Monday, April 12, 2010

Preconception Planning

Preconception Planning

The outcome for a planned pregnancy is greatly enhanced by the planning that goes into the conception. Literature is abundant on the topic. Preconception days are optimal time to evaluate many of the factors that will affect the pregnancy and well being of that new life.

There are several environmental toxins that should be avoided even before a pregnancy is attempted. Solvents and heavy metals top the list. Radiation and even hyperthermia are contraindicated in the preconception period. Play it safe and avoid environmental toxins for 15-60 days before fertilization.

Folic acid should be a daily supplement of 400mcgs minimum and more for known histories of neural tube defects, diabetes or epilepsy and smoking.400- 1000 mcgs of folic acid and a multi-purpose vitamin supplement are the standard recommendation. Omega three fatty acids are used widely and considered optional for pre-conception. Diets rich in whole grains and dark- green, leafy vegetables are the best dietary sources of folic acid.

Exercise is always important and more so in the pre-conception period. Being fit and active promotes good mental health, cardiovascular fitness and has pay-offs in a better night’s sleep and more stamina for the pregnancy.

Have a physical examination that includes a history of immunizations and get them if they are appropriate. Hepatitis B and rubella, varicella and tetanus should be up to date and administered, if necessary, months before conception. Testing for sexually transmitted disease and a thorough discussion of family medical histories is important. Is there a history of pre-term birth or low birth weight? Are there genetic or congenital defects in the family? Is the family of an ethnicity that may require testing for thalassemias, Tay-Sachs, sickle-cell anemia, Cystic Fibrosis or neural tube defects such as Trisomy 13, 18 or 21?

There is no study that supports how much alcohol is too much alcohol so the standard is no alcohol or tobacco or recreational drugs. And some prescription medicines are contraindicated in pregnancy also. Category “B” drugs are safe, across- the- board, and your provider will review medicines with you and advise you as to which are not safe for your pregnancy and in the pre-conceptual period as well.

High blood pressure and diabetes, PKU and deep vein thrombosis, as well as seizure disorders should be evaluated and treated well before conception.

The dentist should be consulted for potential dental problems and gum disease should be treated. It can cause pre-term labor. Flossing is the first line of defense.

Cat feces are potential carriers of toxoplasmosis and should be avoided. That means gloves in the garden, even if you don’t have a cat. Titres can assess if you have an exposure already, before conception. Meat should be cooked well-done. That means no sushi or steak tartar.

Frequent hand washing is how we all try to stay well. It is important to minimize exposure to viruses and bacterial infections by simply remembering to wash your hands. All the hand sanitizers marketed today are good substitutes for soap and water.

There are factors that are sometimes over looked when discussing pre-conception counseling. But they are not to be minimized. Poverty, poor nutrition, depression and inadequate support are important factors to consider in the pre-conception period.

There are many factors to consider and to address when a pregnancy is planned. Pre-conceptual counseling makes a world of difference and a lot of sense before the pregnancy is a reality.