Advice For Preparing Patients For Pregnancy
Preconception counseling by the primary-care physician can help prepare patients for pregnancy, identify risk factors for a poor outcome and uncover any existing medical conditions that should be controlled prior to conception, according to obstetricians and maternal-nutrition specialists.
Such counseling, which should be accompanied by a blood workup, a thorough physical exam and a careful history, can reduce infant-mortality rates, improve pregnancy outcomes and keep perinatal healthcare costs to a minimum, the experts said.
“We can spend a lot of money on high-risk care during pregnancy that won’t do a lot of good, or we can spend more time with the patient prepregnancy,” said Richard Aubry, M.D., obstetrics director at Upstate Medical Center in Syracuse, N.Y.
“I believe that the latter would be more effective, in terms of preventing problems.”
One of the first and most important components of preconception counseling is to educate a woman about precautions that she needs to take while she is pregnant, said Terry German, M.D., an ob/gyn and associate medical director of the Pennsylvania-based health maintenance organization U.S. Healthcare.
“When a woman is trying to conceive, especially in the and half of every menstrual cycle, she should use the same precaution that he would take if she were already pregnant,” he aid. “Likewi e, a woman needs to understand that she should top drinking and smoking while trying to conceive.”
Physicians should also discuss proper nutrition with prospective mother according to Judith E. Brown, Ph.D., a professor of nutrition at the University of Minnesota in Minneapolis.
A side from stressing the importance of a balanced diet, Dr. Brown aid that primary-care physicians should also advise patients to maintain a high iron status, achieve their ideal body weight (since overweight and underweight women tend to have poorer pregnancy outcomes) and reduce alcohol and caffeine intake-alcohol to no more than one drink a day; caffeine to under four cups.
Diabetic patients should be assisted in achieving glucose control prior to conception, in order to reduce the risk of birth defects and other problems, she said.
Patients with phenylketonuria should be advised to maintain a strict PKU diet for several months prior to conception and throughout pregnancy, Dr. Brown added.
Lastly, women who are trying to achieve pregnancy should never take more than the recommended daily allowance of any vitamin or mineral, according to Dr. Brown. Vitamin A in high amounts can be particularly toxic to a developing fetus, and more than 15 mg of beta-carotene per day may impair fertility she said.
After taking a history, physicians should advise women about any special risks they may have for a poor pregnancy outcome, Dr. Aubry said. Among these may be age over 35 or under 18; a family history of illness, such as Tay-Sachs or sickle-cell anemia; hemophilia: hypertension; diabetes; or previous poor outcomes. If genetic risks exist, refer the patient to a genetic counselor, he said.
Patients who have had children with neural-tube defects should take folic acid supplements during pregnancy, Dr. Aubry said. “The bulk of evidence shows that it does help.”
Contrary to earlier practice, a woman need not wait three cycles before trying to conceive after ceasing to take oral contraceptives, according to Dr. German.
Women ought to look carefully at any risks posed by their occupations, he said, including exposure to chemicals, lead or X-ray radiation. They should also avoid exercise more strenuous than what they are accustomed to, he added.
Drs. Aubry and German suggested certain tests that should be taken prior to conception.