Preparation Strategies in Obstetrics

Preparation for pregnancy is the bridge to cost-effective health care through the reduction of medical and obstetrical complications, perinatal mortality, reduction in the incidence of certain fetal malformations, the importance of self-health management, and patient awareness of pregnancy's influence on various disease processes.

DIET: A balanced diet prior to pregnancy is sufficient; however, an additional nutrient, folic acid, should be added to the diet during the preconception period. As little as 0.4 mg of folic acid every day for one month prior to conception and for two months afterwards reduces the incidence of spinal defects (spina bifida, anencephaly). Those mothers who have had a child with these abnormalities benefit from higher doses (4mg per day) of folic acid.

LIFE-STYLE: Prepregnancy healthy life-style choices should include adequate amounts of exercise, reducing amounts of fat in diet, and avoidance of tobacco and drugs.

IMMUNIZATIONS: All patients should have documented immunity to rubella and measles. Certain at-risk patients should complete immunizations for hepatitis B.

WORK ENVIRONMENT: Exposure to toxic chemicals during pregnancy is becoming more common. Women in industrial type jobs should discuss with healthcare providers the actual chemicals with which they come in contact. Any potential affects of these agents on the fetus can be explored.

FAMILY HISTORY: Patients contemplating pregnancy should be aware of any family history of abnormalities for accurate assessment of risk. Testing of affected family members may help determine if fetal testing is possible. If parents view the risk of an abnormal child too high, adoption or artificial insemination may be an appropriate choice.

MOTHER'S HEALTH: Patients with chronic hypertension should avoid certain medications; most notably, angiotensin converting enzyme (ACE) inhibitors which can cause fetal malformations and injure the fetal kidneys. Changing to medications better studied and safer during pregnancy will reduce the fetal risk. Women with insulin diabetes mellitus benefit greatly from prepregnancy counseling. Meticulous control of blood glucose levels at the time of conception reduces the incidence of spontaneous abortion, fetal malformation and in general improves pregnancy outcomes.

Preconception counseling can prove the best path to a successful pregnancy.

Date last updated:  January 27, 2003