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Preconception Care and the Future of Pregnancy Outcomes

August 3, 2018
Katie Visco

A lot of care regarding fertility and pregnancy happens around the time a woman expresses interest in being pregnant. Preconception care (PCC) is a new kind of care that could change pregnancy outcomes by preparing a woman’s body before she conceives. The Australian Journal of General Practice explores how implementing PCC will increase maternal and child health.

  • What is PCC
  • What factors affect maternal and child health
  • Implementing PCC

What is PCC?

PCC is the practice of assessing the health of partners prior to pregnancy to optimize health behaviors and increase the chance of a healthy pregnancy. This could manifest itself as planning, counseling, and adjusting in order to improve lifestyle and overall health.

Often, women do not approach their doctors until they are pregnant or are struggling to conceive. The time before beginning a pregnancy journey is important because poor maternal health and diet prior to conception has implications for the entire pregnancy.

The intrauterine environment affects child healthy immensely, so having an unhealthy lifestyle directly affects fertility and pregnancy.

Poor maternal health does not just affect a pregnancy, it also affects the overall lifetime health of a child. This theory, known as the developmental origins of health and disease (DOHAD), supports the implementation of PCC because improving maternal health prior to conception will increase the health of overall populations.

Factors Affecting Maternal and Child Health

Most factors that can be addressed during PCC are focused on improving overall health. Improving these factors increases the ability to breastfeed and decreases neonatal deaths.

Folic Acid

Adding folic acid to your diet during PCC has been proven to decrease the occurrence of neural tube defects (NTDs). Studies have shown that taking folic acid prior to conception prevents up to 50% of NTDs. NTDs include spina bifida and anencephaly.  

Obesity

A 10% decrease in pre-conception BMI has been shown to decrease preeclampsia, gestational diabetes, and stillbirth by 10%.

Diabetes

Control of blood glucose levels before conception, especially for mothers with type I or II diabetes, has been shown to decrease the incidence of congenital malformations, miscarriage, and preterm birth.

Implementing PCC

PCC can happen in many forms. Some involve direct lifestyle changes, while others need more medical intervention.

Reproductive Planning

Discussing plans to get pregnant is an important part of PCC. This is beneficial for a variety of reasons. First and foremost, discussing your pregnancy plans with a doctor ensures you are screened for any potential pregnancy risk factors before conception.

This gives people a chance to change their lifestyle in preparation for conception rather than after it has occurred. As discussed above, shifting certain lifestyle factors before a pregnancy could have effects that last a lifetime.

Reproductive planning is also important because physicians recommend at least 2 to 5 years between pregnancies. Discussing plans ahead of time ensures that the right measures, such as contraception, are taken.

Exploring Pregnancy History

Looking at past pregnancies could help determine the health of future pregnancies. For mothers who have already given birth once, PCC could focus on their past pregnancy experiences to improve their future pregnancies.

Preterm births, NTDs, and gestational diabetes in previous pregnancies could be used to improve later pregnancies. This can be done by increasing surveillance, monitoring blood glucose, and increasing folic acid dosage before another pregnancy.

Overall, exploring pregnancy history is a tool for improving subsequent pregnancies with very personal experiences.

Assessing Medical Conditions

Assessing medical conditions and medications before conception will minimize the chance of complications during a pregnancy. Conditions that especially affect pregnancy are hypertension, diabetes, epilepsy, cardiac disease, and autoimmune disorders.

People with chronic health conditions should work closely with their doctors to ensure their condition is stabilized prior to conception. Communication among your various doctors and specialists is also a vital part before and during pregnancy.

Reviewing medications taken for chronic and short term reasons is also essential since certain medications can affect hormones, fertility, or overall health.

STI and Disease Screening

Screening for measles, mumps, and other preventable disease ensures you have immunity against common illnesses. If you have been recently vaccinated, it is recommended you wait at least 28 days before trying to conceive.

Checking for STIs in both partners ensures there are no underlying issues affecting conception. Women should also undergo HPV screening every five years.

Making Lifestyle Changes

Diet, weight, exercise, and substance use all affect fertility and conception. Making lifestyle changes before conceiving could have substantial effects on your health and pregnancy health.

Preconception care could become a bigger part of pregnancy health, and it could have great implications for future health outcomes.

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