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If you're thinking about having a baby, don't wait for the results of a home pregnancy test before seeing a doctor. The best time to have that first prenatal visit is before you become pregnant: a healthier you could mean a healthier baby.

Pre-conceptual counseling, as it is called, helps educate women so they can be physically and emotionally prepared and healthy for pregnancy. Pre-conceptual counseling is catching on, as more health care providers emphasize preventive health measures. However, some 45 percent of pregnancies in the United States are either unintended or unplanned, according to the nonprofit Alan Guttmacher Institute.

The March of Dimes Birth Defects Foundation wants women to know that there are things they can do before they conceive, including consulting with their doctor, to help their baby be born healthy. The first few weeks of pregnancy are crucial: that is when a fetus's vital organs begin forming.

Identifying health risks

During pre-conceptual counseling, a doctor can evaluate a prospective mom's health and identify any health risks.

Bruce K. Young, M.D., the Silverman Professor of Obstetrics and Gynecology at New York University School of Medicine and director of the Division of Maternal and Fetal Medicine at New York University Medical Center, says a woman can expect the following during a preconception visit:

• Physical exam
• Review of her medical history
• Review her family's medical background
• Questions about her diet and social habits, such as whether she drinks or smokes
• Review of past pregnancies, birth control use, medication and immunizations
• Referral for genetic counseling, if needed

"A medical history reveals 70 percent to 80 percent of what you are going to find in diagnosis, and a physical exam gives 15 percent to 20 percent more," Young says.

If a woman has a medical disorder, such as diabetes, hypertension or epilepsy, the doctor can make sure she is treated and the condition is under control before she gets pregnant.

Young says patients should also know their family history and query family members on any health condition that might run in the family. "Sometimes Mom and Dad don't like to talk about what Granny or Aunt Bessie had, so it's good to talk to them about this and ask them very specifically," he says.

Such a discussion can help the doctor identify risk factors and make a referral for genetic counseling, if appropriate.

The importance of diet and vitamins

An assessment of a patient's diet is another important element of pre-conceptual counseling. A woman should attempt to reach her ideal body weight before conceiving. Underweight women are at increased risk to deliver a baby with low birth weight, whereas an overweight woman is at increased risk for maternal complications such as hypertension and gestational diabetes.

All women, even if they are well nourished, should begin prenatal vitamins before they are pregnant, particularly folic acid, which has been proven to prevent certain birth defects, Young says. Folate prevents 50 percent to 70 percent of neural tube defects, such as spina bifida, where the brain or spinal cord does not form properly.

The March of Dimes recommends taking 400 micrograms of folic acid daily before conception and in early pregnancy.

Counseling regarding a woman's social habits, such as tobacco and alcohol use, is another crucial part of a preconception visit. Most women know they should avoid tobacco or alcohol during their pregnancy, however, they may underestimate the importance of quitting beforehand.

Cigarette smoking increases a woman's risk for miscarrying and for delivering a low birth-weight infant. Drinking alcoholic beverages can cause Fetal Alcohol Syndrome, a pattern of birth defects that includes mental retardation, as well as cardiovascular, skeletal and facial abnormalities.

"By and large, as long as you lead a relatively normal life and are not exposed to toxic substances, you're not going to have a problem,'' Young says. "Pregnancy, very often, has a perfectly wonderful outcome."

However, he says, pre-conceptual counseling can help increase the odds for a healthy pregnancy and a healthy baby because medical conditions can be managed, risk factors modified and health habits improved.

External Resources: The National Women's Health Information Center The National Healthy Mothers, Healthy Babies Coalition March of Dimes The American Dietetic Association

This article was published on 2000-01-26
This article was reviewed on 2003-02-03