During the pre-trimester period, there are several things you should do before you try to conceive and one of these is seeking preconception care and counseling.
Optimization of the mother's and the father’s health may improve pregnancy outcomes.
Preconception counseling consists of seeing a doctor or fill out an online questionnaire to find out how to improve your chances of having a healthier baby before even getting pregnant. Preconception counseling is challenging for several reasons:
- Medical prenatal visits with your doctors are usually brief and a uniform approach cannot fit all encounters.
- Most doctors are not trained to do adequate preconception counseling and have no time to do it
- Advice must be individualized to a mother's culture, values, habitus, and personal circumstances.
- While 50% of the time there is a male cause of infertility, there is no specialty or doctor caring preconceptionally for men
Preconception counseling is recommended for all women and men before pregnancy
All women and men should be counseled to seek medical care before attempting to become pregnant. Many chronic medical conditions and metabolic syndromes include diabetes, hypertension, psychiatric illness, and thyroid disease have implications for pregnancy outcomes. Managing medical issues both in women and men before pregnancy is safer than during pregnancy. All prescription and nonprescription medications should be reviewed during prepregnancy counseling. This review also should include nutritional supplements and herbal products that women may not consider to be medication use but could affect reproduction and pregnancy.
Adverse pregnancy outcomes are associated with conditions in men preconception
Recent studies have shown that there is an association between paternal health and pregnancy loss. Adverse pregnancy outcomes such as miscarriage and stillbirths have been found to be associated with certain components of metabolic syndrome in men such as blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.
Screening for genetic conditions
Genetics is the study of heredity, the transmission of certain genetic traits from one generation to the other. Heredity is a biological process whereby a parent passes certain genes onto their children or offspring. It is important if you or the baby's father have certain traits that you may transmit to the baby. This is especially important before you get pregnant to get as much information as you can get to make decisions. Women who present for prepregnancy counseling should be offered screening for the same genetic conditions as recommended for pregnant women. Read more here about understanding genetics.
Seeing a doctor as soon as you find out you are pregnant
Women and men should see a doctor as soon as they believe they are pregnant. This helps to correct pregnancy dating and to be monitored for any medical conditions in which treatment should be modified during pregnancy.
Finding out if you and he are healthy and fertile
Part of the preconception evaluation is to find out whether you and he are fertile. That usually means you start by making sure that you ovulate regularly and that your menstrual cycles are normal and that his sperm count is normal? Should he get tested for his sperm count? It's better to find out that his count is normal than to wait many months before you find out that he is not fertile.
This also means that both of you get educated about your fertile days and learn more about how to ensure you have sex regularly to improve your pregnancy chances.
- How to check for ovulation
- Check your fertile window
- What is a normal sperm count?
- More about fertility testing
Many diseases are potentially dangerous in pregnancy, both for the mother and the baby. By making sure your vaccines are up to date you reduce the risk of later complications.
All women of reproductive age should have their immunization status assessed annually for:
- tetanus toxoid
- reduced diphtheria toxoid, and acellular pertussis (Tdap)
- hepatitis B
- COVID-19 vaccine
Additionally, all women (and men) should receive an annual influenza vaccination.
Since these conditions are preventable you must take necessary steps before conception to ensure you do not contract these diseases. By making sure your vaccines are up to date you reduce the risk of later complications.
At the preconception visit, women should be assessed for the need for sexually transmitted infection (STI) screening including HIV, syphilis, gonorrhea, hepatitis B, and chlamydia. Those with potential exposure to certain infectious diseases, such as the Zika virus, should be counseled regarding travel restrictions and appropriate waiting time before attempting pregnancy.
There are different classifications for medications that depend on how safe they are for expecting mothers. You must tell your doctor all of the prescription and non-prescription medicines you are taking as well as any herbal supplements.
Preparing for a baby is about far more than just setting up that beautiful room.
If you are currently taking anything that could harm the baby, your doctor will need to find an alternative medication or have you stop taking them altogether. This is also the time to start taking prenatal vitamins because it is during the first month of pregnancy that many of these vitamins are vital to the development of the fetus.
Alcohol, smoking, and other bad habits
All women should be routinely asked about their use of alcohol, nicotine products, and drugs and it should be recommended they stop before trying to get pregnant including prescription opioids and other medications used for nonmedical reasons. Marijuana is contraindicated before and during pregnancy.
Everyone should be screened for depression and other conditions. This includes screening for domestic partner violence.
Diet and supplementation
All women of reproductive age should have 4-800 mcg folic acid supplementation to reduce the risk of neural tube defects (NTDs) and other pregnancy complications.
Women should be screened regarding their diet and vitamin supplements to confirm they are meeting recommended daily allowances for calcium, iron, vitamin A, vitamin B12, vitamin B, vitamin D, and other nutrients.
Weight loss, exercise, and other lifestyle issues
Before attempting pregnancy, women should be encouraged to try to attain a normal body mass index (BMI), because abnormal high or low BMI is associated with infertility and maternal and fetal pregnancy complications. Before attempting to conceive, moms will want their bodies to be the epitome of health. Losing any excess weight and adopting a healthy exercise regime can help to make the pregnancy and birth processes far easier. Taking a prenatal vitamin for a few months before conception helps to build optimal levels of vitamins, nutrients, and folic acid in the body. Folic acid is most important during the first few weeks after conception and helps to prevent neural tube defects of the fetus.
Exercise programs adopted before conception can be maintained for the length of the pregnancy. In addition to normal exercises, Kegel exercises will help during the birthing process. Kegel exercises are used to tighten the muscles used to push the baby out during childbirth.
Preparing for a baby is about far more than just setting up that beautiful room. The female body will undergo dramatic changes immediately after conception and for the ensuing 40 weeks of fetal growth. The idea is to prepare the body before the baby is conceived and make the growth process all the more enjoyable for mom and baby. If you are thinking about getting pregnant, talk with your gynecologist.
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Pre-Trimester for Men: The Preconception Period Is Vital