Ask the doctor: Should I attend the clinic before pregnancy?

Dear doctor,

I have heard of pre-conception clinics. Are they worth my time as I am ready for conception?

Answer

If you did a survey among your friends who are young parents, you would probably find that most of them did not plan their pregnancies. It would be inevitable then that they did not seek pre-pregnancy advice from a professional.

It would mean that some of these conceptions probably occurred when these couples were in the best of health and this could be why they experienced avoidable pregnancy complications.

In an ideal situation, all pregnancies should be planned, with pre-conceptual advice being part of routine care. Pre-conceptual care is distinct from antenatal care and includes information about health issues that may affect conception and pregnancy.

Pre-conceptual health is discussed, and couples with prevailing medical conditions are identified and remedial measures put in place.

In addition, screening for other disease conditions can be done, and specific interventions put in place. This then ensures conception at the peak of optimal health for the woman and the man. Consequently, excellent pregnancy outcomes can be expected.  

Those found to be leading unhealthy lifestyles get to be advised accordingly. Smoking, alcohol and use of other recreational drugs are all associated with delayed conception, miscarriages, low birth weight babies and other complications. Those with addictions are better off postponing pregnancies till they are well clear of toxins.

Women with a high body mass index (BMI) tend to have more pregnancy problems that include: gestational diabetes, high blood pressure (pre-eclampsia), higher risks of clotting disorders and more complications related to labour and delivery. Diet and exercise contribute to BMI optimisation prior to conception, and a desired reduction in related pregnancy complications.

Couples with chronic conditions like hypertension, diabetes, kidney and heart diseases have specific risks in pregnancy.

Such couples need optimal pre-pregnancy control of their conditions. They may also be on medications that might be harmful to a foetus, which must be substituted prior to conception. Once pregnant, these couples need combined antenatal care with other specialists, and this must be planned pre-conceptually.

Pregnancy risks increase with age, especially for those above 40 years and already in a poor health status. Such risks must be discussed pre-conceptually, coupled with associated genetic counselling for increased risks such as Downs Syndrome. Couples are then able to make informed choices.

Pre-conceptual folic acid supplementation is one of the most important preventive interventions. It reduces the risk of neurological birth defects. Diet alone does not give adequate Folic acid levels, and some women require higher doses especially if epileptic, diabetic or a have family history of associated birth defects. Any other relevant supplements will be advised during your pre-conception consult.

Since you are considering getting pregnant, please consider booking a pre-conception appointment with your gynaecologist. You can always take a chance if you already keep yourself in an optimal health status. But you may be ignorant of some beneficial pre-conception interventions that may play a critical role in your eventual pregnancy outcomes.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. [email protected]