Seeing your GP 6-12 months before you even conceive can significantly change pregnancy outcomes for both Mum and baby. Preconception care consults are one of my favourites as a GP – I get terribly excited about the window of opportunity I am granted to intervene and change outcomes for a mother and the next generation. There is the concept of the first 1000 days which includes the time from conception (the sperm and egg meeting) to when a child is 2; in that period the child is adaptable and sensitive to the environment (the womb and the outside world after birth) they are surrounded by. Simple things like a woman’s nutritional status before she conceives and how well managed her medical conditions like asthma are, can impact on a child’s development.
Here’s the preconception consult broken down and the things we try and cover:
- Medications – we want to know what you are taking both over the counter and prescribed. We try and avoid some medications during pregnancy and identifying them before conception occurs can reduce the risk of harm. Some medications used to treat epilepsy and high blood pressure need to be avoided in pregnancy, so we try and make changes to reduce the risk of congenital malformations in the foetus. Lots of my patients don’t realise that their skin care products can be harmful in pregnancy if they contain Vitamin A derivatives. Reviewing all medications and skin products preconception is critical.
- Supplements – in Australia the recommendation is that every woman ideally take a supplement containing at least 400mcg of folic acid and 150mcg iodine daily 4 weeks prior to conception and for the first trimester. Some women, like those with type 1 or 2 diabetes, require higher doses of folic acid (often 5mg). The folic acid reduces the risk of neural tube defects (like spina bifida) and iodine is critical for baby’s brain and thyroid development. Some women may require additional supplementation with Vitamin D, Vitamin B12 and iron.
- Blood tests – we do a whole range of blood tests ideally before you conceive. For instance, we check if you are immune to rubella (AKA German measles) and varicella (AKA chicken pox). If we can pick up on things before conception, then we can intervene before pregnancy to improve outcomes.
- Genetic carrier screening – this is a blood or saliva test we offer to all women preconception or during early pregnancy. This is a test that can determine if you are a carrier for certain genetic conditions, like spinal muscle atrophy, Fragile X syndrome and cystic fibrosis, which could impact your child.
- Medical conditions – we ideally want to get you as healthy as possible before you conceive. This means looking at any pre-existing conditions like asthma, depression, anxiety, diabetes to see if we can optimise the condition to reduce the risk of complications during pregnancy.
- Lifestyle tips – we ask about physical activity, alcohol intake, smoking and try and bump up the good stuff (like exercise!) and reduce things like alcohol intake, if possible, to reduce risk.
- Diet – if a woman is getting all the nutritional building blocks from her diet it can improve pregnancy outcomes. Things like zinc, iron, Vitamin B12 are critical. Blood tests help us determine if additional supplementation is required but getting to know a patient’s diet preconception can allow some little tweaks (I might say – “let’s try and aim for some more iron rich foods like eggs”) to occur before pregnancy.
As you can see there is a lot to cover before conception even occurs! That preconception consult can change the health trajectory for a pregnancy, for a mother, for her baby. If you are thinking about pregnancy in the next year – now is the time to book an appointment with your GP!