COMMENTARY

Preconception Checklist for Women Planning Pregnancy

Sandra Adamson Fryhofer, MD

Disclosures

April 30, 2012

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Hello. I'm Dr. Sandra Fryhofer. Welcome to Medicine Matters. The topic: Preconception counseling. Here's why it matters.

A summary in Journal Watch Women's Health[1] reported that each year at least 3% of all infants born in the United States -- that's 120,000 babies -- have birth defects. In response, the Centers for Disease Control and Prevention and the Institute of Medicine have gone on record with specific preconception counseling recommendations.[2,3] More than half of all pregnancies in the United States are unplanned, which is why all women of childbearing age should take precautions.

First on the list of recommendations is folic acid. Folic acid prevents neural tube defects, which are severe defects of the brain and spine that affect more than 3000 pregnancies in the United States each year. The neural tube forms immediately after conception, before a woman knows that she is pregnant. That's why all women of childbearing age should take a multivitamin containing 400 µg of folic acid every day, even if they are not planning to become pregnant.

Next, vaccines: They are no longer just for children. Adults need them too, including pregnant women, who should get catch-up vaccines for rubella and varicella at preconception -- at least a month before trying to get pregnant. Tdap and flu vaccinations are also important and can be given during pregnancy. Flu shots at that time protect both the mother and the fetus from infection and also decrease the chances that the infant will be premature or small for gestational age. Women who receive Tdap during pregnancy pass on antibodies that protect against whooping cough in the infant. Tdap can be given to pregnant women after 20 weeks' gestation.[4]

Women with a family history of sickle cell anemia, thalassemia, Tay-Sachs disease, and cystic fibrosis should also consider genetic screening.

Healthy moms are more likely to have healthy babies, so aim for a healthy weight before getting pregnant. Obese mothers are more likely to have preeclampsia, C-sections, preterm deliveries, and stillbirths.

Women with diabetes have twice the risk of having a baby with a birth defect, so maintaining tight control of blood sugar can minimize risks for birth defects and birth trauma.

Women with hypothyroidism may need medication adjustment before trying to get pregnant, as well as during pregnancy. Be sure to check the American Thyroid Association's guidelines on managing thyroid disease during pregnancy and postpartum.[5]

Healthy lifestyles are also important: No drinking while pregnant and no smoking. It's best to stop before trying to conceive. Pregnant women who smoke are more likely to have stillbirths. Alcohol use during pregnancy affects fetal development.

The next recommendation is for physicians. Unfortunately, studies show that at least 6% of pregnant women have had exposure to teratogenic medications. So, ask yourself if a drug may be potentially teratogenic before prescribing any medication to a woman of childbearing age.

Women should also remember that fertility tends to wane as they get closer to age 35, so they shouldn't wait too long to start trying to conceive.

For Medicine Matters, I'm Dr. Sandra Fryhofer.

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