Preconceptional Counselling
It is a health discussion that happens between a couple planning to expand their family and a medical professional (gynaecologist / physician). This discussion is intended to help them make the right preparations to conceive confidently. This will help the couple prepare themselves physically and mentally. This should ideally happen 6 months prior to planning pregnancy.
Why is planning needed before conception?
Though Preconceptional counselling is a routine process in the developed societies, we are yet to adopt it as a norm. Typically in the Indian context, even in an urban – educated setting, the first medical touchpoint in a pregnancy happens after the lady has conceived and a few weeks have passed. By this time, the initial major stages of the baby’s development would have passed. It is indeed sad that we are losing out on a golden opportunity to reduce any risk as well as positively influence the health of the baby at the very onset.
Studies by World Health Organization (WHO) have shown that proper Preconceptional care reduces maternal, infant and child mortality rate. It is to be noted that more than 50% of pregnancies in India are unplanned and the so called “planned” ones are also not planned with a medical professional. It is high time that, as an educated community, we realized that there are many risks involved in the complete lifecycle of a pregnancy – both to the mother and the offspring. We should make use of the earliest opportunity to take necessary care to minimize the risks in this journey as well as enable a good developmental environment for the baby. This would indeed give a better chance for the happy event to happen.
What is done as part of Preconceptional counselling?
The couple is seen together by the gynaecologist and assessments are done. The main ones being :
GENERAL ASSESSMENT
Many health aspects of the lady are evaluated like basic body parameters like height, weight, BMI, pulse, blood pressure; gynaecology related aspects like regularity of periods, awareness of fertile period and examination of the breast, thyroid, abdomen and pelvis with pap smear evaluation etc. are evaluated to understand the state of health.
RISK ASSESSMENT
Previous medical history that are relevant to pregnancy like diabetes, blood pressure, epilepsy, cardiac issues, migraine, depression, anxiety etc. as well as surgical history and medication history are considered and risk assessment done for conception.
DEFICIENCY ASSESSMENT AND SUPPLEMENTATION
The lady is assessed for deficiency of critical nutrients to ensure that sufficient supplements are taken to improve the condition of the body before embarking on the pregnancy journey. For. e.g. most of the Indian women are anaemic and deficient in iron stores right from adolescence and it goes unnoticed.
Apart from this, folic acid supplementation before conception is very important in providing a congenial environment for development of various critical systems of the baby like the nervous system and the cardiovascular system which happen early on in the pregnancy.
IMMUNITY ASSESSMENT AND VACCINATION
There are certain immunity testing to be done and vaccinations to be taken to prevent certain infections that can harm a developing baby. e.g. Rubella, Chicken pox etc.
ASSESSMENT FOR DEPENDENCIES AND DOMESTIC VIOLENCE
Evaluation of lifestyle habits that impact pregnancy like smoking, drinking, drug abuse etc. are done and necessary counselling is provided to guide the couple to start the journey on the right note.
Conclusion
It is vital to understand that care for the pregnancy needs to start early on and needs to be guided by a professional. Preconceptional counselling not only helps the couple to enter pregnancy confidently, but also helps in improving the pregnancy outcome by reducing infant and maternal mortality as proven by studies. It is the earliest medical care that can be given an individual stepping into this world from the comforts of the womb. Any day, prevention is better than cure.