Pre-Pregnancy assessment

Pre-pregnancy considerations

Here are some things to consider to help prepare you and your partner for pregnancy. If you have already started trying for a pregnancy it is never too late to make lifestyle changes that will improve your health.

Pre-pregnancy check up

Now is the time to visit your GP or make a pre-pregnancy consultation with a knowledgeable Gynaecologist.

Chronic/acute medical conditions

Women with health conditions such as high blood pressure, diabetes, thyroid disease, epilepsy, lupus or conditions affecting the heart, lungs and kidneys will need to be carefully managed. If you already have a specialist for one of these conditions,  Dr Kliman will communicate with your specialist to obtain important medical information. If you are not being cared for by a specialist or time has lapsed since you have seen someone regarding your medical issues, we can refer you along to a specialist to ensure your condition is managed appropriately and that your medication regime is correct.

Gynaecological check up

If you have a history of gynaecological conditions such as PCOS, endometriosis or fibroids, conception may be an issue. It is important to mention if you have had previous uterine or cervical surgery. Most women are recommended to have a cervical screening test every five years. Prior to conceiving, ensure that your cervical screening test up to date but you can have the test performed during the first 20 weeks of a pregnancy.

Breast checks

All women should know how to perform a monthly breast self examination. It is important to continue with breast self-examinations during a pregnancy. From the beginning of your pregnancy there are breast changes that you should expect. These changes are normal. If you are unsure a general practitioner or Dr Kliman will be able to advise you how to perform a breast self examination.

STD checks

Sexually transmitted diseases are not uncommon but the type of testing may vary according to your risk factors. If you are concerned you can discuss this with your GP or Dr Kliman so that all testing and appropriate treatment can be organised prior to conceiving.

Dental check

It is important to ensure that you are in good dental health before becoming pregnant. If you require dental treatment, x-rays or any sort of treatment, try to take care of this before you conceive. Please note that most dental treatments can be done during your pregnancy if necessary.

Medications

It is important to discuss all prescribed and over the counter medications you are taking, with your doctor prior to conceiving. This includes medications dispensed by a natural therapist. You probably have a drawer at home that is filled with various over the counter medications – some of which are not safe to use during pregnancy. Check with your GP or Dr Kliman what is safe to use once you start trying to conceive.

Mental health

Pregnancy is the time when some women are at greater risk of becoming depressed or anxious, or their previous mental health problems can be exacerbated. It is vital that if you are under the care of a psychiatrist or psychologist you continue to consult with them and review your current medication. It may mean that you will need to be managed differently but under no circumstances should you stop or reduce your current medication while you are trying to conceive.

Lifestyle Choices

The National Health and Medical Research Council recommends not to drink alcohol during a pregnancy as the only safe option. As we do not know for sure what a few drinks over a short period early in pregnancy can do to a developing baby, the Department of Health also recommends that you give up drinking before conceiving. If you miss the ritual of drinking switch to non-alcoholic beer or wine during your evening meal. If you are finding it difficult to cut down or think you may have a drinking problem, please talk to your GP or Dr Kliman.

Smoking

If you are trying to conceive and you are a smoker now is a good time to give up smoking. Giving up smoking is one of the best things you can do for your own health as well as for the health of your baby both before your baby is born and afterwards. It is thought that women who smoke may be about 25% less likely to become pregnant in the first months of trying if they smoke 20 or more cigarettes a day. This returns to normal if a woman stops smoking. They may also have poorer results for fertility treatment and have a higher miscarriage rate. Men who smoke may have a reduced sperm count and reduced number of healthy sperm. If you have a partner who smokes he can improve his own fertility and health by quitting smoking at the same time as you do.

Recreational/Illicit Drugs

Evidence suggests that most illegal drugs are unsurprisingly potentially damaging for a developing baby. Studies have shown that the use of many illicit drugs are associated with an increased risk of developmental problems and abnormalities, premature birth, miscarriage and stillbirth. If you are planning a pregnancy you should stop using recreational drugs. If you are not yet pregnant it is best advised you use contraception until you have weaned yourself off an addiction to an illicit drug. If you are already pregnant then you should do your best to cut out the use of drugs altogether. It is clear that the quality of antenatal care can play a strong role in reducing the likelihood of the many health problems associated with drug use in pregnancy. It is important that your GP or Dr Kliman is aware of your addiction or habit as they will then be far better placed to give you the best prenatal and antenatal care and support.

Stress

Stress may affect your chances of conceiving. Stress can affect a part of your brain (the hypothalamus) that regulates your hormones. The hypothalamus is the part of the brain  that controls the hormones required to release your eggs. If stress takes a toll on your body then it could mean that you ovulate later than usual in the cycle or not ovulate at all. Your body is most likely used to every day stressors, so your cycle is unlikely to be affected by these and everybody reacts to stress in a different way. You should try to make changes in your life so you feel more relaxed. These changes can include healthy eating, exercising, yoga or meditation. If you are feeling overwhelmed by stress or anxiety it may be worthwhile discussing this with your GP or Dr Kliman or seek the advice of a counsellor or psychiatrist.

Vaccinations

Vaccinations that you receive before and during the pregnancy, play an important role in protecting your health and safe-guarding your baby’s health. Your immunity is your baby’s first line of defence against certain serious illnesses. If you are planning to conceive now is the time to make sure your vaccinations are up to date. Not all vaccines are safe during a pregnancy.

• Rubella (German Measles): This is a mild viral disease that presents with flu-like symptoms often followed by a rash. It can be harmful during a pregnancy. You have most likely been immunised against it during your teenage years but your immunity can be tested via a blood test. If you need to get re-vaccinated as your rubella immunity level is low, you should wait at least a month before trying to conceive.
• Chicken Pox Vaccine: Chicken pox is an extremely contagious disease causing a fever and a very uncomfortable itchy rash. Approximately 2% of the babies of women who develop chicken pox during the first five months of pregnancy will have birth defects. If a woman develops chicken pox around the time of her due date she can also pass a life threatening form of the infection to her baby. Most women have immunity as they would have had chicken pox as a child or been exposed to the virus but a vaccination is available and you need to wait 28 days after the vaccination before trying to conceive.

Some vaccinations are safe during a pregnancy as they do not include live viruses. These include the flu shot and whooping cough.

• Flu Vaccine: This vaccination is free to all pregnant women. It needs to be updated every year as the flu virus itself changes frequently. It is highly effective in protecting babies against the flu for their first six months of life. This vaccination can be given any time during the pregnancy and it is strongly recommended that you have it.
• Whooping Cough (Pertussis): A whooping cough combination vaccine includes tetanus and diphtheria protection. It is recommended to be given in the third trimester of every pregnancy ideally between 28 and 34 weeks’ gestation. It can be given up until delivery. Vaccination during pregnancy has been shown to benefit the newborn by passing protection from the mother to the baby. Whooping cough infection can cause serious complications in the baby. In Victoria this vaccination is free for pregnant women during every pregnancy and partners of women who are at least 28 weeks pregnant if the partner has not received the Pertussis booster in the last 10 years.
• The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANCOG) and Australian Technical Advisory Group on Immunisations (ATAGI) have recommended that all women planning a pregnancy or who are pregnant or breastfeeding can and should receive the COVID-19 vaccine. Global surveillance data from large numbers of women have not identified any significant safety concerns regarding fertility or pregnancy.

Fertility and Weight

If you are trying to conceive or intend to start trying, know that being overweight can affect your chances of conceiving and having a healthy baby. If you are overweight and planning to conceive within the next year or so it is important to commit to a healthy eating and regular exercise plan. Losing even a few kilos can make a difference. A common measure of whether a person is overweight is the body mass index or BMI. To calculate your BMI, a number of free calculators are available on various search engines, these just require your current height and weight to be inserted. A healthy BMI is considered to be between 18.5 and 24.9. Being underweight can also reduce a woman’s fertility. It can cause hormone imbalances that affect ovulation and therefore a woman’s chance of conceiving. Having a BMI under 18.5 is considered underweight. Weight can be difficult to manage and discussions with your GP or Dr Kliman are important. You may be referred to a dietitian who specialises in this area.

Supplements

Vitamins and minerals occur naturally in the foods we eat but can also be taken as a supplement in tablet form. There are national recommended daily intake (RDI) levels for vitamins and minerals and for most people who eat a variety of healthy unprocessed foods there is no need to take supplements. If you are trying to conceive the risk of birth defects can be reduced by supplementing your diet with certain vitamins and minerals.

• Folic Acid: Folate is a vitamin found in some foods including green leafy vegetables. The recommended daily intake of folic acid for women and men is 400mcg per day. This increases to 500mcg for women who are pregnant and 500mcg for women who are breastfeeding. Folic acid is a B group vitamin that is essential for the healthy development of the neural tube in the fetus. The risk of neural tube defects such as spina bifida is higher in women who have low levels of folic acid at the time of conception and in early pregnancy. Women who are planning to conceive should supplement their diet with 500mcg of folic acid daily for at least one month before conceiving and continue this for three months into the pregnancy. Some women may require high doses of folic acid, including those who had a pregnancy affected by a neural tube defect in the past, women who are obese or women who take anti-epilepsy medication or have diabetes. It is important to talk to your doctor to ensure you are taking the right dose.
• Iodine: The recommended daily intake of iodine for women and men is 150mcg per day. This increases to 220mcg for women who are pregnant and those who are breastfeeding. The thyroid is a gland in the neck which uses iodine to produce thyroid hormone. During pregnancy the mother’s thyroid hormone ensures that the baby receives sufficient nutrients. Thyroid hormone is also needed for the baby’s brain development. To support the development of the baby’s brain and nervous system women who are pregnant and breastfeeding and those who are considering pregnancy should supplement their diet with 150mcg of iodine per day.

The risk of some serious birth defects can be reduced if a woman supplements her diet with the recommended dose of folic acid and iodine. Supplements up to the daily recommended intake are likely to be beneficial and there is no evidence that it is harmful. Some well-known pregnancy supplements are available from the pharmacy and include the correct recommended dose of folate and iodine combined.

Genetic Counselling

Sometimes having an understanding of your family history may uncover information about blood relatives with hereditary disorders. Family history may mean that you may or may not have a greater risk of passing on certain genetic disorders. Some of the more common genetic diseases include haemophilia, thalassemia, Tay-Sachs disease and cystic fibrosis. It is important that you discuss this with your GP or Dr Kliman. He may refer you to a specialist genetic counsellor who can help you understand your risk of passing on a hereditary disease and how you may manage this risk and what other decisions you might need to make.

There are a number of simple genetic carrier screen tests that you and your partner can take.

What Role Does Pre-conception Care Have for Men?

Pre-conception care is just as important for men as for women. The male contributes half of the genetic material that makes up the baby. It takes sperm three months to develop so they are able to fertilise an egg. It makes sense to practice pre-conception care for men for at least three months prior to trying to conceive a baby. Guidelines for men are very similar to those provided for women.

There are many things you can do to improve your health that can minimise the risk to your baby all before conceiving. Your GP or Dr Kliman will provide you with expert advice on planning your pregnancy. The pre-conception period (three months prior to pregnancy) is the best time to make life changes for you and your partner that can help boost fertility, reduce problems during the pregnancy and assist in recovering from birth.