Preconception Medical Exams

Preconception medical care is becoming evermore popular among doctors and women considering pregnancy. Preconception medical care and exams encourage optimal health for the future mother and father at the time of conception. They serve to prepare women physically and mentally for pregnancy. There are numerous benefits to the use of preconception exams. The exams are designed to allow the mother's doctor to evaluate her overall health, identify serious potential and existent problems, provide the necessary treatment before conception, and make various suggestions as to how her lifestyle should change in order to best prepare her body for pregnancy. The exam also allows the mother's physician to ensure that she is immune to certain infections such as rubella, and get any chronic long-term medical conditions under control as a safeguard for the baby's health. Often, chronic conditions that had been controlled easily for years require special management during pregnancy because the extra stress and changes in the mother's body cause them to flare.

As mentioned previously, it is recommended by many health care providers that the mother take at least six months prior to attempting to conceive in order to make modifications to her health and lifestyle. Having a preconception medical exam is the first step in this preparation process. During a preconception exam the mother's doctor will ask the mother numerous questions regarding a wide array of topics. It is best that the mother answer these inquiries honestly and openly to ensure that her physician has all the necessary information needed to guide the mother to a healthy and successful pregnancy. It is also important that the mother's partner attend this exam when possible. The preconception visit will likely include the following:

Detailed Medical History

If he is not already aware, the mother's physician will enquire about her past medical history. Particular attention will be paid to any existing medical conditions such as asthma, kidney disease, and allergies. It is important that these conditions are safely under control before conception to ensure the health of both the mother and fetus.

Detailed Reproductive History

The mother's physician will inquire about previous pregnancies (their outcomes, complications, and progress), what types of contraceptives the mother has, previous pap smear results, previous sexually transmitted diseases and vaginal infections, and her menstrual cycle. All of these must be answered honestly and openly as it is vital to the health of the mother's pregnancy.

Family Health History

The mother's physician will inquire about the familial health of both she and her partner to assess the possibilities of risk to the mother and the baby during pregnancy. Many conditions are genetic and when serious enough could pose great problems and may jeopardize any future pregnancy. The mother must be upfront with any family history of hypertension, diabetes, anemia, Tay-Sachs disease, mental retardation, twins, deafness, blindness, congenital birth defects, and miscarriages. This questioning may lead the mother's doctor to recommend genetic counseling which is used to determine the chances of a baby being born with a certain defect or genetic trait or disease. Genetic counseling will be discussed later in this section.

Current Medications and Acute Illnesses

It is vital that the mother make her physician aware of any over-the-counter and prescription medication that she is currently on, and the reason for such medication. Also any enduring and untreated ailments should be discussed. This line of questioning helps the mother's physician identify any medications that may be harmful to her baby and any conditions that must be dealt with prior to conception.

Surgical and Procedural History

The mother should make known to her physician any previous surgical and medical procedures that she has had. This should include blood transfusions, hospitalizations, and clinical procedures.

Lifestyle: Diet and Exercise

The mother's physician will make some very important inquiries regarding the lifestyles of herself and her partner to determine whether any alterations are required. The physician will question the mother on her use of alcohol, tobacco, and illicit drugs - all of which are detrimental to a healthy pregnancy and will require cessation.

The mother's diet will also be brought into question. As mentioned previously, the mother will be the baby's only source of nutrition and as such she must ensure that she is consuming a balanced and proper diet that contains all of the nutrients and minerals that are essential to the growth and development of a healthy fetus. Most times small alterations of diet are needed. These alterations however can be difficult which is why starting months in advance is ideal. This allows the mother time to slowly change her dietary habits and to build up the necessary levels of vitamins in her body. The mother's doctor will recommend that she eliminate intake of caffeine completely or reduce consumption to no more than 2 cups of coffee a day (approximately 300mg per day regardless of the source). It may also be suggested that the mother begin taking a daily multivitamin that contains folic acid, which is essential to the neural development of a fetus and is difficult to obtain through dietary measures.

The mother's physician will also question the mother on her exercise routine and suggest some alterations that will help her body begin preparation for the rigors of pregnancy and labor. If exercise is not already done on a regular basis, the mother's doctor will recommend that she start doing so.

Weight

Discussions of exercise and diet tend to lead to a measurement and assessment of the mother's weight. It is strongly recommended that the mother be as close to her ideal weight as possible before conception. The reasons for this are multiple. Firstly, the mother's weight is often a reflection of the baby's weight. Secondly, overweight women tend to have a much more difficult time during pregnancy and labor. They are also at risk of suffering the effects of high blood pressure during pregnancy which can be dangerous to their health. The stress on the body becomes much greater than what it usually is. Thirdly, underweight women tend to give birth to under weight babies.

Environmental and Workplace Conditions

Finally, the mother's doctor is likely to enquire about the mother's living and working conditions and environment. This will help the physician identify any necessary precautions and changes that will be required to ensure the mother and the baby are safe.

Depending on the results of the medical survey the mother has been given and her age, she may also be subjected to various testing. These tests will seek to find any conditions that the mother's doctor may have over looked or suspected were present. Some of the testing she may encounter at a preconception visit include:

Urine testing
Blood chemistries and screen for various conditions and STD's
Complete blood count
Blood pressure
Pap smear
Chest x-ray for non-pregnancy smokers over the age of 30
Mammogram if you are over 35
Colon cancer screening if you have a family history of the disease

Other tests may be planned if warranted by the mother's family medical history. Personal risk factors that point to the possibility of heart disease, diabetes, cancer, and osteoporosis all call for further examinations. It should be understood that a great deal of this exam will be focused on the mother's sexual history, her menstrual history and health, and her gynecological history. Although it may be difficult to discuss such intimate details with a doctor, especially if he is a male or the mother is unfamiliar with them, she must ensure that she is open and honest. This information could mean the difference between a successful, healthy pregnancy, and a devastating loss.

In addition to the lifestyle alterations that the mother's doctor will no doubt recommend, some valuable additional advice will also be provided. If testing or treatment is being administered to the mother for various illnesses, it is best to wait until after these procedures to cease use of contraceptives and attempt conception. If for some reason one is scheduled for an x-ray, MRI or other radiation related exam, one should ensure that one is administered a pregnancy test prior to exposure to radiation which can be harmful to an embryo and fetus in the early stages of development. Also, most doctors recommend that once discontinuing the use of hormone based contraceptives, the mother use an alternative form of contraception such as condoms or a diaphragm for at least three months or three full and regular menstrual cylces. This allows the mother's body to return to its natural levels of functioning, making it easier to conceive in cases and easier to determine if she is pregnant.

Pregnancy Preparation Checklist

Schedule preconception and prenatal medical examinations
Consider how pregnancy will affect the mother's future plans and goals in relation to her education, career, travel, marriage, etc.
Stop smoking, drinking, and using illicit drugs
Achieve ideal weight
Start a regular exercise routine

Genetic Counseling

If after having her preconception medical exam, the mother's doctor feels that the medical and family history of either or both she and her partner warrants greater investigation and concern, it may be suggested that the advice of a genetic counselor is sought. Genetic counseling is aimed at helping the mother and her partner make an informed decision regarding childbearing. It is designed to determine the risk of passing on an inheritable genetic trait to offspring.

During a genetic counseling session the mother and her partner will be asked to discuss personal and familial medical histories in detail. It is important that each share as much information as possible. It may be requested that birth and death certificates from family members or other pieces of information that may be of help are brought. The entire process can be long and involved, so be sure that each partner is willing and ready to put in the necessary time and cooperation.

Once the genetic counselor has finished, they will inform the mother of her chances of having a child that is born with a certain genetic trait, and will then help guide the mother in making an informed decision regarding whether or not to conceive. They may also suggest further medical exams such as blood work in order for them to be able to create a better estimate of the probabilities. The ultimate goal is early diagnosis and prevention. It should be noted however, that not all diseases, defects and disabilities are genetic in origin. Other factors do play a significant role. Thus, even when it is said that the probability of having a child with a certain condition is low, other problems and complications could still be present.

Genetic counseling is recommended when:

Partner (father) is at least 40 years old
The mother is 35 years old or above
Partners are of African-American or Ashkenazi Jew descent. These groups are predisposed to carrying sickle-cell anemia and Tay-Sachs disease, respectively.
One has previously delivered a child with a birth defect
Either partner has a birth defect
One has had recurrent miscarriages
Either partner has family histories of Down syndrome, mental retardation, muscular dystrophy, spina bifida, epilepsy, dwarfism, cystic fibrosis, blindness, deafness, congenital heart defects
Partners are related

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