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Preconception counseling helps future moms prep for baby

Wed, 08/18/2010 - 5:37pm
Baylor College of Medicine
HOUSTON -- (August 18, 2010) -- When a couple decides to have a child, it is important for the future mom to be in optimal condition, both physically and emotionally, said a maternal fetal medicine expert from Baylor College of Medicine.

"There are a lot of different elements of a woman's health that ideally ought to be taken into account before she tries to get pregnant," said Dr. Kjersti Aagaard, assistant professor of obstetrics and gynecology and maternal-fetal medicine at BCM.

An option is participation in a preconception consultation with an obstetrician, general practitioner, genetic counselor, or midwife to discuss genetic and medical history, work and home environment, nutritional intake and lifestyle behaviors, Aagaard said.

Genetic history

A complete family history can help identify elevated risks for disease and/or pregnancy complications, Aagaard said. "The future parents need to be prepared for any special circumstances they may encounter. Certain diseases are both relatively common and heritable and can be easily screened for, like sickle cell or cystic fibrosis."

Exposures to infectious diseases

During pregnancy, it's important that exposures to a limited number of infections are monitored, Aagaard said. "We want to know if there is a higher exposure to certain infectious diseases that can be harmful to a developing fetus."

For example, she said, women who have not been previously exposed or are non-immune need to take extra precautions to protect themselves from cytomegalovirus, a member of the herpes family virus that can spread from the infected mother to the newborn baby and cause congenital anomalies.

Health care workers and school teachers especially need to practice good hygiene and careful hand washing techniques when caring for patients and children.

Additionally, if a woman has never been exposed to chicken pox, or received the vaccine (also known as varicella), she should make sure she is protected.

"The same goes for the seasonal and H1N1 flu vaccine," said Aagaard. "A pregnant woman can have much more severe complications with this illness and benefit from vaccination."

Management of chronic disease

If a woman has a chronic disease, such as a seizure disorder or an autoimmune disease, she may be on medications that are not safe for pregnant women.

Prior to conception, obstetricians can help the future mom get on new, safer medications that can also help manage her disease, said Aagaard.

"Depending on how the woman manifests the symptoms and manages her disease, she may be put on different medicines or switched off for a period of time surrounding conception and pregnancy," said Aagaard. "We want to make sure the woman is stable for several months before she gets pregnant."

Aagaard emphasized that these are important decisions to be made with the physicians managing these diseases, such as neurologists and rheumatologists.

Nutrition

Prior to and during pregnancy, future parents will benefit from learning about important nutrients.

Women need plenty of folic acid, which is found in highest levels in leafy green vegetables, and supplemented cereals and whole grain breads.

Taking prenatal vitamins prior to getting pregnant also helps, Aagaard said. "We recommend women start about three months before they start trying to conceive."

"Poor folic acid intake has been associated with neural and abdominal wall congenital defects," said Aagaard. "If a woman has a history of having a child with these defects, we will recommend further increased intake to 4 miligrams daily."

Optimize diet

It may also be important for women to make sure their diet is not too high in fat.

"In research with non-human primates, we have shown that females on a high-fat diet (35 percent fat) have a higher risk of having offspring with non-alcoholic fatty liver disease—a precursor to obesity," said Aagaard. "While we will need to confirm these studies in humans, it is safe to suggest that women practice moderation and watch the fat intake in what they eat."

Try to achieve a balance between carbohydrates and proteins, Aagaard said. "The less processed carbohydrates, such as sugary desserts, snacks and beverages, the better."

Obese women are also at a higher risk of preeclampsia (high blood pressure) and pregnancy complications, such as blood clots and cesarean sections, and having children with diabetes.

"Emerging evidence suggests that women who are obese and then lose weight in advance of the desired pregnancy have improved pregnancy outcomes, less gestational diabetes and fewer large-for-gestational-age babies," said Aagaard.

Avoid alcohol, smoking

If a woman is dependent on alcohol and smoking, she should stop these behaviors to prepare for the pregnancy.

"We have understood for several decades that alcohol during pregnancy can cause fetal alcohol syndrome, and that smoking is associated with higher rates of fetal growth restriction, preterm birth, and pregnancy loss," said Aagaard. "It's best to get the body used to not depending on these behaviors."

Emotional and spiritual health check

A mental health check is also important, Aagaard said.

"There are many changes that people go through in their daily life as parents that will change their ability to provide a nurturing environment for their child," said Aagaard. "A woman, and her partner, need to seriously consider whether or not they are ready for this experience."

Women who have issues with depression or mental health will benefit from optimizing their emotional health to provide the best care for their child.

"These issues should not be a barrier to having children," said Aagaard. "We just want to make sure women are in the best frame of mind to accommodate the new challenges that parenting brings."

Aagaard said the decision to have children is a huge step in a woman, and her partner's life.

"There should not be a rush to have children by a certain age," said Aagaard. "We just want the mom to be ready for what is one of life's greatest—and most challenging—adventures."

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