Pre-pregnancy counselling: what is it all about?

You’ve finally reached that point in your life where you feel ready to start a family; you’re

going to stop your contraception and start trying. But before you do, will you make an

appointment to see your GP?

I hope the answer is yes, and that’s not because I doubt your knowledge of how babies are

made. It’s because we know that women who are in the peak of health before they

conceive, go on to have healthier pregnancies, healthier babies and recover more quickly

and so the pre-conception period gives us the perfect opportunity to optimise certain

aspects of health.

Weight management

We know that a huge determinant of having a healthy mum and baby at the end of a

pregnancy is being of normal weight and that being overweight can lead to risks for the

woman (miscarriage, subfertility, diabetes, high blood pressure, infections and riskier

anaesthetics) and for the baby, persisting even as they grow into an adult.

We also know that more women will gain weight during their child-bearing years than will

lose weight, and that the higher their weight was to begin with, the more they are likely to

put on. Of course, this makes sense; losing weight is already so hard but add in a few

children, career, work travel, potentially juggling caring for aging parents as well, and this

makes for little time to concentrate on ourselves.

That’s why the pre-conception period, ideally before the first pregnancy, is such a golden

opportunity to implement lifestyle changes, as it’s a time when most women are especially

motivated, not just by aesthetics or their own future health (although these are completely

valid motivations in themselves), but also by getting things right for their future children.

The reverse situation can also have a negative impact on pregnancy outcomes (preterm

birth, low birthweight and stillbirth) and being underweight is more common amongst Asian

women. Again, if this is the case, we can intervene with lifestyle changes before conception

to increase weight healthily to reduce these risks.

Nutrition

Nutritional deficiencies are common, and it’s well known that most women should start a

prenatal vitamin in the preconception period or at the very least take folic acid. Some

women, depending on their medical history, require larger doses of folate however and the

important window for taking it may be before you’ve even seen your obstetrician.

Iron deficiency is very common in women in their reproductive years, often due to the slow

but sure drip of iron out of the body during menstruation (although there are other

reasons), especially in vegetarians and vegans. This can be associated with risks for the

baby and mother, during pregnancy and effect the mother’s postnatal recovery. Of course,

iron can be given during pregnancy and frequently is, but anyone that has had to deal with

the nausea of pregnancy whilst attempting to keep down sometimes unpalatable iron pills,

would probably prefer the opportunity to do this before pregnancy instead.

The same is true for vitamin D; even though we live in the sun, deficiency is still very

common and if you’re deficient, prenatal supplements are unlikely to contain enough,

adding to your tablet “burden” at a time when that may the last thing you feel like keeping

down.

Vaccinations

Some vaccinations are given during pregnancy to boost maternal immunity and allow

antibodies to be passed on to the baby. But not all vaccines are safe to be given in

pregnancy. One of those is the MMR vaccine that is used to protect against measles,

mumps and rubella. The vaccination uptake for all vaccines amongst children dropped

during the covid years, putting pregnant women and their babies at risk from an outbreak.

Rubella infection in pregnancy can have devastating consequences for the developing baby

and so we would always test women to see if they are immune to rubella in particular. If

this shows that they aren’t immune, a booster of the MMR vaccine can be given before

trying to conceive, but finding out when you are already pregnant means we would have to

wait until after the birth.

Similarly, the chicken pox virus can also be much more severe in pregnancy and have serious

consequences for the baby depending upon the gestation at the time. Whilst lots of

children will be vaccinated against varicella (depending on your location), it is not part of the

routine schedule in all countries, so there is still a risk of exposure. It is often a source of

great anxiety if a woman has an exposure to chickenpox when she is pregnant and is found

not to be immune. We can reduce the risk to the baby by giving something called

immunoglobulin but it is much easier if we know before pregnancy and can administer the

vaccine instead. Like the MMR vaccine, you would need to wait at least 4 weeks between

the last vaccine and getting pregnant, so having the time to complete the course is

important.

Medical history

This will be very dependent on each woman’s individual history but to give you an overview;

there are medical conditions and their associated treatments, that may potentially influence

the outcome of a pregnancy and having the opportunity to discuss them in detail before

pregnancy is vital. An example would be a woman with a history of depression on

antidepressants or a woman with epilepsy on antiepileptics. There are also medical

conditions that can be made worse by pregnancy in some cases, so having the time to

optimize these conditions before becoming pregnant is really useful, for example a woman

with moderate-severe asthma or pre-existing diabetes.

Please don’t worry if you find out you are pregnant unexpectedly and so haven’t managed

to fit in this step; the most important thing in that case is seeing us as soon as you know.

But given most pregnancies are planned, adding this appointment to the to-do list before

stopping your contraception, can be enormously beneficial.