birth and low birth weight.
Women should be in good general health prior to conceiving.
More on preconception training in Part II.