Pre-Pregnancy Counselling

Introduction
It is important that the parents to be should plan for a pregnancy under conditions most likely to ensure a best outcome for both the mother and the baby.

The following points should be considered during a counselling to a couple who are planning to get pregnant.

1. Reduce weight if obese .
2.Ensure the woman is immune to rubella prior to pregnancy.
3.Optimal control of chronic disease (like  diabetes) before conception. This is also important for hypothyroidism as the fetus cannot make thyroxine until 12 weeks and under-replacement may affect neurodevelopment.
4.Strict diet is  essential peri-conceptually for women with phenylketonuria (PKU).
5. Stop teratogens (drugs and alcohol that may lead to fetal abnormalities) or seek expert advice prior to conception .
6.Start Medication to protect the fetus from abnormality (e.g folate supplements for neural tube defects).

7. Provide expert information for those at risk of abnormality so pregnancy or its avoidance is an informed choice, and any tests needed (eg chorionic villus sampling,) are planned.
8. If past/family history of thromboembolism, screen for thrombophilia.

Diet: To prevent neural tube defects (NTD) and cleft lip, all should have folate rich foods + folic acid 0.4 mg daily at least starting one month before conception and to be continued till 13 weeks of gestation (5mg/day if past  history of neural tube defects).

• Use foods with >0.1 mg of folic acid/serving: brussels sprouts, asparagus, spinach, black eye beans, fortified cereals. 
• Avoid  caffeine.

Smoking decreases ovulations, causes abnormal sperm production  and increases the chances of a miscarriage , and is associated with preterm labour and low birth weight babies.

Alcohol consumption High levels of consumption are known to cause the fetal alcohol syndrome. Mild drinking eg 1–2U/wk has not been shown to adversely affect the fetus but alcohol does cross
the placenta and may affect the fetal brain.
Miscarriage rates are higher among drinkers of alcohol.

Search for those who need the most counselling
• Diabetes mellitus
• Tropical travellers
• Frequent miscarriage
• Hypothyroidism
• Epilepsy
• Rubella-susceptible
• Pet-owners (toxoplasmosis risk )
• Phenylketonuria
•  High BP history
• SLE
• Genetic history, eg: spina bifida , thalassemia , Duchenne’s , cystic fibrosis etc.