WHY IS IT IMPORTANT?:
- Offers best protection against birth weight and other poor pregnancy outcomes.
- Healthy pregnancy is closely related to a women’s health before conception. It has also been shown that preconception planning improves the chances for a healthy baby.
WHAT DOES IT INVOLVE?
- Assessing risks of the medical and non-medical factors including diabetes mellitus, hypertension, heart disease, psychiatric disorders, domestic abuse, and genetic disorders.
- It should also involve a discussion of nutrition, medications the mother is taking, exercise, smoking, alcohol and drug use, family support, and financial stability.
- The most critical time for the fetus is day 17 to 56 when organs, limbs, skeletal and central nervous systems are forming.
- The potential for exposure to environmental hazards should also be assessed. Some of these things include paint thinners, varnish removers, cat litter, and sources of radiation.
CONSIDERATIONS FOR POTENTIAL PARENTS:
- Financial responsibility including:
- Cost of prenatal care, delivery, loss of work income, cost of childcare and cost of child rearing in the future.
- Healthcare benefits: are they adequate to support maternal/infant pre-and postnatal care?
- It is advised that women planning to conceive should visit a healthcare provider at least once before conception to address some or all of the above issues.
- Vaccination status.
KNOWN HIGH RISK FACTORS FOR THE MOTHER:
- Social/Personal: Low income, poor nutrition, multi-parity, being either under or overweight, being younger than 16 or over 35, use of tobacco and/or alcohol, history of illicit drug use.
- Pre-existing Medical Conditions: diabetes, heart disease, anemia, hypertension, thyroid disease, renal disease.
- Obstetric: history of previous stillbirth or spontaneous abortions, history of C-sections, history of venereal disease.
CONTROLLABLE RISK FACTORS:
- Nutrition: ideal body weight, the expected weight gain, the importance of calcium, zinc and folic acid (as well as good sources of them), and the potential risks of vegetarianism should all be reviewed with the potential mother.
- Folic Acid: should be supplemented in all women of child bearing age, especially those who are considering becoming pregnant. The recommended dose during pregnancy is 800 to 1000 micrograms daily.
- The importance of taking pre-natal vitamins that contain both folic acid and iron should be emphasized.
- Avoid mercury!: recommended that pregnant women consume no more than 12 oz of mercury per week. Shrimp, salmon and catfish are considered to be OK. However, swordfish, shark, mackerel and other fish are known to contain high levels of mercury.
- Exposure to oral contraceptives and “over the counter (OTC)” medications: oral contraceptives have shown to have adverse effects on the fetus and exposure should be avoided if possible. OTC medications that are used to treat headaches and common colds have been shown to cause birth defects.
- Tobacco: this has been associated with spontaneous abortions, ectopic pregnancy, infant mortality and can potentially decrease fertility.
- Alcohol: no known safe level during pregnancy! It should be avoided during the entire time one is attempting to conceive, during conception and throughout pregnancy. If has been associated with malformations, slow fetal growth, fetal death, neurological defects and spontaneous abortions.
- Illicit or “street drugs”:
- Marijuana: this is the most common drug abuse. Babies born to mothers who abuse marijuana tend to be born earlier and be small for gestational age.
- Cocaine: abuse of this drug has been associated with premature birth, brain damage and placental abruption.
- Heroin: typically IV drug users and need to be evaluated for AIDS and hepatitis.
- Exercise (in moderation):
- Boosts self image, reduces tension, and decreases physical discomfort.
- Recommended forms of exercising include walking, riding a stationary bicycle or swimming. Downhill skiing, horseback riding, tennis and all other activities with any risk of traumatic injury should all be avoided.
- Medical clearance should be obtained before beginning any exercise program.
- Avoid exercising in hot/humid weather or to the point of exhaustion.
FDA PREGNANCY RISK CATEGORIES FOR DRUGS:
- USELESS!: With the exception of category D and category X, these results are relatively meaningless when it comes to humans.
- For example, category B drugs have never been tested in humans and category C drugs have shown adverse reactions in lab animals (like rats), but no human data is available either.
- These classifications were scheduled to be revised over 10 years ago.
AND FOR THE FATHERS:
- Review family medical and genetic history.
- Practice sexually transmitted disease risk reduction behaviors.
- Avoid tobacco, alcohol, illicit or street drugs.
- Assess financial status.
- Be supportive of partner.
- Play an active role in the pre-pregnancy planning.
Please feel free to reach out with questions to 919-636-5240 or you can chat online, and write us an email. CPCH is here to help you with preconception planning.
Dr. Nicola Gray,
Cognitive Psychiatry of Chapel Hill