Pre-conception counseling

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Pre-conception counseling (also called pre-conceptual counseling) is a meeting with a health-care professional (generally a physician or midwife) by a woman before attempting to become pregnant. It generally includes a pre-conception risk assessment for any potential complications of pregnancy as well as modifications of risk factors, such as increasing folic acid intake to reduce the risk of neural tube defects and counseling on smoking cessation, alcohol reduction, and medications that may compromise fetal development. [1] Physicians, midwives and baby experts recommend that a woman visit them as soon as the woman is contemplating having a child, and optimally around 3 to 6 months before actual attempts are made to conceive. [2] This time frame allows a woman to better prepare her body for successful conception (fertilization) and pregnancy, and allows her to reduce any health risks which are within her control. Agencies such as the March of Dimes [3] have developed screening tools that healthcare providers can use with their patients. In addition, obstetricians or midwives (see Obstetrics, Midwifery, General Practitioner) have developed comprehensive check-lists and assessments for the woman who is planning to become pregnant.

Contents

In one sense, pre-conception counseling and assessment can be compared to a well-baby visit in which a baby is screened for normal health, normal development, with the benefit of identifying emerging problems that may have gone unnoticed in an infant. For a woman, the Pre-Conception Counseling Assessment and Screening is intended to assess normal health of a child-bearing woman, while at the same time identifying:

Obstacles to pre-conception counseling

A common obstacle to pre-conception counseling and assessment is that many pregnancies are still unplanned.[ citation needed ] Globally, 38% of pregnancies are unintended. [4] For this reason, many experts recommend that all women of childbearing age be offered preconception care counseling regardless of intent to become pregnant. [5]

Another common obstacle to pre-conception counseling and assessment is of women not knowing, realizing, or understanding the benefits of visiting their physician or midwife before trying to become pregnant. Most women still take for granted the biological aspects of becoming pregnant, and do not consider the value of pre-screening before becoming pregnant. Most women who want and anticipate having a baby are naturally prone to thinking in terms of having a well baby. In the majority of cases, women do not think about having a baby who has any kind of problem. Most women do not know how their own medical history could pose risks to a developing fetus. Likewise, they may not understand that pregnancy carries a certain number of risks as well. When family history risks and pregnancy risks are considered together, it may point to potential problems for that particular woman, or to her unborn baby once she becomes pregnant.

What is involved in pre-conception counseling?

Questionnaire

Pre-screening covers many body-system areas (not just the reproductive organs), as well as aspects of the woman's lifestyle, and family history information. It begins with basic information and becomes more in-depth, especially if the woman has had previous illnesses, diseases, etc. Pre-screening assessments begin with a questionnaire which the woman fills out, generally before seeing the physician or midwife. Some offices have the woman go over parts of the questionnaire with a Nurse Practitioner, if available.

Blood work

Certain blood work may be ordered. Preconception counseling and testing identify couples at risk for hemoglobinopathies that might affect their offspring. [6] [7] This often includes a CBC (Complete Blood Count) which can show anemia. A CBC includes WBC (White Blood Cell Count) which can show the presence of infection. Anemia and infection, indicating problems with the woman's overall health at that moment, can both affect a woman's ability to become pregnant at that time as well as affect the stability of the pregnancy and the health of the fetus. In the majority of cases, both infection and anemia can be treated once the cause is identified. Anemia may require ongoing evaluation and iron supplement. Based on these results, patients may be offered genetic counseling, hematology consultation, and fetal diagnostic testing.

Urinalysis

Urine sample or urinalysis can reveal the presence of proteinuria (protein in the urine), a possible indicator of infection or kidney disease, or the presence of blood which can indicate a urinary tract infection. Urinalysis might also show the presence of glucose (glycosuria), but women of child-bearing age are unlikely to have undiagnosed diabetes (this is separate from gestational diabetes that may occasionally develop during the course of a subsequent pregnancy).

Using the assessment

Physicians

When women have pre-existing illnesses / conditions / diseases, these may add to pre-natal risks and will need ongoing evaluation. Also any medications which are used to treat these conditions will need monitored and possibly reduced or increased.

The presence of Diabetes remains a huge risk for the unborn child, and a woman will be screened specifically for this condition. Known diabetics will need monitored closely. For more information, see this online article Diabetes and Diabetic risks. [8]

The woman's role

A woman may need to adjust certain aspects of her health and well-being which are in her control. These usually include aspects of lifestyle, drug and alcohol use, exercise, rest and stress reduction. In addition, she may need to discontinue certain herbs or over-the-counter medications as recommended by her healthcare provider. Many physicians will also recommend pre-natal vitamins before a woman actually conceives in order to boost her overall health.

In the United States

Pre-conception counseling in the United States is recommended to include: [9]

See also

Related Research Articles

Midwifery

Midwifery is the health science and health profession that deals with pregnancy, childbirth, and the postpartum period, in addition to the sexual and reproductive health of women throughout their lives. In many countries, midwifery is a medical profession. A professional in midwifery is known as a midwife.

Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field.

Miscarriage Natural death of an embryo or fetus before it is able to survive independently

Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the natural loss of an embryo or fetus before it is able to survive independently. Some use the cutoff of 20 weeks of gestation, after which fetal death is known as a stillbirth. The most common symptom of a miscarriage is vaginal bleeding with or without pain. Sadness, anxiety, and guilt may occur afterwards. Tissue and clot-like material may leave the uterus and pass through and out of the vagina. Recurrent miscarriage may also be considered a form of infertility.

Prenatal care Medical check-ups during pregnancy

Prenatal care, also known as antenatal care, is a type of preventive healthcare. It is provided in the form of medical checkups, consisting of recommendations on managing a healthy lifestyle and the provision of medical information such as maternal physiological changes in pregnancy, biological changes, and prenatal nutrition including prenatal vitamins, which prevents potential health problems throughout the course of the pregnancy and promotes the mother and child's health alike.The availability of routine prenatal care, including prenatal screening and diagnosis, has played a part in reducing the frequency of maternal death, miscarriages, birth defects, low birth weight, neonatal infections and other preventable health problems.

Pre-eclampsia Hypertension occurring during pregnancy

Pre-eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath due to fluid in the lungs, or visual disturbances. Pre-eclampsia increases the risk of undesirable outcomes for both the mother and the fetus. If left untreated, it may result in seizures at which point it is known as eclampsia.

Pregnancy Time when children develop inside the mothers body before birth

Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but can also occur through assisted reproductive technology procedures. A pregnancy may end in a live birth, a spontaneous miscarriage, an induced abortion, or a stillbirth. Childbirth typically occurs around 40 weeks from the start of the last menstrual period (LMP). This is just over nine months. When using fertilization age, the length is about 38 weeks. An embryo is the developing offspring during the first eight weeks following fertilization, after which, the term fetus is used until birth. Signs and symptoms of early pregnancy may include missed periods, tender breasts, morning sickness, hunger, and frequent urination. Pregnancy may be confirmed with a pregnancy test.

Large for gestational age Medical condition

Large for gestational age (LGA) is a term used to describe infants that are born with an abnormally high weight, specifically in the 90th percentile or above, compared to other babies of the same developmental age. Macrosomia is a similar term that describes excessive birth weight, but refers to an absolute measurement, regardless of gestational age. Typically the threshold for diagnosing macrosomia is a body weight of between 4,000 and 4,500 grams, or more, measured at birth, but there are difficulties reaching a universal agreement of this definition.

Complications of pregnancy are health problems that are related to pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. Severe complications of pregnancy, childbirth, and the puerperium are present in 1.6% of mothers in the US, and in 1.5% of mothers in Canada. In the immediate postpartum period (puerperium), 87% to 94% of women report at least one health problem. Long-term health problems are reported by 31% of women.

Maternal health is the health of women during pregnancy, childbirth, and the postpartum period. It encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to ensure a positive and fulfilling experience, in most cases, and reduce maternal morbidity and mortality, in other cases. Maternal health revolves around the health and wellness of women, particularly when they are pregnant, at the time they give birth, and during child-raising. WHO has indicated that even though motherhood has been considered as a fulfilling natural experience that is emotional to the mother, a high percentage of women go through a lot of challenges where they suffer health-wise and sometimes even die. Because of this, there is a need to invest in the health of women. The investment can be achieved in different ways, among the main ones being subsidizing the healthcare cost, education on maternal health, encouraging effective family planning, and ensuring progressive check up on the health of women with children.

Maternal–fetal medicine

Maternal–fetal medicine (MFM), also known as perinatology, is a branch of medicine that focuses on managing health concerns of the mother and fetus prior to, during, and shortly after pregnancy.

Drugs and medications should be avoided while pregnant. Women should speak to their doctor or healthcare professional before starting or stopping any medications while pregnant. Tobacco, alcohol, marijuana, and illicit drug use while pregnant may be dangerous for the unborn baby and may lead to severe health problems and/or birth defects. Even small amounts of alcohol, tobacco, and marijuana have not been proven to be safe when taken while pregnant. In some cases, for example, if the mother has epilepsy or diabetes, the risk of stopping a medication may be worse than risks associated with taking the medication while pregnant. The mother's healthcare professional will help make these decisions about the safest way to protect the health of both the mother and unborn child. In addition to medications and substances, some dietary supplements are important for a healthy pregnancy, however, others may cause harm to the unborn child.

The following outline is provided as an overview of and topical guide to obstetrics:

Prenatal nutrition

Prenatal nutrition addresses nutrient recommendations before and during pregnancy. Nutrition and weight management before and during pregnancy has a profound effect on the development of infants. This is a rather critical time for healthy development since infants rely heavily on maternal stores and nutrient for optimal growth and health outcome later in life.

Prenatal care in the United States is a health care preventive care protocol recommended to women with the goal to provide regular check-ups that allow obstetricians-gynecologists or midwives to detect, treat and prevent potential health problems throughout the course of pregnancy while promoting healthy lifestyles that benefit both mother and child. Patients are encouraged to attend monthly checkups during the first two trimesters and in the third trimester gradually increasing to weekly visits. Women who suspect they are pregnant can schedule pregnancy tests prior to 9 weeks gestation. Once pregnancy is confirmed an initial appointment is scheduled after 8 weeks gestation. Subsequent appointments consist of various tests ranging from blood pressure to glucose levels to check on the health of the mother and fetus. If not, appropriate treatment will then be provided to hinder any further complications.

Pre-conception counseling in the United States allows for optimization of US prenatal care. Pre-conception counseling is a meeting with a health-care professional by a woman before attempting to become pregnant. It generally includes a pre-conception risk assessment for any potential complications of pregnancy.

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References

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  2. "Preconception health". womenshealth.gov. 13 December 2016. Retrieved 9 August 2019.
  3. "Get Ready for Pregnancy". March of Dimes. October 2013. Retrieved 4 November 2014.
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  5. Coffey, Kevan; Shorten, Allison (22 August 2013). "The challenge of preconception counseling: Using reproductive life planning in primary care". Journal of the American Association of Nurse Practitioners. 26 (5): 255–62. doi:10.1002/2327-6924.12054. PMID   24170712. S2CID   25404691.
  6. Sabath, DE (1 July 2017). "Molecular Diagnosis of Thalassemias and Hemoglobinopathies: An ACLPS Critical Review". American Journal of Clinical Pathology. 148 (1): 6–15. doi: 10.1093/ajcp/aqx047 . PMID   28605432.
  7. Vrettou, C; Kakourou, G; Mamas, T; Traeger-Synodinos, J (May 2018). "Prenatal and preimplantation diagnosis of hemoglobinopathies". International Journal of Laboratory Hematology. 40 Suppl 1: 74–82. doi: 10.1111/ijlh.12823 . PMID   29741247.
  8. Herman, William H.; Denise Charron-Prochownik (Summer 2000). "Preconception Counseling: An Opportunity Not to Be Missed". Clinical Diabetes. 18 (3): 122.
  9. Health Care Guideline: Routine Prenatal Care. Fourteenth Edition. Archived 5 July 2008 at the Wayback Machine By the Institute for Clinical Systems Improvement. July 2010.