Preconception Care and Counselling

• The fetal organ development occurs early in pregnancy. With most organ development including the neural tube-brain and spine-occuring in the embryonic period before 10 weeks gestation. This is why you need to start for instance,  folic acid supplementation at least 3 months before conception. Folic acid is important for neural tube development and also prevents some congenital malformations
• Most pregnancies are unplanned and you might be caught unaware and unprepared
• Some interventions can take long before reaping the benefits . For example, weight reduction may not happen overnight yet it helps to improve fertility in some cases.

There are several discussion points with different risks mentioned to optimize your health.

1. Healthy (not underweight or overweight) -physically and nutritionally. Optimized weight and nutrition serves to improve ovarian function by improving ovulation. It also helps to ensure adequate stores for different micronutrients for you and your baby when conception happens.
2. Medications. Some medications are not safe for the embryo and fetus. They are said to be teratogenic and can harm the baby once conceived and therefore need to be changed with safer ones to manage the reason for which the medications are taken -medical conditions or otherwise.
3. Excessive intake of coffee (>300mg/day) is not recommended
4. Cigarettes are a health hazard to your body. Stop smoking cigarettes or smoking other substances-bhang, heroin-name it. This includes second hand smoking These substances affect the sperm and egg quality and are also teratogenic
5. Keep your system free of alcohol since alcohol-beers/spirits/wine-is harmful to the fetus. No studies have been done to find out the safe alcohol limit for the unborn fetus and you do not want to be the guinea pig if such a study were to pass ethical approval.
6. Stress from whichever quarters has a negative impact on pregnancy. Financial stress, social stress-lack of social support, intimate partner violence and mental health concerns.
7. Folic Acid supplementation. Folic acid is a very important vitamin for neural tube development and closure which happens very early on before 6 weeks of pregnancy. You will need to build adequate stores starting 3 months before conception. About 0.4mg-0.8mg is required in patients who do not have additional requirements for folic acid. Patients who have a previous baby born with neural tube defects like spina bifida or other anomalies, those with diabetes or on antiepileptic medications, users of alcohol and other substances et cetra need up to 5mg daily doses of folic acid.
8. Chronic Medical Conditions. Patients with chronic conditions need to have the conditions optimized (well controlled) before they can conceive. Some of the conditions are high blood pressure (hypertension), diabetes, HIV, heart disease, asthma, thyroid disease, SLE, SCD.
9. Screening for various health conditions-anaemia, syphilis, HIV, Hepatitis, mental health issues such as depression and anxiety. Blood group and rhesus antigen typing is done during this visit and management of the conditions if diagnosis is confirmed. Some of the conditions can be transmitted from mother to baby.
10. Counselling on safe sexual practices like condom usage.
11. You will be asked if you are up to date with vaccinations.
12. Environmental risks include chemicals such as lead.