It is an incredibly exciting time when you decide that you’re ready to “try” for a baby whether it be naturally or through IVF. You start envisioning life differently – which room will become the nursey? What will the colour scheme be? Will you have a feeding chair that is stationary or rocks? Which pram will you decide to go with? These are all mammoth decisions; I’ve been there – the planning and dreaming starts early!!
People often get so excited with the idea of the baby (and that’s very understandable!) that they forget about the health checklist that should be ticked off before they even conceive! We call it preconception care and we know that seeing a doctor (and getting as healthy as possible) before you try to conceive leads to better pregnancy outcomes for mum and baby. Preconception consults are 1 of my favourites– I’m passionate about this stuff; to think we can improve the trajectory of a baby’s health both inside and outside the womb is amazing.
Here is my checklist – if you’re thinking about pregnancy (even kind of) then this is for you. It’s not exhaustive; what every woman needs pre-pregnancy is different according to her medical and family history (particularly of genetic conditions).
- Are you as healthy as you can be?
I cover loads in preconception consults with my patients. Blood pressure, weight and BMI are a start– are you overweight or obese and do you need to try and lose some weight before you conceive? Even just 5-10% of your body weight? We know obesity can be dangerous in pregnancy and that if an obese woman can lose weight before she conceives she can reduce risk of complications for herself and her child. Having said that, being underweight also carries risks – actually getting pregnant can be harder. If you are underweight and not having regular menstrual cycles then discussing some weight gain pre-pregnancy to regulate the menstrual cycle might be a factor.
Do you have asthma, thyroid disease, diabetes or any medical condition that needs to be controlled carefully before you conceive to improve baby’s chances of a normal development? Common conditions like asthma can go haywire in pregnancy. It is worth making sure firstly, you are on safe medications for your asthma in case you get pregnant and secondly, that you are well controlled. Poorly controlled asthma (I’m talking lots of symptoms and Ventolin use) can have any negative impacts such as affecting the growth of the baby. Talking about medical conditions – mental well-being is equally important. If you suffer from depression or anxiety is it as well controlled as it can be? And if you are on medication is it safe in case you do get pregnant?
Are you using over the counter medications that should be avoided when pregnant? You won’t know unless you check! Lots of non-pregnancy supplements contain Vitamin A which can be harmful. I often discuss with patients stopping some supplements or changing some of their regular prescribed medications so that everything they are on is deemed safe for pregnancy. By the time you get pregnant and come in to the doctor cells have already started rapidly dividing in the embryo and unsafe medications may have had an impact – this is why we try to make the changes before conception.
There are now also genetic carrier tests we can offer for women and their partners pre-pregnancy (these do cost money and are not currently government funded) – are you a carrier of cystic fibrosis, spinal muscle atrophy or fragile X syndrome? Is your partner? We can now test to see if you or your partner are carriers for certain genetic conditions which means you can assess what the baby’s risk might be if you were to conceive. Ideally tests like this should be done before pregnancy so you can plan if you and your partner are carriers for a condition (it means the baby is more likely to be affected).
- Are your vaccinations up to date?
If you come in and tell me you are planning a pregnancy I will always order blood tests. There are certain standard tests every woman gets like rubella antibodies, syphilis antibodies and HIV antibodies to name a few. We test everyone for these things – it is routine. The rubella test is an important one – rubella infection in pregnancy can have devastating consequences for the baby if they are also infected – vision and hearing problems as well as serious development issues. Most women are immune thanks to vaccination BUT if you’re not we ideally vaccinate you before you conceive to make sure you and your baby are protected. The rubella vaccine (MMR) is a live vaccine so pregnancy needs to be avoided for 28 days after and we cannot give the vaccination during pregnancy. We also check you’re up to date with vaccinations like Tetanus, hepatitis B and the flu vaccine.
- Are you taking the right supplements?
The recommendation in Australia is that every woman take 400mcg of folic acid and 150mcg of iodine 4 weeks prior to conceiving and ideally for the first trimester (at least). Folic acid can reduce the risk of neural tube defects like spina bifida and iodine is crucial for baby’s brain development. Some women need higher doses of folic acid (obese women and diabetic patients are 2 examples) and you won’t know if you fall into that group unless you see your doctor beforehand! Iron, vitamin B12, vitamin D – not all women planning pregnancy need these, but some do – it’s worth finding out!
- Are you covered?
This might sound boring but worth thinking about trust me. If you have a baby where would you have it? Which public hospital’s catchment area do you fall into and are you happy to go there? If not, do you have private health insurance so you can choose your obstetrician and hospital? If you decide to get private health insurance – are you immediately covered for pregnancy or is there a waiting time? These are the types of things you want to ideally have sorted before you get pregnant!
- Are you ACTUALLY ready for this?
Again, no one really wants to talk about this stuff. I raise with women the nitty gritty stuff that we know is important but no one wants to talk about. Family violence is common – far more common that what you realise I suspect. Women exposed to family violence in pregnancy have higher rates of miscarriage. So this is why I try to ask women BEFORE they conceive “do you feel safe at home?”
So there you have it – the general checklist; like I said not exhaustive because it depends on every woman’s personal history. I know my health check list isn’t as exciting as deciding on wallpaper in the nursery or names – but I can assure you it is vital. Plan ahead, get as healthy as you can- the aim is to do everything you can to improve your (and your future baby’s) chances of a healthy successful pregnancy!