Prepregnancy Counseling

Definition

Prepregnancy pregnancy counseling is advice supplied by an obstetrician, nurse, certified nurse-midwife, or childbirth educator about those steps a mother-to-be and father-to-be can take in preparation for pregnancy. Basically, it is a checklist for people to see if they are living lives that are most accommodating to having a healthy pregnancy. Prepregnancy counseling gives time for one to make changes before pregnancy.

Purpose

The purpose and goal of prepregnancy counseling is to help patients have full-term, healthy pregnancies and babies. The counseling and education are important because lifestyle habits such as smoking or alcohol usage can be hazardous to a developing fetus.

Precautions

Women who have diabetes should take special precautions before pregnancy. This counseling, usually provided by a team of professionals including a registered dietitian, diabetes educators, an obstetrician, and others, helps to prevent early pregnancy loss and congenital malformations in infants of diabetic mothers.

Women who have a history of genetic disease can opt to have genetic testing. Prepregnancy counseling can include referrals to those specialists.

Women who are over 40 have higher cesarean section rates. They are also more likely than younger women to have conditions such as high blood pressure, and are more likely to have babies with genetic problems, such as Down syndrome.

Women who are considering pregnancy should avoid exposure to hazards such as chemicals, illicit drugs, alcohol, and smoking. They should reduce their caffeine intake and be careful not to let their body temperatures rise to dangerous levels.

Description

Prepregnancy counseling involves communicating important aspects about nutrition, medication use, and lifestyle months in advance of getting pregnant. Issues include diet, nutrition, exercise, smoking, alcohol, drugs, emotional health, and referral to genetic counseling if a patient knows of a history of inherited disease.

Preparation

The mother-to-be should stop using birth control pills to allow for at least two regular menstrual cycles to occur before conception. This requires that she stop taking birth control pills several months before getting pregnant.

Other steps to prepare for pregnancy include:

Being at optimal weight. Women should not go on prepregnancy weight loss diets unless they are under the care of a physician because abrupt weight loss can affect the mother's menstrual cycle and reduce fertility.

Eating a balanced diet. This is achieved by taking a prenatal vitamin provided by a health care provider and focusing on nutrients that are important for a developing fetus. These include folate, or folic acid, which is important for the development of the baby's brain and spinal cord. Folate can be found in fortified cereals, citrus fruits, and green leafy vegetables. Calcium is important for baby and mother. It helps the baby's bones to develop normally and keeps the mother from suffering a calcium deficiency during pregnancy. Iron keeps the mother from developing anemia during pregnancy. Good sources of iron are green leafy vegetables, red meat, beans, and fortified cereal. Fiber helps mothers avoid constipation, a common occurrence during pregnancy. Good sources of fiber include beans, fruits, and vegetables.

Exercising on a regular basis. One should exercise for general overall health.

Undergoing routine physical and dental exams. These include having a physical and breast examination and Pap test. Other tests might be recommended according to a woman's health and genetic history. They should also report any prescription drugs, over-the-counter medications, or natural vitamins and herbs they are taking. This is the time for a woman to make sure she is up to date on her immunizations. A dental exam, with x rays, can eliminate the need to have x rays while pregnant.

Getting psychological support. Mental support is also important in the prepregnancy stage. This can help a woman to relax and better prepare mentally and physically for what lies ahead.

Risks

About 10-15% of couples in the United States experience infertility. When couples should seek medical evaluation and an infertility work-up depends on their ages. Generally, it takes longer for older couples to conceive. Prepregnancy counseling might include a referral to such a specialist. While infertility is often treatable, treatment can be expensive, emotionally difficult, and time-consuming. About 10 percent of the time, doctors cannot detect a reason for the infertility.

There always is the risk that a pregnancy goes awry or a baby is born with a medical condition, regardless of whether or not a person has had prepregnancy counseling.

Normal results

The counseling can provide guidelines for people so that they can maximize their chances to have emotionally and physically healthy pregnancies and healthy babies.

KEY TERMS

Preeclampsia— Also called toxemia, preeclampsia is a condition during pregnancy that results in high blood pressure, swelling that doesn't go away and large amounts of protein in the urine. Without treatment, it can progress to a dangerous condition called eclampsia, in which a woman goes into convulsions.

Abnormal results

Many abnormal results, such as genetic conditions, miscarriage, preeclampsia (also known as toxemia), and preterm births, cannot be avoided even with prepregnancy counseling. Still, some abnormal results, such as miscarriages and preterm births, may occur when mothers and fathers lead unhealthy life-styles despite their counseling.

Resources

ORGANIZATIONS

"About infertility and pregnancy." Ciberdiet.com. 〈http://www.cyberdiet.com/modules/ip/reproductive_years/preparation/nutritional_health.html〉.

"General pre pregnancy guidelines." 〈http://parentsplace.com〉.

"Preconception care of women with diabetes." American Diabetes Association. 〈http://journal.diabetes.org/FullText/Supplements/DiabetesCare/Supplement100/S65.htm〉.

"Take a health inventory before pregnancy." UC Davis Health System. UC Davis Medical Center. 2315 Stockton Blvd. Sacramento, CA 95817. (916) 734-2011. 〈http:www.ucdmc.ucdavis.edu〉.

Trish Booth, M.A., LCCE, FACCE, Childbirth Educator, Educational Process Consultant. 7507 Northfield Lane. Manlius, N.Y. 13104. (315) 682-2922.