Pre-pregnancy counselling – Most of the pregnancies are unplanned. Hence some of the complications of pregnancy which occur early enough are difficult to avoid unless a pre-pregnancy health check up and counselling is done. This becomes especially important if you have chronic diseases like diabetes, hypertension, epilepsy, obesity etc. For example in diabetes if you have uncontrolled sugars, the risk for abortions and having a malformed baby is high. This risk can be minimized if the sugars are well controlled when planning for pregnancy.
There is no such ideal time for becoming pregnant. But because of the increased risk for complications after 35 years it is advisable to complete family before 35 years of age. The ideal gap between 2 pregnancies would be 2 years to allow for the complete care of the elder one including lactation and for full recovery of the health of the mother.
At the Pre-pregnancy counselling visit, the doctor takes a detailed history and makes necessary examinations. If the lady has not undergone her routine pap smear, then pap smear for cervical cancer screening is also taken at the same visit. Basic blood investigations and any particular test based on the history and examination if required are sent during pre-pregnancy consultation.
Your BMI will be measured and your doubts regarding proper diet and exercise will be addressed during the pre-pregnancy consultation. The diet should be a well balanced one. Preferably home cooked meals are advisable to avoid stomach upsets. Any exercise programme which you have been doing can be continued. This may require slight modification once you are pregnant to avoid strain on the tummy.
The medicine which is usually prescribed is folic acid. This should be started at least 1 month prior to conception. Folic acid deficiency is associated with defects in development of the baby’s spinal cord, increased risk for abortions, anemia etc. Hence folic acid supplementation is advisable when trying for conception.
If your first conception is after 40 years, then definitely you should have a health check up and pre-pregnancy counselling before planning for pregnancy. This will tell whether you are healthy enough to carry a baby without causing grave complications to your health.
As age increases, people tend to be at increased risk for developing hypertension, diabetes etc. When you have such illnesses, pre-pregnancy counselling visit ensures the control of the disease, modification of the medicines being taken, folic acid supplementation etc. becomes absolutely necessary.
During pregnancy, older women tend to have increased risk of developing pregnancy induced hypertension, diabetes, premature labour etc. It would be better to have pregnancy care at a secondary or tertiary centre where if required doctors from other specialties can also be involved in your care.
The problem older ladies who get pregnant for their first time faces is that they may have growths called fibroids in their uterus which are probably first detected in their first scan in pregnancy. Fibroids in pregnancy can cause abortions, premature labour etc.
Advancing age is also associated with fetal chromosomal abnormality like Down’s syndrome. These can be screened for by an ultrasound and blood tests at 12 weeks.
Miscarriage is a very disappointing thing to happen and having recurrent miscarriages is very tragic. Having a single miscarriage does not lessen your chances of having a normal pregnancy, but having 2 or more miscarriages reduces your chances of having a normal pregnancy to some extent. In other words, a single abortion may occur by chance but if you have 2 or more abortions there may be a likely cause in 50% of the cases which needs to be treated to get a normal outcome.
Miscarriages occurring early (<10 weeks) are more likely due to some genetic defect in the baby so that baby doesn’t grow well. The other reasons for early miscarriages may be uncontrolled sugars in the mother.
Late pregnancy loss after 10 weeks could be due to antibodies in the mother causing abnormal clotting (APLA syndrome). It could also be due to structural problems in the uterus like presence of big fibroids inside the uterus, bands or walls inside the uterus or due to problems with mouth of the uterus (cervix) which gives way even before time.
When you have two or more abortions, consult a doctor to check for any particular cause like this. If diabetes is found it can be controlled, fibroids can be removed before the next pregnancy, band or septums may be removed before next pregnancy. If antibodies are found (APLA), treatment with medicines for blood thinning markedly improves the pregnancy outcome. Sometimes a chromosome check of the parents may be required and if found abnormal a genetic counselling may be required.
Sometimes no cause may be found and we may have to closely follow up the subsequent pregnancies.