07 Apr Preconception Examination
Preconception examination or pre-pregnancy care is important in helping couples to have a healthy pregnancy and a healthy baby. It involves assessments of a woman’s overall health and identifications of risks factors that may complicate pregnancy.
During the visit to the gynaecologist, a detailed medical history including family history of high blood pressure, diabetes, and/or mental retardation will be taken. Medical conditions that may require special care during pregnancy, such as epilepsy anaemia, and allergies will be recorded. Past surgical history especially surgery involving reproductive organs, hernia repair and appendicectomy is important as the fertility potentials may be compromised. Past pregnancies, including the number, length of pregnancy (gestation), previous pregnancy complications, pregnancy losses (miscarriages and stillbirths) will be asked in detail. Vaccination status especially German measles and chickenpox will be assessed. Sexually transmitted infection, urinary tract infection, or other infection that could be harmful to the foetus and to the mother will also be recorded.
During the physical examination, the general state of health will be noted. Pelvic examination will be done to find out the presence or absence of tumour such as fibroid or ovarian cyst. Investigations will include blood tests for diabetes, hepatitis B status, thalassaemia (a hereditary disease causing lack of blood (anaemia) in the mother), German measles and other sexually transmitted diseases.
A parasite called Toxoplasma gondii can cause repeated miscarriage. A blood test before pregnancy can determine if a woman has been exposed to the Toxoplasma.
Advice in the following areas may be given after medical evaluation:
- Proper diet and healthy life style
Eating a balanced diet is not only good for the mother’s overall health, but essential for producing a healthy baby. Taking folic acid each day, a nutrient found in green, leafy vegetables, nuts, dried beans, citrus fruits, and fortified breakfast cereals can help reduce the risk of birth defects of the brain and spinal cord (also called neural tube defects). It is important to exercise regularly and maintain a proper weight before pregnancy. Women who are overweight may experience medical problems such as high blood pressure and diabetes.
- Medical management of pre-existing conditions
Any current or pre-existing medical problem should be treated accordingly and advice given regarding the optimum time to have the baby.
- Smoking and other substance abuse
Studies have shown that babies born to mothers who smoke tend to be lower in birth weight. In addition, exposure to second-hand smoke may also adversely affect the foetus.
Avoid exposure to alcohol and drugs. In addition, any medications (prescription and over-the-counter) that are currently taken may have adverse effects on the developing foetus and should be discussed with the gynaecologist.
- Avoid exposure to harmful substances:
Pregnant women should avoid exposure to toxic and chemical substances (i.e. lead and pesticides), and radiation (i.e. X-rays). Exposure to high levels of radiation and some chemical and toxic substances, may adversely affect the developing foetus.
- If the wife has thalasseamia, it is important to check the husband’s status as stillbirth may occur if both have same type of thalasseamia.
Vaccination against German measles, chicken pox and hepatitis B before pregnancy would be advisable to avoid contacting the diseases during pregnancy.