Importance of Preconception Counselling and Care

Introduction

The journey from pregnancy to parenthood is a precious one in the lives of nearly all men and women. According to a study, pregnant women tend to be happier than their non-pregnant counterparts. However, over 40% of pregnancies worldwide are unplanned. Lack of information and medically unsupervised pregnancies can increase the chances of a failed one, challenging the health of the mother and her baby. Therefore, it becomes essential to make preconception counselling a part of primary health care for all women of reproductive ages and men.

About preconception counselling

According to the WHO, "Preconception care provides biomedical, behavioural and social health interventions to women and couples before conception occurs". Preconceptional counselling and care aim to address all the medical and social issues that can complicate pregnancy or put the baby at risk. It is essential, not only for married women but also for teenage girls, to ensure reproductive health. Ideally, a couple planning a baby should visit their doctor for preconception counselling at least three months before conception. Your doctor will look at your family and medical histories and your lifestyle. Subsequently, lifestyle and diet changes are suggested for a healthier pregnancy.

Topics of concern in preconception counselling

Preconception counselling tackles all the medical, social, and behavioural issues that can complicate pregnancy. An ideal preconception counselling and care checklist addresses the following issues:

• Nutritional status of the mother
• Use of tobacco and alcohol
• Genetic disorders running in the family tree
• Environmental issues threatening health & hygiene
• Substance abuse such as cocaine
• Presence of infections such as HIV and hepatitis that can transmit through pregnancy, and
• Social issues include female genital mutilation, violence & abuse, and mental health.

Additional genetic counselling, karyotyping, anatomical examination, and infertility diagnoses is recommended for patients with consecutive miscarriages and failure of fetuses to thrive.

Interventions

After comprehensive health checkups and investigations, preconception counselling and care questions need resolution. A couple is asked to take various steps to resolve the concerns. The significant interventions introduced via preconception counselling and care are listed below:-

• Nutritional interventions:

A low BMI or a high BMI is equally harmful to a future pregnancy. Nutritional deficiencies such as anaemia, vitamin D, and vitamin A must be corrected before pregnancy is begun and monitored throughout pregnancy. Women should avoid unpasteurized dairy, caffeine, and unwashed fruits. Supplementation of folic acid, iron, and vitamins through tablets can improve pregnancy outcomes.

• Lifestyle changes:

Preconception counselling and care checklist limit the use of alcohol and tobacco in women trying to conceive. Daily exercise should be introduced into the routine lives of women, along with cutting down on caffeine intake. Substance abuse in women addicted to illicit drugs such as cocaine and heroin should be discontinued, and rehabilitation must be provided.

• Infections & vaccines:

Maternal infections such as rubella, toxoplasmosis, HIV, and hepatitis can get transmitted to the baby in the uterus or during delivery. It can predispose the baby and the mother to health deficits. Therefore, it is essential to resolve all the untreated infectious processes in the mother. Additionally, vaccines against viruses such as varicella can be provided to prevent future infections. Preconception counselling becomes important because some vaccines can only be administered before pregnancy and avoided during pregnancy. Thus, an early visit to your doctor ensures that you are free of such life-threatening infectious processes.

• Chronic diseases:

Women with chronic diseases such as diabetes, hypertension, and asthma, among other disorders, require special care. Preconception counselling and care questions provide answers about the current management of such diseases in the patient and the future issues that can arise. Administration of glucose in diabetes and management of blood pressure via medications is essential before and during pregnancy. These diseases, when uncared for, can lead to intrauterine growth restriction, a low or high birth weight baby with varying degrees of developmental delays and mental retardation.

During preconception counselling, assessing the patient's medicines is currently used. ACE inhibitors, antibiotics, and anti-seizure medicines can lead to congenital disabilities in an unborn child. These drugs must be stopped immediately in a pregnant female, and substitution with safer options must be provided.

• Infertility & other family issues:

Mental health is as important as physical health for a successful pregnancy. A couple who is suffering from infertility issues and failure to conceive has to deal with a considerable amount of mental and social stress, which further aggravates the problem. Preconceptional counselling allows such couples to use assisted reproductive technologies such as IVF. Preconception counselling also addresses any issues of possible interpersonal violence and abuse. Ensuring a safe and happy house becomes essential for the arriving baby.

In addition to all the above interventions, preconception counselling and care also tackle diseases running in the family, endocrine disorders, and screening for cervical dysplasia and cancer.

Who should receive preconception counselling?

Preconceptional counselling and care are not only crucial for married couples but also adolescent girls. Teens should get this counselling to be better informed about methods of contraception and their rights to access abortion and prenatal care. Women of higher age (>35 years) should be informed about the high risks of genetic defects in the baby.

Conclusion

Thus, preconception counselling and care are essential to public and personal health. Access to preconception counselling is adequately provided in developed countries. Developing countries need to reboot their administrative structure to make pre-conceptional counselling services accessible. Improvements in neonatal and maternal mortality and the prevention of spontaneous abortions or miscarriages are the most significant ways preconception counselling and care can serve the population.

References

• Tydén T. (2016). Why is preconception health and care important?. NCBI
• Josephine R. Fowler; Heba Mahdy; Brian W. Jack. (2021). Preconception Health. www.ncbi.nlm.nih.gov
• Fowler JR, Mahdy H, Jack BW. (2022). Preconception Counseling. NCBI
• Semin Reprod Med. (2011). Preconception Health.www.pubmed.ncbi.nlm.nih.gov
• The American College of Obstetricians and Gynecologists. (2002). Preconception Health.www.health.ny.gov