Prevention is the key for a healthy pregnancy
The preconception assessment or medical consultation is defined as an opportunity to determinate the most healthy choices and caring life style whose purpose is to benefit of the child and mother. within this evaluation will be possible to detect some factors such as medical problems, environment factors and some patterns and life style behavior that might increase damages to fetus and mother if its not modified.
In the embryonic stage (during the first 8 weeks of pregnancy) is a rapid period of growth of the fetus and at the end of the organs and systems of the body had begun to form , and this is a critical time to develop malformations and growth alterations when the baby is exposed for example if the mother smokes, drink alcohol or intake medications without knowing she is pregnant
In this consultation the physician will ask questions about the clinical history of the mother and father, as past illnesses, chronic conditions, such as diabetes, high blood pressure, depression, hypothyroidism, to mention some and the potential risks of presenting complications related to the same disease , as the type of medication intake to treat and it might not be safe for the fetus, and to seek for an alternative drug during pregnancy.
Also the congenital heart defects such as severe aortic stenosis, which ideally before being pregnant its appropriate to schedule some surgical treatment, in order to improve the prognosis for the pregnant woman. Diseases in the family, origin of their offspring, since certain diseases occur in certain geographical areas. Or antecedent of genetic syndromes, relatives with some type of malformation or intellectual deficit, in order to assess the risk of being able to inherit it.
About medications and supplements, including over-the-counter medications and herbal medicines, they can sometimes be harmful to you baby. Immunosuppressive drugs for patients with lupus or some rheumatic disease must be modified, and in some of them the period between stopping them and a pregnancy sometimes must be up to 6 months to a year, radioactive Iodine for patients with thyroid dysfunction is another example that It is common in women. And you should also know that although some medications may increase the risk of birth defects, the benefits of continuing to use them during pregnancy may outweigh the risks to your baby, such as antiepileptics for example
The obstetric history of the patient, for example if she had previous pregnancies, the phycisian ask about how their outcome was? Are the babies healthy? Do they live? Were there maternal complications? certain disorders that happened in a previous pregnancy can occur again, such as preterm labor, high blood pressure, pre-eclampsia, gestational diabetes, and a medical intervening in time can reduce the risk of their appearance.
The type of diet, lifestyle, for example if you are vegetarian, if you consume dairy products, allergy to some type of food, if you eat long fasts, are overweight, or weigh less than normal, and maintaining a balanced diet is vital to maintain good health, and it is necessary to have a dietary reference that must be obtained from the food you eat. Folic acid, the essential vitamin, helps prevent neural tube defects and it is recommended that all women consume 400 micrograms of folic acid daily. In patients who already have a history of a child with a neural tube defect (anencephaly, spina bifida, myelomeningocele) or breasts with obesity BMI greater than 30, it is recommended that you take 4 mg of folic acid daily for 1 month, before conceiving and during the first 3 months of pregnancy.
Being overweight before pregnancy predisposes to developing complications such as gestational diabetes, high blood pressure, pre-eclampsia, premature delivery, and the risk of having a gross baby, that is, fetal weight higher than normal for gestational age, and therefore risk of injury to the baby during delivery or risk of being born by cesarean section.
In cases of significant obesity, bariatric surgery, inclusive, and if performed, must wait 12 to 24 months to attempt a pregnancy.
And last but not least, it is important to evaluate the situation of your vaccines, since there are some that contain live attenuated viruses and cannot be applied while pregnant and if they do not have them, the patient and the fetus are at risk.
For example, I mention those that should be administered at least 1 month before pregnancy: against the flu with live attenuated organisms, nasal spray, against measles, mumps, rubella, and against chickenpox. And those that can be safely received in pregnancy: Hepatitis A, B, influenza or influenza, meningococcal, pneumococcal, tetanus reduced diphtheria and acellular whooping cough.
In conclusion, preconception consultation and counseling is the ideal time to ask questions, ask for advice, resolve related concerns about the pregnancy process, put yourself in the best conditions, and prepare both physically and emotionally to await the arrival of a new member in the family. and thereby increase the chances of the term pregnancy will be successful.
Dr. Adrián Israel Ramírez Mendoza
Jefe del Servicio de Medicina Materno Fetal
