Preconception Counseling

by Alan Copperman, MD

There are many important steps that a couple needs to take when getting ready to conceive a child. It is very important that both partners are prepared both physically and emotionally for this life-enhancing event.

The first step is to inform your regular Obstetrician/Gynecologist that you are ready to talk about getting pregnant and you would like to schedule an appointment. At the appointment, your doctor will probably have a routine set of questions and tests that they give to a couple preparing for pregnancy.

This article lists the routine questions and tests that I recommend to my patients, and offers you some background information for that first visit to the Ob/Gyn.

The Doctor Visit

The visit to your doctor should occur at least three months before you want to begin trying to get pregnant. This visit should include a full physical examination including a Pap smear and cervical cultures, as well as blood tests. These blood tests will test you for anemia, and your immunity to rubella and chicken pox. If you are not immune to one or both of these viral infections, you may need to be vaccinated. In this case, it is best to wait three months before trying to conceive.

Genetic disorders
You and your partner should also undergo genetic counseling and testing prior to becoming pregnant. Based on each partner's family history, targeted tests can be performed to find out whether a couple is at risk for having a child with certain diseases. Some examples include Tay Sach's disease, most commonly seen in those of Ashkenazi Jewish decent, sickle cell anemia, most common in African Americans, and cystic fibrosis, which is most common in Caucasians. If both husband and wife are carriers of a certain disease, there is a technique available to prevent passing on any disease to the child. The technique requires, however, that a couple go through in vitro fertilization, often a very expensive procedure. If you and your partner are both carriers of a genetic disease, it is best to discuss your pregnancy options with a genetic counselor.

Sexually transmitted diseases
Sexually transmitted diseases (STD's) can also have an effect on a woman's fertility. Your doctor should discuss your medical history with you and may decide to perform cervical cultures or blood tests to prove that there are no infections that would hinder your ability to conceive. STD's, like chlamydia, gonorrhea and genital herpes, can effect your ability to conceive by causing scarring of the fallopian tubes. Recently, mycoplasma (a type of bacteria) has been identified as an agent that may be capable of preventing couples from getting pregnant. If any of the tests are positive, antibiotics can be prescribed to kill the bacteria in both partners. It is usually recommended that a couple abstain from intercourse until the infection is completely cured.

Lifestyle

Prenatal Vitamins and Good Diet
In addition to visiting your doctor, another important step a woman should take before trying to conceive is to begin taking prenatal vitamins that provide between 400 and 800 micrograms of folic acid (most prenatal vitamins have at least this much). Studies have shown that taking prenatal vitamins, especially those with at least 400 micrograms of folic acid, can reduce the chance of having a baby with brain and spinal cord malformations called neural tube defects.

The prenatal vitamins should, of course, be supplemented with a well balanced diet. If you are anemic, vegetarian, or eat very lightly, you may need to change your eating habits as you are trying to conceive. Not having enough nutrients in your body can cause many problems as your baby develops. A woman who is anemic, for instance, may not have enough iron stores for normal red blood cell production in the fetus. Most importantly, deficient caloric intake can lead to growth retardation and a smaller fetus.