Preparing for a pregnancy

 

Pre pregnancy counselling provides an excellent opportunity to assess the overall health of the woman and fitness for pregnancy, before they “start a family”, It allows

 
  • Informed choice, which helps women and men to understand health issues that may affect conception and pregnancy.

  • Women and their partners to be encouraged to prepare actively for pregnancy, and be as healthy as possible.

  • Identifying couples who are at increased risk of having babies with a genetic malformation. Provide them with sufficient knowledge to make informed decisions.
 

Several conditions that have previously remained hidden, such as congenital heart defects and glucose intolerance, become apparent with the extra burden exerted by pregnancy.

 

What important factors should you consider before conceiving?

 

  • If you are healthy and on a normal diet, eat plenty of fruit and green leafy vegetables and drink plenty of milk to raise stores of vitamins, iron and calcium. Women who are either overweight or underweight, find it difficult to get pregnant and also suffer more complications. They may also need a consultation with a dietitian. You should be cautious to avoid herbal preparations and tea; their use and safety in pregnancy has not been studied.

Women who exercise regularly should be advised to continue to do so. Those who are inactive should start a gentle programme of regular exercise. Strenuous exercise in the first 3 months of pregnancy is not advisable.

The daily requirement of Folic acid in a pregnant woman is 400mcg. Diet alone cannot supply this amount. Therefore supplementation with folic acid is important, which needs to be started ideally about 2 months prior to conception. This is taken by the intake of 1 tablet of Folic acid per day. It can be bought over the counter, cheaply. It is important that you start folic acid before conception, because the baby’s nervous system starts to develop very early in pregnancy, and therefore by the time you detect your pregnancy, it may be too late.

Smoking in pregnancy is associated with a large number of adverse effects including miscarriage and stillbirth.

High levels of alcohol consumption during pregnancy result in the Foetal Alcohol Syndrome (FAS).Growth retardation, mental retardation, facial anomalies and behavioural problems are common manifestations of this syndrome.

It is good practice to minimise exposure to all drugs including those bought over the counter & herbal preparations.If you suffer from an illness, inform your doctor about the possibility of conceiving & he will be able to prescribe drugs which are safe.

 

1. Diabetes

  • Patients need to ensure very tight control of their blood glucose at the time of conceiving and during pregnancy.
  • Type 2 diabetics may need to be changed to insulin.

2. Chronic Hypertension

  • Certain drugs used in chronic hypertension should not be used in pregnancy & therefore switching to a safer drug may have to be done by the medical specialist.

3. Epilepsy

  • Most anti-epileptic drugs are teratogenic(can cause foetal abnormalities) although the risk is reduced if used as as a single drug.
  • Therefore its is important that you meet a medical specialist so that disease control can be achieved while mininmising the risk to the foetus.

 

1. Rubella

 

Infection in the first 8-10 weeks of pregnancy results in damage in up to 90% of infants. Defects include mental handicap, cataract, deafness, heart abnormalities and intra-uterine growth retardation.
Therefore,all girls are vaccinated against Rubella at school.If you are planning to get pregnant, but if still not vaccinated,make sure you get it atleast 3 months prior to getting pregnant.

2. Chickenpox infection(Varicella)

Chickenpox infection in the mother in the first 20 weeks of pregnancy, may cause “congenital  varicella syndrome” in the foetus. This may cause limb hypoplasia (small limbs) microcephaly(underdeveloped head), cataracts, growth retardation and skin scarring.
Varicella vaccines must not be given to pregnant women.Make sure that you don’t get pregnant for atleast 3 months if you have received the Varicella vaccine.
 

 

 

The risk of fetal chromosomal abnormalities, particularly trisomy 21(Down syndrome) increases  with maternal age, especially after 35 years.
There is also an increased risk of miscarriage, twins, fibroids, high blood pressure and diabetes during pregnancy, with increasing age.

This is recommended for those who have had a previous child with an inherited disease such as Down syndrome or Thalassaemia, or have a family history of a genetic disorder.

Down syndrome

What is it?

Down syndrome is a genetic condition known as trisomy 21, where a person inherits an extra copy of one chromosome. People with the syndrome have three copies of chromosome 21 rather than two.

Who’s affected?

The chance of having a baby with Downs syndrome increases with the age of the mother, especially over the age of 35. But as the majority of women have their children when they’re younger, most Downs babies are born to younger parents.

Having a child with Downs syndrome is more likely if a woman already has a child with the syndrome, or if a close family member has had an affected child. But most cases are sporadic (the parents aren’t affected) and the risk of recurrence in future pregnancies is very small.

Downs syndrome affects people from all ethnic groups and cultures.

 Antenatal screening

It’s not possible to prevent the genetic abnormality that causes Downs syndrome, but in recent years it has become possible to identify more accurately in early pregnancy, those babies most at risk.

The antenatal screening for Downs syndrome is best done by combining:

  • Ultrasound scan of the baby (this test, which measures the small pool of fluid underneath the skin at the back of the baby’s neck, is called a nuchal translucency measurement) which is carried out at 11 to 14 weeks of  pregnancy.
  • Blood tests which measure certain chemicals (free beta-hCG, alpha feto protein,oestriol) in the mother’s blood.This is called the Triple test and is done between 15-22 weeks of pregnancy.

The results are then combined with the woman’s age at her expected date of delivery in order to give an estimated level of risk of  Downs syndrome.

It’s important for parents to realise that screening, only identifies those women who are at an increased risk of having a baby with Downs syndrome and estimates the level of that risk – it doesn’t actually tell them for certain whether or not their baby has Downs syndrome.

Those women who are found to be at a higher risk of having a baby with Downs syndrome are offered the opportunity of further tests to establish whether or not their child is affected. The tests offered may be amniocentesis or chorionic villus sampling. These provide a definitive answer, but are invasive and can trigger a miscarriage.

Screening for Downs syndrome isn’t compulsory. Women are offered screening if they wish to know the likelihood of having a baby with Downs syndrome. If they are at high risk, they can then decide whether to have a definitive test.

Even though these tests confirm Downs syndrome there is no treatment for these syndromes, in Sri Lanka,as the existing laws do not permit termination of pregnancy.

Thalassaemia

What is Thalassaemia?

A group of genetic blood disorders. It is due to a defect in the synthesis of Haemoglobin(the component in your blood responsible for carrying oxygen). There are two major types of Thalassaemia.

  • Alpha Thalassaemia
  • Beta Thalassaemia

There are 3 types of Beta Thalassaemia

  1. Thalassemia Minor or Thalassemia Trait-
    A person with this condition simply carries the genetic trait for thalassemia and will usually experience no health problems other than a mild anemia.
  2. Thalassemia Intermedia-
    In this condition, the disease is severe enough to cause a moderately severe anemia and significant health problems.Therefore,the patient may need blood transfusions to improve their quality of life.
  3. Thalassemia Major –
    This is the most severe form of beta thalassemia , which causes a life-threatening anemia that requires regular blood transfusions and extensive ongoing medical care, for survival.