Preconception counselling is a meeting or an appointment with a health care professional before a woman tries to get pregnant and to plan for future pregnancy. It is a part of a planned and healthy pregnancy. It is very important to take preventive action as early as possible before pregnancy occurs because most adverse pregnancy outcomes occur in women who are unaware of being at risk.
When a couple is seen and counselled about the course and outcome of pregnancy well before the time of actual conception is called preconceptional counselling. It is a new approach to improve the health of future children through primary intervention and it is a part of preventive medicine.
The goal of preconceptional counselling is health education and promotion of health. The objective is to ensure that a woman enters pregnancy with an optimal state of health that would be safe both for herself and the baby.
It is too late to advise the woman who is seen first time in the antenatal clinic because all the adverse factors have already begun to exert their effects(organogenesis is completed by the first trimester).
Preconception phase
- It is the time to identify risk factors that could complicate the pregnancy adversely.
- The woman is informed about the risk factors and care is provided to reduce or eliminate the risk factor to improve the pregnancy outcome.
Preconceptional visit, risk assessment and health education
During the meeting, various aspects of pregnancy are discussed. An appointment should happen at least three months before a woman starts trying to get pregnant.
- Identification of high-risk factors- It includes a detailed assessment of the family, medical, personal and obstetric history. Laboratory tests (CBC, pap smear, test for rubella & hepatitis, diabetes & thyroid test and HIV test) are done to assess the risk factors if required.
- Immunization– Rubella and hepatitis immunization in a non immune woman are done.
- Folic acid supplementation– Woman is advised to start taking Folic acid 4 mg/day, 4 weeks before conception up to 12 weeks of pregnancy to reduce the incidence of neural tube defects.
- Base level health status– Blood pressure is recorded to assess the health status of the women.
- Optimization of maternal health in preconception phase– Evaluation of overweight, underweight and anaemia problems and treated appropriately.
- Preconceptional education– Fear of incoming pregnancy is removed by preconceptional education.
- Patient with medical conditions – Education should be provided to the patient about the effects of the disease on pregnancy and also the effects of pregnancy on the disease. Pregnancy is discouraged in extreme medical conditions. Pre-existing diseases such as hypertension, diabetes and convulsions are stabilized by taking appropriate interventions to an optimal state.
- Drugs used before pregnancy– If a woman continues taking drugs during pregnancy, it could harm the foetus in the womb. Drugs are verified and changed if required to avoid any adverse effect on the foetus during the period of organogenesis. Drugs such as warfarin are replaced by heparin, oral anti-diabetic drugs are replaced with insulin and anticonvulsant drugs are also checked.
- Inheritable genetic diseases such as cystic fibrosis, sickle cell disease and thalassemia are screened before conception and the risk of passing the disease condition to the foetus is discussed with the couple. It could be managed either by primary prevention (eliminating the casual factor) or by secondary prevention (terminating the affected fetus).
- Smoking, alcohol and other abusing drugs have adverse effects on the foetus during the pregnancy so the women should be urged to stop and specialized care is given to the addicted woman.
- Importance of prenatal diagnosis– Couple is educated about the importance of prenatal diagnosis (biochemical, biophysical and cytogenetic) for chromosomal or genetic diseases.
- Couples with a history of recurrent fetal loss– Mother who is experiencing repeated fetal loss or with a family history of congenital abnormalities (genetic, chromosomal & structural) are investigated and counselled appropriately.
Limitations
Unfortunately, only a small percentage of women take the advantage of preconceptional counselling and care, the reasons are-
- Lack of public awareness.
- Many pregnancies are unplanned.
Lifestyle changes
- Always stay hydrated- Drink plenty of water.
- Nutritious diet- Good nutrition is required for the fetus to grow and develop healthy.
- Regular exercise- Helps to maintain good body weight.
- Maintain good eating habits.
- Quit smoking and alcohol consumption.
- Avoid stress.
Conclusion
In the above post, we discussed Preconceptional counselling, its goals and objectives, preconception phase, risk assessment, health education, limitations and lifestyle changes.
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