| Is
preconception care the same as genetic counseling?
Preconception
care is a relatively new concept in preventive
medicine that helps couples to develop and maintain a
healthy lifestyle before conception. Genetic
counseling may be included in preconception care, but
the primary areas if concern are aspects of the
couple's health and lifestyle. Nutrition, exercise,
and substance use and/or abuse are some of the obvious
areas of concern. The theory behind preconception care
is that a woman who maintains good health habits is
more likely to have an easy pregnancy and delivery
- and a healthy baby - than a woman who is not
healthy.
Should
I make a special appointment with my doctor to discuss
preconception care?
As
a woman of child bearing age, you should already be
seeing a physician for annual examinations and family
planning. If you are seeing a doctor for routine
health maintenance, the components of preconception
care can easily be integrated into these visits. In
fact, your doctor may already have initiated some
aspects of preconception care by advising you on good
nutrition and proper exercise and by making sure you
have kept up to date on important immunizations. If
you've never discussed preconception care with your
physician, you might want to bring the topic up during
your next appointment, particularly if you have a
chronic disease such as diabetes, epilepsy, or asthma.
If you don't have a primary care physician - either an
obstetrician/gynecologist or a family practice or
internal medicine specialist - you should choose one
right away and make an appointment for a routine
physical. The issue of preconception care can be
raised at the time of your first visit.
Why
do I need to worry about my health and lifestyle
before I get pregnant?
The
first eight weeks of pregnancy are crucial to the
developing fetus. During this time, many of the baby's
vital organs begin to form, among them the neural tube
(which becomes the brain and spinal cord), heart,
digestive tract, and sensory organs. Such outside
influences as an inadequate diet or the use of
alcohol, cigarettes, and drugs can have an adverse
effect on the fetus during this early period of
development. A pregnancy is usually not confirmed
until the important eight-week period has passed,
unhealthy habits could damage the fetus before a woman
even knows she's pregnant.
Can
we wait to think about preconception care until we
decide whether we want to have a family?
Although
the reliability of many birth control methods has
improved dramatically in recent years, there is still
no method that is 100% effective. As many as 50% of
the pregnancies in the United States are unplanned.
Such a pregnancy is a realistic possibility,
preconception care is an important concern for all
women of reproductive potential who are sexually
active with a male partner.
What
are some other aspects of preconception care?
The
more your doctor knows about your state of health and
lifestyle the better. Some of the areas your doctor
will explore include prior pregnancies; problems with
the reproductive organs; history of sexually
transmitted diseases; presence of such chronic
conditions as hypertension (high blood pressure),
seizure disorders, renal (kidney) disease, and auto
immune problems; immunization history; family history
of close relatives with certain medical problems that
might suggest a need for genetic counseling; and
social history, including conditions in your work or
living environment that might have an impact on
pregnancy.
Could
my regular exercise regimen be damaging to a fetus?
Generally,
a program of regular exercise is beneficial both
before and after conception. Excellent physical
condition is a definite advantage for a healthy
pregnancy. What doctors worry about are the extremes.
An exercise program that is too strenuous can be
harmful to both the mother and the developing fetus.
Many doctors advise active women to cut their exercise
routine by about 40%.
They
may also advise against weight lifting or any other
strenuous exercise that involves a "grunt".
A woman who has been sedentary most of her life can
benefit from some form of aerobic exercise, but she
should not suddenly begin exercising strenuously in
anticipation of conception. Most doctors would
encourage an inactive woman to begin some form of
aerobic exercise, like taking a brisk walk three times
a week, that she can continue throughout her
pregnancy.
When
I'm ready to conceive, should I stop taking my
prescription medication?
Not
Always.
Women who are being treated for chronic conditions,
such as asthma or diabetes, should never stop taking
their medication without talking to their physician.
Going without needed medication could be more harmful
to developing fetus than continuing to take it. If you
are of childbearing age, chances are that the
medication your physician prescribed has little if any
potential for harming a fetus. However, there are some
prescription medications that will need to be stopped
before pregnancy and/or during. Sometimes alternate
medications can be used for a condition which can be
safe during pregnancy. Once again, it's
important to talk with your physician about any
concerns you may have.
Would
taking vitamin supplements before I get pregnant
improve my chances of having a healthy baby?
Generally,yes,
a well-balanced diet is essential, but doctors do
recommend that women of child-bearing age take a
vitamin containing folic acid, which helps prevent
neural-tube defects, such as spina bifida, that occur
in the early weeks of pregnancy.
I
am about 50 pounds over weight. Should I consider
dieting?
Most
doctors would advise women who are trying to conceive
against dieting and would recommend instead that they
follow a well-balanced diet designed to help them
maintain their current weight. Malnourishment at the
time of conception may be detrimental to the health of
the fetus. Obese women for whom weight reduction is
indicated should take steps to avoid pregnancy while
participating is a supervised weight-loss program.
My
husband smoked marijuana and experimented with other
recreational drugs when he was in college. What effect
could this, or his current health status and
lifestyle, have on a fetus?
Although
some residue from marijuana and certain other drugs
has been found in semen, there is no evidence that
their presence at the time of conception is harmful to
a fetus. However, there is evidence that secondary
smoking is potentially harmful to both the expectant
mother and her fetus, so if your husband is a smoker,
your doctor might recommend counseling for smoking
cessation. Other potentially significant aspects of
the father's health include the presence of any
genetically determined condition that could be passed
on to a baby, a history of sexually transmitted
disease, or an abnormality in the genitalia that might
effect his fertility.
Can
an occasional drink really be harmful to a fetus?
Maternal
consumption of alcohol has been identified as the
chief cause of preventable mental retardation in the
U.S. The exact timing of alcohol damage to the fetus
is still unclear, it seems likely that some of it
occurs before a mother realizes she is pregnant.
Although complete abstinence from alcohol during
pregnancy is recommended, most doctors realize that it
is unrealistic to expect a woman to drink nothing at
all for the entire child bearing period of her life.
Your doctor would probably counsel you to avoid
regular and excessive use of alcohol when you are
actively attempting to conceive, suspect you might be
pregnant, or have confirmation of pregnancy.
Could
soaking in our hot tub be dangerous to a fetus?
It's
not advisable for women who are trying to get pregnant
to use a hot tub regularly. Raising the body's
temperature can be dangerous to a fetus, because blood
is diverted away from the uterus to the skin as the
body attempts to cool off. Also, frequent soaking in a
hot tub can lower a man's sperm count and possibly
affect his fertility.
If
other questions arise please feel free to make an
appointment with Drs. Simon or Grade or their nurse
practitioner for preconception counseling.
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