Requisite for risk assessment of pregnancy to the woman and to the foetus
A simple consultation with a gynaecologist three to six months before planning your pregnancy can make for a healthy baby and mother. Pre-conception counselling as the first step before getting pregnant can reduce maternal and neonatal deaths by correcting abnormalities in mother and ruling out possible birth defects in the baby.
Pre-conception counselling is requisite for risk assessment of pregnancy to the woman and to the foetus. The session may incorporate blood tests and ultrasound tests for women with pre-existing conditions, multiple pregnancy losses and children with disabilities.
Correcting folic acid deficiency before pregnancy can rule out various defects like cleft lip, cleft palate and neural tube defects in newborns, says Ramani Devi, vice-president, Tiruchi Obstetrics and Gynaecological Society (TRIOGS). Folic acid supplements are vital for married women to rule out deficiency-related problems. Thyroid deficiency is another important condition to be corrected as uncorrected hypothyroidism may pass on the child and is a significant cause for low intelligence and mental retardation in children. Obese women with menstrual irregularities are also advised to get a thyroid screening.
The risk of anomalies or birth defects in offspring is three times higher for women with diabetes, notes the obstetrician. Pre-conception counselling can help to control blood glucose levels as diabetic mothers can conceive children with vertebral, anal, trachea, renal, oesophageal defects or reduction in size of limbs.
Counselling for women with epilepsy or recurrent seizures is significant in managing medication before pregnancy. They maybe advised to switch to drugs considered safer for the foetus. Women with cardiac disease and hypertension are warned if there are chances of their conditions replicating in the foetus. They may require a foetal ECHO. “Women with such complications are advised conception at a tertiary care centre in case offspring are diagnosed with anomalies.”
Women with two or more miscarriages should go in for pre-conception counselling, insists Dr.Ramani. “Most causes for recurrent pregnancy losses are curable, unless they are due to genetic disorders. Major causes are diabetes or uterine anomalies like abnormal shape of uterus. A disorder called antiphospolipid syndrome where the body produces antibodies against its own proteins, causing thrombosis or clots in the arteries, is another common cause of miscarriage. But all these are correctable.”
Couples having children with disabilities or mental retardation, Downs Syndrome and muscular dystrophy will benefit most from a pre-conception counselling, says foetal medicine expert, Malathi Prasad.