Your Preconception Visit

Pregnancy is a major event. If you plan for it, you can make wise decisions that will benefit both your health and that of your baby. Good health before pregnancy can help you cope with the stress of pregnancy, labor, and delivery. It can also help ensure that neither you nor your baby is exposed to things that could be harmful during pregnancy. Getting good health care before you become pregnant--sometimes called preconceptional care--will help you throughout your pregnancy. It also provides a chance to find any risks and treat any medical problems you may have.

Many women do not know they are pregnant until several weeks after they have conceived. These early weeks are some of the most crucial ones for the fetus--the baby growing inside you during pregnancy. It is during this time that the organs are formed. Certain substances such as cigarettes, alcohol, and some medications can interfere with normal growth, whereas healthy habits can help promote it. Preconceptional care can guide you in planning a healthy pregnancy.

Planning Your Pregnancy
If you are planning to become pregnant, you may wish to schedule a preconceptional visit with your health care provider. As part of your visit, you will be asked questions about your family and medical history, medications you take, your diet and life style, and any past pregnancies. Your answers should be honest and open because they will help show whether you could need special care during pregnancy.

Your preconceptional visit is a time for you to ask questions. Don't hesitate to seek advice or discuss any concerns you might have. Your health care team is there to give information and guidance.

Family History
Some conditions occur more often in families. If a close member of your family has a history of a disorder, you may be at greater risk of having it, too. For example, you may be asked whether any member of your family has ever had diabetes, hypertension (high blood pressure), epilepsy (seizures), or mental retardation. You also may be asked if anyone in your family has a history of twin pregnancies.

Certain disorders can be inherited. These are called genetic disorders. Based on your age or family history, you may be advised to see a genetic counselor--someone with special training in inherited disorders. Genetic counseling can help couples be aware of their chances of having a child with an inherited disorder. It can also help pinpoint a pattern of inherited disorders, if one exists. Genetic counseling involves a detailed family history and sometimes a physical exam along with lab tests. Some genetic disorders can be detected by testing before you are pregnant.

Medical History
Some women have medical conditions, such as diabetes, high blood pressure, and epilepsy, that call for special care during pregnancy. The condition may be an illness you had before pregnancy. Because pregnancy puts new demands on your body, a health problem that is normally under control can change while you are pregnant. If you have certain medical conditions, they should be brought under control before you become pregnant. They may require you to see your doctor more often or get other special care. Changes in your life style may also be necessary.

You can download a Prenatal Medical History Form to complete and bring with you to your preconception visit.

Questions you may be asked about your medical history include:

• Do you have diabetes, high blood pressure, or epilepsy? If so, when did it begin?
• Are you or have you ever been anemic? If so, for how long?
• How old were you when you had your first menstrual period?
• Have you ever had surgery? If so, what type?
• What type of birth control do you use?
• Have you had any accidents? What type?
• Do you have any allergies?

Genetic Disorders

The following diseases are inherited and, in some cases, can be detected before you are pregnant:

• Thalassemia
• Tay-Sachs disease
• Sickle cell disease
• Hemophilia
• Muscular dystrophy
• Cystic fibrosis
• Huntington chores
• Fragile X (mental retardation)

This list changes as new information on how disorders are inherited is obtained.

You can download the list of Prenatal Screening Questions to complete and bring with you to your preconception visit.

Past Pregnancies
Another part of preconceptional care is a review of your obstetric history. You will be asked about any previous pregnancies and if you had any complications.

If you had a problem in a past pregnancy, that doesn't mean the problem will recur or that you shouldn't try to get pregnant again. Some problems recur, but most do not. Previous problems can be a sign that you may need special attention before and during your current pregnancy.

Some women worry that they will have trouble having a baby if they have had a miscarriage. One in five women who become pregnant are known to have a miscarriage at some point in that pregnancy, and many more that are not detected are thought to occur. Most of these women go on to have normal pregnancies the next time they conceive. A few women have recurrent miscarriages (three or more pregnancy losses in a row). Most likely, though, if you have one miscarriage you will not have others and will be able to have a normal, healthy baby.

Most doctors agree that having a previous pregnancy terminated (induced abortion) does not make it harder to get pregnant again, nor will it affect the outcome of a future pregnancy. However, not much is known about the risk for women who have had more than one abortion. It is possible that more than one abortion might increase the risk for a low birth weight or a preterm baby.

Medications
You will be asked about any medications you are taking, including those bought over the counter (such as aspirin, antihistamines, and diet pills). Some medications could affect your fetus and should not be taken while you're pregnant. For example, a prescription medication for acne called isotretinoin can cause birth defects, and medications for high blood pressure called ACE inhibitors can cause kidney problems in the fetus. If you're taking certain medications, you may need to switch to others before you try to get pregnant. You will also be asked if you're still taking birth control pills. It's a good idea to take any medications you are using with you to the preconceptional visit.

Stopping Birth Control
Women who are planning pregnancy should stop using birth control sever months in advance. Although methods vary, it can take a while for periods to resume and become regular. Because some methods are more effective than others, pregnancy can occur while a woman is using birth control. In most cases this does not pose a problem, although a woman should contact her doctor if she could be pregnant.

The birth control pill, or oral contraception, is the birth control method most commonly used by women. When you stop using birth control pills, your menstrual periods may be irregular for a while. This can make it hard to detect your fertile times, which means it may take longer for you to get pregnant. Irregular periods can also make it hard to tell your due date whe you become pregnant. Using birth control pills before you become pregnant does not cause birth defects, no matter how close to conception you use them.

Other forms of hormonal birth control, such as implants and injections may also cause a delay in getting pregnant. If you are using implants and want to become pregnant, have your doctor remove them.

If you have been using an intrauterine device (IUD) to prevent pregnancy, you should have it removed before you try to conceive The IUD works by preventing sperm from fertilizing the egg. Even so, pregnancy ca occur with an IUD in place. If this happens, your doctor should remove the device right away because the presence of an IUD during pregnancy is linked with infections and miscarriage.

Questions you may be asked about other medications include:

• Do you take sedatives or tranquilizers?
• Do you use illegal drugs?
• Do you drink alcohol? This includes beer and wine.
• Do you smoke? How many packs a day?

Source: Patient education material from the American College of Obstetrics and Gynecology was used as a source of information to develop the content for this topic.

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