Pre-conception counseling

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Pre-conception counseling is based on the medical theory that all women of child-bearing years should be pre-screened for health and risk potentials before attempting to be pregnant. Physicians and baby experts recommend that a woman visit her physician as soon as the woman is contemplating having a child, and optimally around 3 to 6 months before actual attempts are made to conceive. This time frame allows a woman to better prepare her body for successful conception (fertilization / fertilization) and pregnancy, and allows her to reduce any health risks which are within her control. Agencies such as the March of Dimes [1] have developed screening(medical) tools that physicians can use with their patients [the March of Dimes web site has a PDF file which can be opened and viewed.] In addition, obstetricians (see Obstetrics and General Practitioner)have developed comprehensive check-lists and assessments for the woman who is planning to become pregnant.

In one sense, Pre-Conception Counseling and Assessment can be compared to a well-baby visit in which a baby is screened for normal health, normal development, with the benefit of identifying emerging problems that may have gone unnoticed in an infant. For a woman, the Pre-Conception Counseling Assessment and Screening is intended to assess normal health of a child-bearing woman, while at the same time identifying:

• Existing or emerging illness or disease which may have gone undetected before, and
• Existing risks for the woman who may become pregnant, and
• Existing risks which may affect a fetus if the woman does become pregnant.

Contents 1 Obstacles to Pre-Conception Counseling 2 What is involved in Pre-Conception Counseling? 2.1 Questionnaire 2.2 Blood Work 2.3 Urinalysis 2.4 What is asked on the questionnaire? 3 Using the assessment 3.1 Physicians 3.2 The woman's role 4 Conclusion 5 References

[edit] Obstacles to Pre-Conception Counseling

The most common obstacle to pre-conception counseling and assessment is that many pregnancies are still unplanned.

If birth control methods fail, there is no opportunity for pre-screening and assessment.

The second most common obstacle to pre-conception counseling and assessment is that most women do not know, realize, or understand the benefits of visiting their physician before trying to become pregnant.

Most women still take for granted the biological aspects of becoming pregnant, and do not consider the extreme value of pre-screening before becoming pregnant.

Most women who want and anticipate having a baby are naturally prone to thinking in terms of having a well baby. In the majority of cases, women do not think about having a baby who has any kind of problem.

Most women do not know how their own medical history could pose risks to a developing fetus. Likewise, they may not understand that pregnancy carries a certain number of risks as well. When family history risks and pregnancy risks are considered together, it may point to potential problems for that particular woman, or to her unborn baby once she becomes pregnant.

The third most common obstacle to pre-conception counseling and assessment may be the lack of health insurance. However, most insurances will cover this as a screening visit. Also, many physicians will do the pre-conception screening during a regular office visit or gynecological visit if the woman just informs the doctor of her desire to become pregnant. Most gynecologists will inquire about child-bearing intentions anyway.

[edit] What is involved in Pre-Conception Counseling?

[edit] Questionnaire

Pre-screening covers many body-system areas (not just the reproductive organs), as well as aspects of the woman's lifestyle, and family history information. It begins with basic information and becomes more in-depth, especially if the woman has had previous illnesses, diseases, etc. Pre-screening assessments begin with a questionairre which the woman fills out, generally before seeing the physician. Some offices have the woman go over parts of the questionnaire with a Nurse-Practitioner, if available.

See below for more details about the questionnaire.

[edit] Blood Work

Certain blood work may be ordered. This often includes a CBC (Complete Blood Count) which can show anemia. A CBC includes WBC (White Blood Cell Count) which can show the presence of infection. Anemia and infection, indicating problems with the woman's overall health at that moment, can both affect a woman's ability to become pregnant at that time as well as affect the stability of the pregnancy and health of the fetus. Fortunately in the majority of cases both infection and anemia can be treated once the cause is identified. Anemia may require ongoing evaluation and iron supplement.

[edit] Urinalysis

Urine sample or uninalysis can reveal the presence of protein in the urine, often found in diabetes, and the presence of blood which can indicate a urinary tract infection. Urinalysis is useful in other ways also.

[edit] What is asked on the questionnaire?

• Family Medical History:

• Has anyone in your family ever had diabetes, hypertension, a stroke, epilepsy or other seizure disorders, kidney disease, hepatitis or other liver disease, heart disease, a clotting disorder, lung disease (including asthma), thyroid disease, cancer, or a connective tissue disease, such as lupus or rheumatoid arthritis?

• Has anyone in your family had a child with any genetic disorder? Include your parents, grandparents, aunts and uncles, your own siblings and their children, your first cousins and their children.

• If you know there is a family history of possible or probable genetic conditions, bring up your concerns and questions.

• Woman's vaccination history:

If you have your official records, bring these to your appointment. Women who have not had certain vaccinations are at greater risk (as well as the fetus) if they come in contact with those illnesses. Your doctor may set up a plan for you to receive missing vaccinations or boosters. During the time of receiving these vaccines, it will be important to 'NOT' get pregnant!

• Woman's Medical history
• Have you ever had any serious medical problems?

Do you have diabetes, hypertension, epilepsy or other seizure disorders, kidney disease, hepatitis or other liver disease, heart disease, a clotting disorder, lung disease (including asthma), thyroid disease, cancer, or a connective tissue disease, such as lupus or rheumatoid arthritis?

• Do you have any digestive problems?

• Have you ever been hospitalized for any reason? What reason?

• Have you ever had any operations? When and why? Have you ever had any problems with anesthesia?

• Have you ever had a blood transfusion?

• Are you being treated for any conditions right now?

• What prescription or over-the-counter medications are you taking, including herbs, vitamins, or supplements? What are the doses and how often?

• Are you allergic to any drugs, herbs, vitamins or supplements? (Remember that many over-the-counter or herbal products contain some of the same elements that make prescription drug treatments).

• Any other allergies?

Don't forget to include allergies to contrast dye, latex, tape, and other non-medication allergies.

• Have you ever been exposed to any infectious diseases? (AIDS, HIV, Hepatitis, Tuberculosis, etc.) Is there anyone in your household who has (or had) hepatitis? Tuberculosis? Have you recently been exposed to a child or children with a contagious illness such as mumps or chicken pox?

• Do you currently have cancer? Are you receiving treatment and what kind of treatment?

• Do you have any kind of low back condition with pain?

• Are you currently taking any pain medications, by prescription or over-the-counter, on a regular basis?

• Do you have any trouble walking or standing?

• What is your general sleep pattern? Do you suffer from insomnia? Why, if you know the cause?

• Emotional and social history

• Have you ever suffered from any mental or emotional problems, including depression or eating disorders?

• How would you describe the level of stress in your day to day life? Do you know ways to reduce stress?

• What is the status of your current relationship?

• Have you ever been a victim of domestic violence? In your current relationship, do you ever feel threatened or are you physically or verbally abused? Have you ever been kicked, hit, or slapped? Have you ever been forced to have sex against your will?

• Are you able to keep yourself safe?

• Are you receiving psychological help to deal with any problem?

• Have you ever been hospitalized for an emotional or psychological reason?

• Lifestyle questions

• Do you smoke or use tobacco products, or are you exposed to second hand smoke? How much do you smoke in a day?

• Do you drink coffee or other caffeinated beverages?

• Do you see a dentist regularly? Do you have current tooth decay and / or gingivitis?

• Do you exercise regularly?

• Do you have trouble maintaining a healthy weight?

• Do you follow any particular kind of diet or have any dietary

restrictions?

• Do you eat a lot of fish? Do you consume fresh fish that you (or family) caught yourself?

• Do you ever eat raw or undercooked meat, fish, or eggs?

• Do you have any pets or do any gardening?

• Do you regularly use hot tubs or saunas?

• What do you do for a living? Do you or your partner live or work near any possible hazards, such as paints or solvents, pesticides, radiation (x-rays), lead, or mercury?

• Do you or your partner have any hobbies (such as ceramics) that might expose you to toxic substances?

• Drug and Alcohol Use, Current and Past

• Have you used illicit drugs in the past? What kind?

• Are you currently using illicit drugs? What kind? How much? How often?

• Have you recently stopped drug use, say in the last 6 months? What was the date you last used drugs?

• Have you had a low-birth weight infant in the past?

• Do you drink alcohol? How much and how often?

• Have you had a drinking problem in the past?

• Gynecological history

• What age were you for your first menstrual period?

• When did your last menstrual period start?

• Are your periods regular?

• What kind of birth control are you using now, and what kinds have you used in the past?

• are you consistent in using the birth control now?

• Have you ever had an abnormal Pap smear?

• Have you or your partner ever been diagnosed with a sexually transmitted infection?

• Have you ever been diagnosed with pelvic inflammatory disease?

• Have you ever been tested for HIV?

• Have you been tested for HPV ?

• Are you currently in a monogamous relationship? (Multiple relationships increase the risk of having an STD, HPV, and HIV).

• Have you ever been told you have any uterine abnormalities? This can include a 'tipped uterus'... or uterine fibroids.

• If you were born before 1972, do you know if your mother took DES when she was pregnant with you?

• Have you ever had any kind of gynecological surgery?

• Have you ever been treated for infertility?

• Obstetric history

NOTE: If you've ever had any complications during a pregnancy, labor, or during delivery that your practitioner is not aware of, bring the related medical records with you to your checkup.

• Have you ever been pregnant before? If so,

• Have you ever had a miscarriage? If so, how many weeks pregnant were you? Did you have a D&C? Were there complications? Do you know the cause of the miscarriage?

• Have you ever had or do you know you now have ovarian cysts?

• Have you ever had an ectopic pregnancy? (implantation outside the uterus) If so, how many weeks pregnant were you? Did you have surgery?

• Have you ever had an abortion? If so, in which trimester? Were there any complications?

• For each child you've given birth to: What was the birth date? Place of birth (hospital; home)? How many weeks gestation? Gender? Birth weight? What kind of delivery? Any labor or delivery complications?

• Did you have extreme weight gain during any pregnancy? If so, how was this explained to you? (For example, Toxemia in pregnancy can cause increased weight gain by fluid retention, along with high blood pressure.

• Have you ever had preterm labor or delivery?

• Have you ever had spotting during pregnancy after the first trimester?

• Were you ever ordered to bed rest in a previous pregnancy?

• Have you ever had a cesarean section?

• Have you ever had any pregnancy complications, such as preeclampsia, gestational diabetes, or placental problems? (such as retained placenta)

• In a previous delivery, did you hemorrhage?

• Previous Post-Partum History
• In any previous pregnancy, did you experience "baby blues" after giving birth? How long did you experience these feelings?
• In any previous pregnancy, did you experience "post partum depression" after giving birth? How long did you experience these feelings?
• Did these feelings overwhelm your ability to function? In what ways?
• Did these feelings overwhelm your ability to connect to your baby or to feel loving feelings towards your baby?
• Did others in your family tell you that you did not seem to be thinking very well during that time?
• What sources of help did you turn to during that time?
• Are you concerned you may experience either baby blues or post partum depression if you become pregnant again?

[edit] Using the assessment

[edit] Physicians

The areas a physician will assess are too numerous to include here. When women have pre-existing illnesses / conditions / diseases, these may add to pre-natal risks and will need ongoing evaluation. Also any medications which are used to treat these conditions will need monitored and possibly reduced or increased.

The presence of Diabetes remains a huge risk for the unborn child, and a woman will be screened specifically for this condition. Known diabetics will need monitored closely. For more information, see this online article Diabetes and Diabetic risks http://journal.diabetes.org/clinicaldiabetes/V18N32000/pg122.htm

[edit] The woman's role

A woman may need to adjust certain aspects of her health and well being which are in her control. These usually include aspects of lifestyle, drug and alcohol use, exercise, rest and stress reduction. In addition, she may need to discontinue certain herbs or over-the-counter medications as recommended by the physician. Many physicians will also begin pre-natal vitamins before a woman actually conceives in order to boost her overall health.

[edit] Conclusion

Pre-Conception Counseling, Assessment and Screening can aide the woman and her unborn child if she conceives. Attention to areas which can be controlled, listed above, can improve a woman's chances to conceive as well as improve the in-utero environment of the fetus and improve the overall health of the fetus. Pre-Conception Counseling, Assessment and Screening also assists the Physician in being aware of pre-existing conditions and areas of potential problems so that he/she can better evaluate and guide the woman-patient. Women who are thinking of getting pregnant should see their physician first, before stopping their current birth control. Investment of time, energy and attention to potential problems during a pre-conception planning stage can greatly benefit both the woman and future pregnancy.

[edit] References

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