Dr Renu Sharma, Dr Harleen
The news of pregnancy is a joyous moment not only for the conceiving couple but also for the whole of the family. The expected outcome is a healthy mother with a healthy baby. Most people know that it is very important to take care of the expecting mother during pregnancy, which is “antenatal care.” However, people are unaware that the care of the woman and her partner should start before she becomes pregnant. The aim is that whenever she conceives, she is in the best of her health. It has been noticed there are a number of risk -factors present before pregnancy that can adversely affect pregnancy outcomes. If these risk factors are addressed before conception, pregnancy-related complications are decreased and maternal and neonatal health improves. Not only this, but it also acts as a window period during which we have an opportunity to improve the overall health of the women, which they often neglect due to various socio-cultural factors.
This care provided to a reproductive-age woman/couple in the form of various biomedical, social and behavioral interventions before conception is referred to as “Preconception care.” WHO has also stressed the need for the development of policies by its member nations to provide Preconception care depending on their own social, cultural and economic situations. National Family Health Survey 5(NFHS- 5) 2019-21 from India shows that the number of women receiving antenatal care has already increased up to 94%. So, in order to achieve the Sustainable Development Goal 2030 of a national maternal mortality rate of <70/100,000 live births and a neonatal mortality rate of < 12 /1000 live births, it is essential to focus on preventive preconception care services along with strengthening already existing antenatal care services.
In India, like many other nations, people do not receive preconception care due to various factors such as lack of awareness, unavailability of dedicated centers for preconception care, and about 50% of pregnancies are unplanned. So, by the time a woman reaches a hospital, she is already pregnant by 2-3 months and many risk factors have already affected the unborn baby. This is especially true in rural India, where most of our population resides.
The various components of Preconception care are-
Health awareness and education- Preconception care is about health promotion and prevention. So, the woman is educated about the importance of a healthy diet, good eating habits, exercise and importance of weight management
Nutritional supplementation-
* Folic acid supplementation-Folic acid is a vitamin (Vitamin B9), important for the prevention of birth defects like spine and brain defects. Folic acid tablets must be started 1-3 months before pregnancy in women who are planning for it.
* Screening, prevention and treatment of anemia (Low hemoglobin)-About 57% of reproductive-age women and 53% of pregnant women have low hemoglobin levels in India. Anemic women are prone to complications like low birth weight babies, premature births, infections, excessive blood loss during pregnancy, etc. Hence, women are tested for Hb levels preconceptionally and if found anemic, they are educated to take iron, vitamin C, and a protein-rich diet. Simultaneously, iron tablets or injections are prescribed and deworming is done.
Obesity- The prevalence of obesity is increasing day by day in our population due to faulty dietary habits and a sedentary lifestyle. According to NFHS-5, around 40% of Indian women have abdominal obesity making them prone to metabolic diseases like Type II diabetes, hypertension, stroke, and heart attacks. Infertility is also common in such females and when these women become pregnant, they have more chances of pregnancy-related complications. Children born to them have more risk of developing obesity and other metabolic diseases in their later life. Such women are counseled for weight management through behavioral changes, dietary modifications and regular exercise.
Screening and management of chronic medical disorders like hypertension, diabetes, hypothyroidism, epilepsy, heart disease, etc. is an essential component. Many patients remain undiagnosed until some complication arises during pregnancy. During their visit to a health center, women are screened by measuring their blood pressure and checking blood sugar levels and treated to achieve optimal control before pregnancy. Also, not all antihypertensive, antidiabetic or antiepileptic medicines are safe during pregnancy and can cause harm to the unborn child. Therefore, such medicines are replaced by safer medicines that are non-teratogenic and produce no harm.
The immunization status of the woman is checked. There can be mother-to-child transmission of diseases like Hepatitis B and Rubella, against which protective vaccination is available. These vaccinations must be given before pregnancy if, she is not immunized earlier. Pregnancy is avoided for one month after the Rubella vaccination.
Screening for genetic or familial diseases and genetic counseling- There are some diseases that run in the families and the number of children affected and the severity of the disease depends upon the pattern of inheritance. Family history is taken about such diseases and specific tests are done in case of positive family history, followed by genetic counseling on the basis of test reports. Thalassemia, one such blood disorder, is very common in our part of the world and it is better if the couple is screened beforehand. Other such genetic diseases are some types of muscular dystrophy, sickle cell anemia, cystic fibrosis, etc.
Substance abuse- During this era, many women suffer from substance abuse like alcoholism, smoking, etc., which proves harmful not only for the female but also for the growing baby in the womb. Counseling and behavioral interventions are done in such cases
Today, everybody is aware of the influence of environmental factors on health. Many women are exposed to pesticides while working in fields, indoor pollution at homes and harmful chemicals like lead and mercury at factories. Women are counseled about their ill effects and are encouraged to take adequate precautions. Besides this, mental health issues and intimate partner violence are also taken care of.
If a woman is not planning for pregnancy, then family planning services are offered because studies have shown that unwanted, unplanned pregnancies do not fare well. It provides liberty to the women to get pregnant at the right time chosen by them while taking care of their own health and that of their would-be babies. Also, reproductive tract infections responsible for the chronic ill-health of many females are managed.
In a nutshell, preconception care provides an opportunity to improve the overall health of women in a holistic fashion. These healthy women can procreate healthy offspring, leading to healthy future generations. Hence, couples should not wait till pregnancy to visit a health facility and preferably go to a doctor or obstetrician before conception to optimize their health and have better pregnancy outcomes.
(The authors are, Associate Professor and Assistant Professor, Department of Obstetrics & Gynaecology, AIIMS Jammu)
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