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Pre-conception counseling
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<h2 id="obstacles-to-pre-conception-counseling">Obstacles to pre-conception counseling</h2> <p>A common obstacle to pre-conception counseling and assessment is that many pregnancies are still unplanned. Globally, 38% of pregnancies are unintended.<a class="footnote-ref" id="fnref:4" href="#fn:4"><sup>4</sup></a> For this reason, many experts recommend that all women of childbearing age be offered preconception care counseling regardless of intent to become pregnant.<a class="footnote-ref" id="fnref:5" href="#fn:5"><sup>5</sup></a> </p><p>Another common obstacle to pre-conception counseling and assessment is of women not knowing, realizing, or understanding the benefits of visiting their physician or <a href="/facts/Midwife/TPmf0st6">midwife</a> before trying to become pregnant. Most women still take for granted the biological aspects of becoming pregnant, and do not consider the value of pre-screening before becoming pregnant. Most women who want and anticipate having a baby are naturally prone to thinking in terms of having a well baby. In the majority of cases, women do not think about having a baby who has any kind of problem. Most women do not know how their own medical history could pose risks to a developing <a href="/facts/Fetus/evocHd0Y">fetus</a>. Likewise, they may not understand that pregnancy carries a certain number of risks as well. When family history risks and pregnancy risks are considered together, it may point to potential problems for that particular woman, or to her unborn baby once she becomes pregnant.Therefore, comprehensive pre-pregnancy counseling and genetic screening can be invaluable in preparing for a healthy pregnancy and minimizing these risks. </p> <h2 id="what-is-involved-in-pre-conception-counseling">What is involved in pre-conception counseling</h2> <h3>Questionnaire</h3> <p>Pre-screening covers many body-system areas (not just the reproductive organs), as well as aspects of the woman's lifestyle, and family history information. It begins with basic information and becomes more in-depth, especially if the woman has had previous illnesses, diseases, etc. Pre-screening assessments begin with a questionnaire which the woman fills out, generally before seeing the physician or <a href="/facts/Midwife/TPmf0st6">midwife</a>. Some offices have the woman go over parts of the questionnaire with a <a href="/facts/Nurse_Practitioner/GGINrFkT">Nurse Practitioner</a>, if available. </p> <h3>Blood work</h3> <p>Certain blood work may be ordered. Preconception counseling and testing identify couples at risk for hemoglobinopathies that might affect their offspring.<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a><a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a> This often includes a <a href="/facts/Complete_blood_count/NF9lNJL3">CBC</a> (Complete Blood Count) which can show <a href="/facts/Anemia/AgEPPmg8">anemia</a>. A CBC includes <a href="/facts/White_blood_cell/vsDunUK0">WBC</a> (White Blood Cell Count) which can show the presence of infection. Anemia and infection, indicating problems with the woman's overall health at that moment, can both affect a woman's ability to become pregnant at that time as well as affect the stability of the pregnancy and the health of the fetus. In the majority of cases, both infection and anemia can be treated once the cause is identified. Anemia may require ongoing evaluation and iron supplement. Based on these results, patients may be offered genetic counseling, hematology consultation, and fetal diagnostic testing. </p> <h3>Urinalysis</h3> <p>Urine sample or <a href="/facts/Urinalysis/PeS2UfIG">urinalysis</a> can reveal the presence of <a href="/facts/Proteinuria/cFXX8w1F">proteinuria</a> (protein in the urine), a possible indicator of infection or kidney disease, or the presence of blood which can indicate a <a href="/facts/Urinary_tract_infection/4NwY9tL0">urinary tract infection</a>. Urinalysis might also show the presence of glucose (<a href="/facts/Glycosuria/af605y5o">glycosuria</a>), but women of child-bearing age are unlikely to have undiagnosed diabetes (this is separate from <a href="/facts/Gestational_diabetes/1Nn5kF5G">gestational diabetes</a> that may occasionally develop during the course of a subsequent pregnancy). </p> <h2 id="using-the-assessment">Using the assessment</h2> <h3>Physicians</h3> <p>When women have pre-existing illnesses / conditions / diseases, these may add to pre-natal risks and will need ongoing evaluation. Also any medications which are used to treat these conditions will need monitored and possibly reduced or increased. </p><p>The presence of Diabetes remains a huge risk for the unborn child, and a woman will be screened specifically for this condition. Known diabetics will need monitored closely. For more information, see this online article Diabetes and Diabetic risks.<a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a> </p> <h3>The woman's role</h3> <p>A woman may need to adjust certain aspects of her health and well-being which are in her control. These usually include aspects of lifestyle, drug and alcohol use, exercise, rest and stress reduction. In addition, she may need to discontinue certain herbs or over-the-counter medications as recommended by her healthcare provider. Many physicians will also recommend pre-natal vitamins before a woman actually conceives in order to boost her overall health. </p> <h2 id="in-the-united-states">In the United States</h2> <p class="note">Main article: <a href="/facts/Pre-conception_counseling_in_the_United_States/PCSB1Woy">Pre-conception counseling in the United States</a></p> <p><a href="/facts/Pre-conception_counseling_in_the_United_States/PCSB1Woy">Pre-conception counseling in the United States</a> is recommended to include:<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> </p> <ul><li>Height and weight to calculate <a href="/facts/Body_mass_index/UX4YrUTx">BMI</a></li> <li><a href="/facts/Blood_pressure/VtqqSM2J">Blood pressure</a></li> <li><a href="/facts/Medical_history/P2xSfuYF">Medical history</a></li> <li><a href="/facts/Abdominal_examination/yJUoxlqP">Abdominal</a> and <a href="/facts/Pelvic_examination/0872q0hz">pelvic examination</a></li> <li><a href="/facts/Pre-conception_counseling_in_the_United_States/PCSB1Woy">Rubella screening</a></li> <li><a href="/facts/Pre-conception_counseling_in_the_United_States/PCSB1Woy">Varicella screening</a></li> <li><a href="/facts/Pre-conception_counseling_in_the_United_States/PCSB1Woy">Domestic violence screening</a></li> <li>Depression screening</li> <li>Testing for <a href="/facts/Gonorrhea/xulQCkLF">Gonorrhea</a> and <a href="/facts/Chlamydia_infection/bcKTIM1L">Chlamydia</a> for women at high risk for <a href="/facts/Sexually_transmitted_disease/IYL1rxdI">STDs</a></li></ul> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/List_of_counseling_topics/NegQy5mS">List of counseling topics</a></li> <li><a href="/facts/Genetic_testing/H21wH0ze">Genetic testing</a></li> <li><a href="/facts/Designer_baby/R3K7PRSU">Pre-implantation genetic diagnosis</a></li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>Williams, Letitia; Zapata; D'Angelo; Harrison; Morrow (2012). "Associations between preconception counseling and maternal behaviors before and during pregnancy". Matern Child Health J. 16 (9): 1854–1861. doi:10.1007/s10995-011-0932-4. PMID 22173331. S2CID 12433235. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>"Preconception health". womenshealth.gov. 13 December 2016. Retrieved 9 August 2019. <a href="https://www.womenshealth.gov/pregnancy/you-get-pregnant/preconception-health" target="_blank">https://www.womenshealth.gov/pregnancy/you-get-pregnant/preconception-health</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>"Get Ready for Pregnancy". March of Dimes. October 2013. Retrieved 4 November 2014. <a href="http://www.marchofdimes.org/pregnancy/getting-healthy-before-pregnancy.aspx" target="_blank">http://www.marchofdimes.org/pregnancy/getting-healthy-before-pregnancy.aspx</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Speidel JJ, Harper CC, Shields WC (September 2008). "The potential of long-acting reversible contraception to decrease unintended pregnancy". Contraception. 78 (3): 197–200. doi:10.1016/j.contraception.2008.06.001. PMID 18692608. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>Coffey, Kevan; Shorten, Allison (22 August 2013). "The challenge of preconception counseling: Using reproductive life planning in primary care". Journal of the American Association of Nurse Practitioners. 26 (5): 255–62. doi:10.1002/2327-6924.12054. PMID 24170712. S2CID 25404691. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>Sabath, DE (1 July 2017). "Molecular Diagnosis of Thalassemias and Hemoglobinopathies: An ACLPS Critical Review". American Journal of Clinical Pathology. 148 (1): 6–15. doi:10.1093/ajcp/aqx047. PMID 28605432. <a href="https://doi.org/10.1093%2Fajcp%2Faqx047" target="_blank">https://doi.org/10.1093%2Fajcp%2Faqx047</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>Vrettou, C; Kakourou, G; Mamas, T; Traeger-Synodinos, J (May 2018). "Prenatal and preimplantation diagnosis of hemoglobinopathies". International Journal of Laboratory Hematology. 40 (Suppl 1): 74–82. doi:10.1111/ijlh.12823. PMID 29741247. <a href="https://doi.org/10.1111%2Fijlh.12823" target="_blank">https://doi.org/10.1111%2Fijlh.12823</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Herman, William H.; Denise Charron-Prochownik (Summer 2000). "Preconception Counseling: An Opportunity Not to Be Missed". Clinical Diabetes. 18 (3): 122. <a href="http://journal.diabetes.org/clinicaldiabetes/V18N32000/pg122.htm" target="_blank">http://journal.diabetes.org/clinicaldiabetes/V18N32000/pg122.htm</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>Health Care Guideline: Routine Prenatal Care. Fourteenth Edition. Archived 5 July 2008 at the Wayback Machine By the Institute for Clinical Systems Improvement. July 2010. <a href="http://www.icsi.org/prenatal_care_4/prenatal_care__routine__full_version__2.html" target="_blank">http://www.icsi.org/prenatal_care_4/prenatal_care__routine__full_version__2.html</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> </ol>