Should we try to conceive right now? This question should not be asked only by a couple. Before you conceive, talk to your doctor especially if you have pre-existing illnesses such as diabetes or a medical history of high blood pressure.
When the first ante-natal clinic comes too late
Some time back, a woman came to see me for her first clinic visit. She was in her second trimester. I asked her about her medical history and she told me that she has been epileptic since childhood but was on medication all through. I was relieved to hear she was fine, but I was very concerned when she mentioned the name of the anti-epileptic drug she was on since it can cause severe fetal anomalies especially if taken during the first trimester. It was too late!
Another woman came for her first visit. She was in the middle of her second trimester as well. She told me she developed preeclampsia in a previous pregnancy and she had been hypertensive ever since. I noted down in the file that she should have received Aspirin from 12 weeks of her pregnancy which significantly reduces the risk of recurrence of preeclampsia, which can be fatal. Too late now!
A third woman steps into my office. She is diabetic and in her first trimester. She admits her blood sugar hasn’t been so well controlled before she got pregnant. I look at her HbA1c level— a blood test telling me how her sugars have been on average the last three months. It is bad. I know how poorly controlled sugar levels can cause fetal anomalies during the first trimester. But it is too late now!
These are everyday examples of patients with medical conditions who all would have benefitted from pre-conception care. Pre-conception care prepares you for pregnancy even before the test turns positive.
Pregnancy can affect your medical condition
Nowadays, many women are battling with different medical conditions. It could be diabetes, hypertension, sickle cell, rheumatic, cardiac or kidney diseases, or mental illness. Some are on treatment but sadly a pregnancy can easily worsen the condition.
Beyond the growing belly, the body undergoes enormous changes, affecting essentially all organs from the very first days of pregnancy. Many of these changes are invisible to the eye but not less important. These changes can make it difficult for the body to cope if there is already a medical illness to battle. A pregnancy in a woman with a medical illness can represent a risk both to the mother and the baby. In addition to this, many drugs used to treat certain illnesses can be dangerous to the growing fetus.
For these reasons, the obstetric care of a woman with a medical condition should start before she gets pregnant for doctors to ensure the safest possible pregnancy and delivery. The care starts at the pre-conception clinic.
The importance pre-conception review
A pre-conception review is a medical evaluation done to a woman looking to get pregnant. The review serves many purposes for the potential mother. These include:
· It allows doctors to change any medication the potential mother is taking, to pregnancy-safe alternatives.
· Doctors can optimise the control of any pre-existing disease before the pregnancy-induced body changes make this more challenging.
· This ensures that all necessary investigations are done in a good time.
· Doctors can decide on safe family planning methods as they wait for the disease to be well controlled and it is safe to try to conceive.
· Doctors can provide the woman with knowledge about the reproductive effects of her condition and make sure she understands the safety profile of the medication she is using.
· This gives the patient control over her condition – not the other way around! Unfortunately, some women have more complicated pregnancies than others. However, thorough pre-conception care and planned pregnancies significantly improve the outcome for women with pre-existing medical conditions – and that brings us back to our main goal – a healthy baby delivered by a healthy mother. It is not too late!
Dr Gichere is an obstetrician/gynaecologist at Aga Khan University Hospital, Nairobi.