Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Preconceptual Counseling

With a small amount of pre-pregnancy planning, many potential complications in pregnancy can be avoided. For this reason, women who are contemplating pregnancy over the next year should take the opportunity to prepare for pregnancy. Some preparation may require major lifestyle modifications that may take time but can have a major impact on the outcome of the pregnancy. For example, women who smoke should quit smoking prior to conception. There is very strong evidence that smoking tobacco is associated with many complications in pregnancy. Women with coexisting chronic medical conditions such as high blood pressure, thyroid disorders, asthma, or diabetes should make certain that they have good control of the disease process and that their current medications are safe.

There are also some lifestyle changes that even healthy women with no medical illnesses should make. For example, all women should begin a folic acid supplement with 400 micrograms (0.4 milligrams) of folic acid prior to conception. Folic acid has been shown to reduce the development of defects of the spine such as spina bifida. The spine is formed by 6 weeks after the last period or before many women realize they are pregnant. Folic acid may be taken as a solitary supplement or in the form of a prenatal vitamin. Vitamins not designed for women or pregnancy may have levels of vitamin A that are too high and may be unsafe. Avoid supplements with more than 10,000 IU of vitamin A during pregnancy. High levels of vitamin A may be associated with birth defects.

Though exposure to communicable disease may not be preventable, there are some vaccines that are available to women before conception. For example, women who have not had chicken pox and have not received the vaccine should be immunized while using contraception. Similarly, all women should be screened for immunity to Rubella (German measles) and immunized while using contraception. All women should also be tested for hepatitis B and immunized if possible. There are some infections that women may be exposed to but no vaccine is available. In this case, women can be tested for immunity. If a woman is immune to the infection then there is no risk if she is exposed to the disease. If she is not immune, than lifestyle changes can be made to reduce the chance of infection. A good example is toxoplasmosis. Toxoplasmosis is an organism that may be found in raw or undercooked meat, soil, or cat feces. The infection is rare enough that it is not currently recommended to screen all women. Since cats can become a host for the organism, cat owners may be at slightly increased risk and should be screened for immunity. Women who are not immune should then avoid contact with cat feces such as while changing the litter box. As the organism can be found in raw meat and soil, all pregnant women should avoid eating raw meat, practice good hand washing while handling raw meat, and wear gloves while gardening.

Pregnancy is a very natural part of a lifetime and should be a low stress and beautiful event in our lives. Meeting with the obstetrician prior to pregnancy allows for screening for risk factors, lifestyle modifications, and immunization. It also allows for development of a plan for observation and treatment if risk factors are present.