By: Natasha Lowe Osho MD (OB/GYN), NASM Certified Personal Trainer, Pre/Postnatal Performance Training Specialist
“Would you like to become pregnant within the next year?” If the answer to this question is “yes,” “if it happens, it happens,” or you are not taking steps to actively prevent pregnancy, you should consider preconception counseling. Preconception counseling is important because the foundation for a healthy pregnancy begins before your positive pregnancy test.
What is Preconception Counseling?
Preconception counseling is a visit to a healthcare provider with the goal of optimizing your health prior to pregnancy. This visit should be schedule with a provider who has expertise in pregnancy care such as an OB/GYN, Midwife, or Women’s Health Nurse Practitioner.
What topics are discussed during preconception counseling?
Medical History: There are some common conditions that should be well controlled before pregnancy to decrease risks for complications. These conditions include high blood pressure, diabetes, asthma, thyroid disorders, mood disorders, seizure disorders, and even severe forms of acne requiring treatment with prescription medications.
Medication and Supplement Use: A detailed review of all medications, including prescription and over the counter supplements, is important to make sure they are safe for pregnancy. Exposure to potentially harmful medications could affect your developing baby. Reviewing your medications before pregnancy provides an opportunity to switch to a safer alternative and optimize the dose necessary for treatment.
Surgical History: This can be important when it comes to delivery planning. Specifically, it is important to discuss all procedures/surgeries done on your uterus such as cesarean sections, dilation and curettage (D+C), and myomectomy (removal of fibroids). It is also crucial to discuss any complications from previous surgeries such as infection, excessive bleeding, or blood clots in the lungs or legs.
Family History: This is important for a discussion regarding risks for inherited genetic disorders. These are conditions passed within families through a gene. A detailed family history for you and your partner should be discussed to access the risk of passing certain genetic conditions to the baby. Examples of inherited genetic disorders include sickle cell anemia, cystic fibrosis, certain forms of intellectual disability, and genetic cancer syndromes such as BRCA.
Pregnancy History: This discussion focuses on the number of previous pregnancies, the type of delivery, and pregnancy complications. Examples of complications include gestational diabetes, gestational hypertension (high blood pressure), preeclampsia, gestational thrombocytopenia (low platelet counts that occur towards the end of pregnancy), occurrence of deep vein thrombosis or pulmonary embolism (blood clots in legs or lungs), preterm delivery, and excessive bleeding with delivery. This is not a comprehensive list of complications but having a preconception counseling visit allows for an in-depth review of your personal history and possible measures you can take to decrease the risk of recurrence.
Other components of the preconception counseling visit include vaccination history (particularly regarding varicella [aka chickenpox], measles/mumps/rubella, Tdap, and flu), exercise counseling, nutrition counseling, and tobacco/alcohol/substance use. It is also appropriate to discuss any work-related concerns. This is particularly important if your job is physically demanding or involves exposure to chemicals. The preconception visit is also an appropriate time to discuss personal concerns, such as intimate partner/domestic violence.
These are just a few topics to discuss with your women’s health provider before pregnancy. A deep dive into your medical history, surgical history, medication and supplement use, surgical history, family history, pregnancy history, vaccination history, diet and exercise habits, substance use, work environment, and living situation are all important topics to discuss. If you are not actively preventing pregnancy, it is recommended to schedule a preconception counseling visit to take the necessary steps to optimize health before your positive pregnancy test.