by Suneeta Mittal.
Pre-conception care is the provision of medical, behavioral and social health interventions to women and couples before pregnancy occurs. It aims at improving their health status, and reducing factors that contribute to poor maternal and child health outcome. Even though it is proven to increase the well-being of women and couples and subsequently improves pregnancy and child health outcomes, there is still very little awareness of its big benefits. Here is how it works.
Even if pre-conception care aims primarily at improving maternal and child health, it brings health benefits to the adolescents, women and men as individuals in their own right (not just as potential parents). For example, many nutritional, environmental, mental health interventions as well as interventions aiming to reduce psychoactive substance use and interpersonal violence improve health and well-being of girls and boys, women and couples irrespective of their plans to become parents.
Pre-conception care includes providing optimal nutrition to the adolescents and prospective parents including screening for anemia and diabetes and their appropriate management. Those who are known diabetic or have a family history of diabetes should plan a pregnancy only after optimum blood glucose level. Similarly, peri-conceptional consumption of folic acid brings down the risk of having a baby with birth defects of the brain, spine, or spinal cord significantly.
Both under-nourished and overweight women need to achieve optimal weight before pregnancy. Also, screening for thyroid dysfunction and its correction before planning a pregnancy helps reducing neonatal adverse outcomes. Women as well as men and their family members who smoke need to go through a de-addiction program, as both active as well as passive smoking can have adverse effects on pregnancy.
Taking a thorough family history to identify risk factors for genetic conditions is required including genetic counseling, carrier screening and testing, and appropriate treatment of genetic conditions. Such studies can help to identify high prevalence of Thalassemia (a blood disorder which can be transmitted to the child), problems of the hemoglobin (the protein that carries oxygen in the blood) or Sickle cell disease.
At the same time, blood group and Rh typing before conception is useful to take care of Rh iso-immunization. Rh-negative women may develop antibodies to an Rh-positive baby during pregnancy.
Environmental health is another risk factor. By providing guidance and information on environmental hazards, future parents can avoid radiation and lead exposure and unnecessary pesticide use in occupational, environmental, and medical settings.
Pre-conception care also includes providing age-appropriate comprehensive sexuality education that addresses gender equality, human rights, and sexual relations. Educating couples about sexually transmitted infections and HIV as well as screening and appropriate treatment is important for providing mother and future baby’s health services.
Last, pre-conception care also includes assessing mental health and psycho social problems and counseling, and treating and managing depression in women planning pregnancy.
Pre-conception care has a positive effect on a wide range of health outcomes in terms of reducing maternal and child mortality, preventing unintended pregnancies and complications during pregnancy and delivery, stillbirths, preterm birth and low birth weight babies, birth defects, neonatal infections, vertical transmission of HIV/STIs, lowering the risk of some forms of childhood cancer, type 2 diabetes and cardiovascular disease later in life.
How much information is there available in your country about pre-conception care? Please share your thoughts about how this practice could benefit your community.
Dr. Suneeta Mittal is renowned in the field of Obstetrics and Gynaecology having a wide experience of more than 35 years. She is a pioneer who has introduced Emergency Contraception in India, has done an Adaptation and Indianisation of the World Health Organization Medical Eligibility Criteria Wheel, and has developed Minimum Standards for Mother Baby Friendly Hospital Initiative with GOI & UNICEF.