Planning a pregnancy? Congratulations! Having decided to embark on expanding your family is a BIG decision and an important first step in what could be the most incredible journey.
This time before you conceive is called the preconception period. It would be prudent to meet a gynecologist at this time as this is a golden window of opportunity when we doctors can intervene to reduce the risks to the would-be mother and baby. This pre-pregnancy assessment and advice is also relevant to men as their lifestyle and health may also affect the pregnancy. Hence, we're happier to see the couple together for this session!
History
Your gynecologist would begin by asking you a few questions. This would include details of any pregnancies that you have had before. Their course, any complications during pregnancy, mode of delivery (normal or caesarean), post delivery problems - all may have a bearing on planning care in the future pregnancy. Details of your menstrual cycle would indicate if you may need help in conceiving.
Lifestyle
She would assess your lifestyle with particular reference to smoking, alcohol intake, weight issues (over or underweight) and any drug use. The harmful effects of smoking, alcohol and drugs are well known to most of us. These have especially been proven to be very hazardous in pregnancy, causing miscarriage, birth defects, growth problems in the baby, premature delivery, and even termination of pregnancy in some cases. This is a good time to stop. Seek help if you need to.
Obesity
Planning a pregnancy is a big motivation to achieve ideal or near ideal body weight. Being over or severely underweight can both cause difficulty in conceiving and several pregnancy related complications. Obesity in particular, may cause delay in conceiving and increases the risk of miscarriage, birth defects, diabetes in pregnancy. It reduces the chance of having a normal delivery and also complicates recovery.
Viral infections
Certain viral diseases like chickenpox and rubella (German measles) can be disastrous during pregnancy. The doctor will assess immunity to these and vaccinate you if required.
Pre-existing illnesses
Any diseases that you may be suffering from such as diabetes, high blood pressure, asthma, epilepsy, thyroid disorders etc. will be considered. A multidisciplinary approach (involving an obstetrician/gynecologist, relevant physicians, dietician, counsellor etc.) with an agreed documented plan in place for when you get pregnant would be wise and comfortable for all. Any relevant condition in the family will be discussed such as any genetic diseases, thalassemia, twins, or other medical disorders like diabetes, hypertension, thyroid disorders etc. if required, a genetic counselling session may be arranged with a clinical geneticist for certain special situations.
Dental health
A thorough dental check up is recommended. If there are any issues that need attention such as cavities etc., these are best tackled before pregnancy so as to minimize risks. Any dental procedure in pregnancy can cause entry of germs of the mouth into the blood stream. Depending on the stage of pregnancy, it may lead to complications such as miscarriage, preterm labour and sepsis.
Preconception tests
You will be advised certain tests like blood group and Rh factor, hemogram, viral markers (HIV, HBsAg, anti HCV), rubella IgG, HPLC (thalassemia screen), fasting blood sugar, thyroid profile, and urine - routine. The tests may be customized depending upon your history and health and you will need to review with the doctor once their results are in.
You should share with your doctor any and every concern you may have regarding your future pregnancy. This time usually fosters a relationship of trust and care that ensures a more comfortable understanding during pregnancy.
Happy pregnancy to you!