Monday Medical: Pre-pregnancy care
For Steamboat Pilot & Today
Thinking about getting pregnant can be an exciting time. But for women who have certain health conditions or who have had a difficult pregnancy before, it can be downright scary.
Preconception care can help.
Below, Dr. Teresa Harper, a maternal and fetal medicine specialist with University of Colorado School of Medicine on the Anschutz Medical Campus who also sees patients at UCHealth Women’s Care Clinic in Steamboat Springs via virtual visits, outlines what preconception care is and how it can make a big difference in pregnancy.
What is preconception care?
“Preconception care is care provided by a physician to a woman planning or considering pregnancy, before she is pregnant,” Harper said.
A preconception visit may be as easy as getting recommendations for prenatal vitamins and the reminder not to change the cat litter, or it can be more involved, with your doctor creating a plan to help manage health conditions or prevent pregnancy complications.
While any woman can see a maternal and fetal medicine specialist for preconception care, Harper most often sees women who have a medical condition, such as diabetes or high blood pressure; women who have had challenges conceiving on their own; women who take multiple medications; and women who have had an issue with prior pregnancies, such as preterm delivery or stillbirth.
“Laying out a plan of care for these women is amazing,” Harper said. “They go from a lack of confidence that they’ll be able to have a successful pregnancy, to having a reassuring plan.”
How does preconception care help?
While studies are ongoing about the difference preconception care may make, there are signs that it can have a big impact.
For instance, women with uncontrolled diabetes can have up to a 25% risk of having a baby with a serious birth defect. “Whereas, if we can get their diabetes under control, that birth defect risk can drop down to baseline level,” Harper said.
Similarly, certain medications used for anxiety, depression or bipolar disorder may carry a relatively high risk of birth defects. A maternal and fetal medicine doctor can work with a psychiatrist to recommend alternative medications that are also effective, but without that risk.
For women who have had a preterm birth, steps, such as taking a progesterone supplement or putting a stitch in the cervix if it begins to shorten, can reduce risks of a second preterm birth by 30%. And for women who previously had a stillbirth, Harper can look for ways to dramatically decrease the risk of it happening again.
“There are just so many things we can do,” Harper said. “People feel so empowered going back and making sure they didn’t do anything wrong in that previous pregnancy, which of course they virtually never did.
“There’s no joy in pregnancy after a loss — these women can be terrified. But we provide a sense of hope and control, and a plan.”
Anyone thinking about getting pregnant should consider preconception care. In most cases, it is covered by insurance.
Women who think it may be helpful to see a maternal and fetal medicine specialist can make an appointment or call for more information.
What if the recommended changes seem hard?
Lifestyle changes can feel overwhelming. But Harper helps provide tools to make changes, such as losing weight or quitting smoking, easier.
“This is one time in people’s life that lifestyle modifications are relatively effective,” Harper said. “People will do things for their future babies that they won’t do for their future selves.”
And, she reminds women that nothing has to be perfect.
“Even if you don’t follow every single guideline perfectly, everything you do to take a step towards improved health can improve a pregnancy outcome,” Harper said.
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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