The pandemic seems to have led to a baby boom, worldwide. From Anushka Sharma and Kareena Kapoor Khan, who gave birth to a daughter and son respectively, to Gal Gadot and, of course, Meghan Markle and Prince Harry’s second baby—celebrities across the world have grown their families. But planning for pregnancy can mean a big change in your life and most often you will find yourself flooded by information from different sources. Doubts and confusion are inevitable and part of the learning process. Our expert Dr Anuradha Panda, gynaecologist, obstetrician, laparoscopic robotic surgeon, Department of Obstetrics and Gynaecology, Apollo Hospitals, Hyderabad shares pregnancy tips covering everything we need to know about preconception planning and prenatal care, from health checkups to pregnancy diet plan. Preconception counselling and care is intended to enhance a woman’s health before she embarks on pregnancy.

“Ideally a visit to the gynaecologist should be planned at least 3 months before planning for pregnancy. Creating a healthy intrauterine environment will establish a lifetime of health for your baby. With this simple preconception care, cases of preterm birth, underweight babies, diabetes mellitus and heart disease in babies can be avoided later in life,” says Dr Panda. “Preconception planning also includes screening for infection, polycystic ovaries or any other gynae problems which may cause subfertility,” she adds.

 

 

Take Charge of Your Health Before Planning for a Baby

Increase your vitamin intake. Supplements like folic acid, Vitamin B12, Vitamin B6 should be started at least 2-3 months prior to pregnancy planning. Deficiency in folic acid leads to major malformations such as spina-bifida, menegomyclocle and anencephaly.

 

Schedule an appointment. Meet your doctor to assess thyroid health, weight and to rule out any other areas of concern. “Overweight and obese women are at risk of diabetes, hypertension, miscarriages and preterm births. Practice eating a balanced diet and indulge in exercise to achieve an ideal weight before planning,” says Panda. Speak to your doctor about previous bad obstetric history—recurrent pregnancy loss, birth trauma or stillbirth.

 

Review your medical history and screen for diseases. Discussing family history of sickle cell disease/thalassemia or other genetic conditions in the family is important. If there is any history of such conditions the couple can go for genetic counselling and carrier screening. Any medical history of epilepsy, diabetes, hypertension, thyroid disorders, heart disease or autoimmune diseases is important and should be discussed with your doctor.

 

Get checked for anaemia. Anaemia (low hemoglobin) should be corrected first. Iron deficiency in pregnancy leads to low birth weight babies and increases the risk of hypertension in pregnancy.

 

Get vaccinated. If tests show that you are not immune against Rubella, get vaccinated for it. Post-vaccination it is better to avoid pregnancy for 1-2 months. The Rubella virus can lead to serious complications such as sight, hearing and heart problems in the fetus.

1. Hepatitis B vaccination should be given for at-risk healthcare workers.
2. In terms of a COVID-19 vaccination, it is better to complete 2 doses before getting pregnant. The disease causes more complications in pregnant women near term. The vaccine can also be taken in pregnancy.

 

Trust your doctor with personal history. Refrain from using drugs, alcohol or tobacco. Women should be advised to stop these and practice lifestyle management as these indulgences can put the health of the fetus at risk. Go for a healthy pregnancy diet plan that includes green leaves, fruits, nuts and vegetables.

 

Discuss any ongoing medication. Certain medicines like anti-epileptic drugs have to be changed to medicines that are less harmful to the fetus at the lowest possible dose. Speak to your neurologist 3 months before planning. Folic acid should be added for better outcomes. Some women on blood thinning agents like warfarin need to stop and change their medication to an injection before planning.

 

Review diabetic history. Diabetic women should plan for pregnancy only when their sugar is well controlled. Their HbA1C levels should be less than 6.5 suboptimal control and certain drugs prescribed for diabetes mellitus cause defects in heart and spine.

 

History of heart disease. Patients need to consult their cardiologists to find out if it’s safe for them to become pregnant. According to a journal published by the FOGSI heart disease affects 0.3 to 5 percent of pregnant women. Early detection and correction before pregnancy (in the case of congenital heart disease) is safer for the mother.

 

Precautions for hypertension. Avoid certain drugs like ACE inhibitors and ARB which are teratogenic (causes abnormality) to the fetus. Consult your physician and start on antihypertensives that are safer.

 

Precautions for hypothyroidism. Women should never stop the medication (Eltroxin) before planning. Aim to maintain a TSH level less than 2.5 before planning. For proper growth, the fetus needs maternal thyroxine till 20 weeks, after which the fetus itself will produce it.

According to an article published by the US National Institute of Health, overt hypothyroidism has been linked to miscarriage, anemia, pregnancy-induced hypertension, postpartum haemorrhage, premature birth and low birth weight.

 

Screen for infections. Women planning for pregnancy should get tested for HIV, Hepatitis, Syphilis (VDRL) and other sexually transmitted diseases (STDs) if indicated. Screening for UTIs is also equally important. If untreated, UTI can lead to infection in the kidneys, which may further cause issues including premature birth. Early detection helps prevent any issues later in the pregnancy.

 

Pre-pregnancy Screening Checklist:

• Blood group Rh factor
• Complete blood picture and urine examinations and kidney functions test (creatinine)
• Sugars and HBA1C (if one is diabetic /or has PCOS)
• Thyroid function tests (TSH, T3, T4)
• Rubella IgG (for immunity against Rubella)
• VDRL, HIV tests
• Other tests may be suggested by our doctor if necessary.