Earlier this year, researchers at Yale published their study demonstrating that women lack knowledge about their own fertility, ability to get pregnant, or risk factors that could keep them from getting pregnant. Some 40 percent of women studied were concerned about conception, and 40 percent were also unfamiliar with how ovulation, the very foundation of conception, works. This data underscores the importance of preconception care — seeing a doctor before getting pregnant to be in the best possible health at the time of conception.
As an obstetrician in a busy urban practice, I take care of women of all ages during their pregnancies. Frequently, there is a sense that pregnancy is just something that happens to a woman, whether planned or unplanned. A woman often seeks medical care for the first time after she’s already pregnant. Or, women do not seek help until they’ve failed to conceive for a long time. Either way, opportunities for patient education and improving health prior to pregnancy are lost.
This knowledge deficit could hurt even more pregnant women as birth rates rise. Last week, the Centers for Disease Control released their annual report on birth rates, which reveals some positive trends. In 2013, there were 3.96 million births in the United States, which is slightly more than the previous year. The number of teenage girls’ births also dropped from the year before, following a trend that began in 2007. In contrast, and likely good news to many who choose to delay pregnancy, is that the birth rates for women in their late '30s and early '40s increased, and are at the highest rates since the 1960s.
The idea behind preconception care is that the health of mothers and babies is improved by optimizing a woman’s health before and around pregnancies, no matter the age of the pregnant woman. Generally speaking, women are capable of reproducing for four decades of their lives, and medical conditions and pregnancy planning can differ greatly at different ages. Women may not have accurate information about how fertility changes with age, or the risks that their medical problems bestow on a pregnancy.
Women should have continuous care from their primary care physicians and gynecologists to obtain accurate and helpful information. Problems or conditions that could impact pregnancy may be found, and the period before conception occurs is the best time to identify these, so that measures might be taken.
Some women have medical problems that need improvement before pregnancy, such as diabetes. Women with diabetes have much healthier pregnancies if their blood sugars are controlled before getting pregnant.
Some conditions can affect a woman’s ability to conceive, and women may need specialized care to improve these conditions. Couples could have genetic disorders or other inherited diseases that impact the health of their future children, and these couples may need referrals to genetic counselors.
A common example is hemophilia, a condition in which life-threatening bleeding occurs. This genetic condition is passed through families, and parents should have access to testing options.
As simple as it sounds, some women just don’t know how to best achieve pregnancy, or don’t know about resources available to them. Some women work in places where they are exposed to substances that could be harmful to a pregnancy, so they would need information about limiting those exposures.
For example, an x-ray technician in a hospital ought to discuss with her doctor ways to reduce radiation exposure in early pregnancy. Some immunizations can’t be given in pregnancy, so receiving certain vaccinations may be required before conception. Rubella, also known as German measles, is an infection that can cause problems in pregnancy. It is preventable through vaccination, but the vaccination must given before conception, and can’t be given during pregnancy.
The responsibility of preconception care does not fall solely on women, but also on their healthcare providers. All practitioners caring for reproductive-aged women need to ask their patients about pregnancy plans, identify opportunities for improving health before pregnancy, and need to educate women about the risks of lifestyle habits on a new pregnancy.
Providers should discuss issues including smoking cessation, avoiding alcohol, and healthy diet and exercise habits. Simply knowing to take a vitamin with folic acid can decrease the risk of a neural tube defect, a birth defect of the brain and spinal cord. Women will not always bring up these issues on their own, and many don’t realize what they should incorporate or discard even prior to pregnancy, so it’s up to practitioners to realize the importance of these conversations.
Sure, most women have good outcomes during pregnancy, and most babies and children are healthy. But isn’t it a shame to think that some moms and babies could have done better if only a doctor had helped in planning for pregnancy?
People are now learning about the importance of preventative health — health measures that help people avoid developing certain illnesses or conditions. For women, preventative health includes mammograms for breast cancer screening, Pap smears for detecting cancers of the cervix, and this essential preconception care. We need to move away from managing or “fixing” medical problems after they’ve developed — we must focus on reducing risks. Preconception care is critical part of the health care of women … and their future babies.
Dr. Jessica Kiley is an obstetrician-gynecologist in Chicago, and Assistant Professor of OB/GYN at Northwestern University’s Feinberg School of Medicine.