Pre-Conception Counseling Can Be Key to a Healthy Pregnancy
Jennifer Williams, MD, MHSA
For women who have a high risk of complications during pregnancy, pre-conception counseling can lead to interventions that can significantly reduce complications and improve the health of the baby and the mother. Unfortunately, all too often, we don’t see our high-risk patients until they are 8 or 10 weeks into their pregnancies. That’s often too late to prevent some very serious complications.
As a Maternal-Fetal Medicine specialist, I provide obstetric care to women who have a high risk of complications during pregnancy. I always advise women to consider pre-conception counseling. Primary care physicians are usually very good about referring their high-risk patients to us when they know a woman is planning to conceive. But what about the women who don’t inform their primary care physicians that they are planning to have a baby? For this reason, it’s important for women to be their own health advocates. If you are at a high risk of pregnancy complications due to a known medical condition, you should plan to have pre-conception counseling before you start trying to get pregnant. This crucial step provides the opportunity to get concerns of your medical condition under control well before attempting to conceive.
Who is at High Risk of Complications? When I think about risk factors for pregnancy complications, I usually categorize them into two groups: maternal risk factors and obstetrical risk factors. Maternal risk factors include things like advanced age of the mother and serious (but common) medical conditions, including:
- High blood pressure
- Asthma
- Type I or II diabetes
- Lupus
- Thyroid disease
- Obesity
Obstetrical risk factors include things like fetal abnormalities or growth concerns, pregnancies of twins or triplets, recurrent miscarriages and recurrent abruption. Abruption is when the placenta separates from the side of the uterus. Clearly some of these obstetrical risk factors are not known until after conception, but maternal risk factors and certain obstetric risk factors (like a history of recurrent losses) are usually known before conception and are good reasons to seek out pre-conception counseling.
What Happens During Pre-Conception Counseling? For women with serious medical conditions, the pre-conception counseling session gives us a chance to optimize their health before they conceive. This is extremely important for the health of the baby.
Every counseling session is different; it all depends on the woman and her specific medical conditions. For the woman with Type II diabetes that I mentioned earlier, we discuss blood sugar control, weight loss/exercise and nutrition. A woman with pre-gestational diabetes will always be at a higher risk of complications, but optimizing these things pre-conceptually reduces that risk.
In other situations, we might want to achieve a very different set of targets before conception. For a woman with high blood pressure, we might identify a target blood pressure to achieve. For a woman with lupus or thyroid disease, we’d want to make sure those diseases are properly controlled prior to conception. In some cases, we might want a patient to stop taking certain medications that could be harmful to a baby.
Every situation is different, but there’s almost always something we can do to optimize a high-risk patient’s health before conception. Even in the healthy patient, a counseling session to discuss ongoing maintenance of health while pregnant can be a great benefit.
Jennifer Williams, MD, MHSA, is board-certified in obstetrics & gynecology with sub-specialty training in Maternal-Fetal Medicine. She is particularly interested in multiple gestations, maternal medical disorders during pregnancy and pre-conception/genetic counseling. She practices at IHA Maternal-Fetal Medicine at 4990 W. Clark Rd., Suite 100, Ypsilanti, MI 48197. She can be reached at 734.528.9125. For more information please visit www.ihacares.com.