Well before each baby is conceived, the two parents involved should actually decide to conceive the baby (as opposed to find yourself pregnant), carry the pregnancy to term and give birth to a healthy baby, while ensuring the mother is healthy throughout the pregnancy and during the post delivery period. During the preparation phase of conception, the two parents to be should undergo pre- conception care.
Pre- conception care is the care given to both men and women who are planning to conceive, with the aim of increasing chances of conception, and reducing the risk of death during pregnancy, with an aim of giving birth to a healthy baby.
It offers patients an opportunity to discuss risk factors that can be minimized before and during pregnancy to ensure a healthy outcome for the mother, father and the baby. The issues to be discussed and addressed include;
Couples on contraception who wish to get pregnant should discuss it with their obstetrician and gynecologists. Those on implants and intra-uterine devices should have them removed. Those on three monthly injections should be counselled on the possibility of a delay in the return to fertility for about three or so months.
Maternal chronic diseases
Before pregnancy, women who suffer from chronic diseases like diabetes, hypertension, epilepsy, HIV should be seen by their gynecologists. They should be treated to a level where their diseases or the drugs they take won’t affect the well being of the baby.
- Diabetic women
should have their sugars well controlled before they become pregnant. They should also have their medicines changed from oral tablets which have teratogenic potential to insulin injections.
- Hypertensive women
should have their pressures well controlled before pregnancy. They should also discuss the potential to have their drugs changed to drugs that have no teratogenic potential.
– women with epilepsy and who are on medications should not ideally get pregnant without discussing it with their doctors. Most of the anti-epileptic drugs they use may cause birth defects such as spina bifida. They are therefore supposed to be started on a course of folic acid supplementation several months before they become pregnant. They should also have their drugs changed to drugs that don’t cause fetal defects.
- HIV positive women
should be put on anti-retrovirals till their viral load is undetectable so as to reduce the possibility of mother to child transmission.
– women using anti-thyroid drugs should be seen by their doctors and advised if at all getting pregnant is safe at all. They should also have their drugs changed to drugs that don’t cross the blood placental barrier hence causing fetal defects.
Such as depression and anxiety disorders should be screened and treated before pregnancy. Women who are on continuous treatment for mental illnesses should be put on medications that are safe for the child who is about to be conceived.
All women desiring pregnancy should have their nutrition assessed. They should start feeding on folic acid rich foods and taking folic acid supplements if need be. Folic acid prevents against neural tube defects.
Women with a body mass index (BMI) of 30 and above should be advised to lose some weight. Obesity is a risk factor for infertility among women. It is also a risk factor for other pregnancy complications like deep venous thrombi i.e clots.
Sexually transmitted diseases
Both parents should be screened and treated for sexually transmitted illnesses such as syphilis so as to eliminate the risk of transmitting it to the unborn baby.
Family and Genetic history
Assess pregnancy risks on the basis of maternal age, maternal and paternal health, obstetric history and family history. Possibility of passing genetic defects like sickle cell to the unborn baby should be discussed.
Advanced maternal age and the risk of getting babies with Down syndrome should also be discussed.
Images courtesy of Citizen Kenya & Lune Magazine