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Care Before Pregnancy


Planning
Not all pregnancies can be planned. Both human and technological errors occur with all methods of family planning. Planning, however, has definite benefits; healthy pregnancies are most likely to occur in healthy women. Effective methods of contraception should be used until you know you want to get pregnant. Although many forward-thinking doctors have informally provided preconception care to women for decades, the concept that this is a distinct type of care visit has only recently gained wide acceptance.

If you are planning to become pregnant within a year, or are actively trying to get pregnant, and have not discussed your plans with your gynecologist or nurse practitioner, you should call for an appointment. Screening tests that can pick up potential problems for a pregnancy were probably not conducted at your routine annual gynecologic visit, not were you likely to have been given information regarding self-help measures and practices to aid in preventing birth defects and other problems that can occur in pregnancy. These measures can be most important even before you know you are pregnant. A few birth control methods, such as Norplant or the IUD, require a health care visit for removal. This would be a good time to have preconception care. If you use Depo-Provera, you can combine a preconception visit with your last shot.

Preconception Visit
The preconception visit gives you and your practitioner the opportunity to review specific risks that might complicate your pregnancy, to screen for and treat undetected conditions that could affect your pregnancy adversely, and to discuss pregnancy specific health promotion activities. These include nutrition and nutritional supplementation, smoking cessation, and avoidance of toxic substances such as alcohol, drugs, and even some over-the-counter medications.

Assessment of pregnancy risk and health screening are carried out through a complete health history, a physical examination that includes a pelvic exam, and certain laboratory tests. The history will cover medical, menstrual, obstetric, and gynecologic issues. Any previous pregnancies will be discussed in detail, especially if you had problems. You will be asked questions about your psychological well-being.

You will be asked questions about your sexual health, including any history of sexual abuse and your risk of acquiring sexually transmitted diseases. The health of your partner will be included in the history taking. Laboratory test will be done for anemia, sexually transmitted diseases, cervical cancer, and German measles (rubella). You may be tested for chicken pox (varicella) if you canít remember having the disease, and tuberculosis if you live in an area where it is common. Your sugar may also be checked if you are at risk for diabetes and show diabetic symptoms.

Some women are at risk for hepatitis B, a serious viral infection for the liver that can be passed to fetus during pregnancy. The federal governmentís Centers for Disease Control and Prevention recommend that all pregnant women be screened for this infection. If you have a cat or eat rare or raw meat, you can be tested for toxoplasmosis, although this is not commonly done.

Nutrition
Women who are either overweight or underweight should use this planning time to try to achieve a healthful weight. Women who are underweight at the start of pregnancy tend to have smaller babies, even if they gain as much weight during pregnancy as somebody who starts her pregnancy at normal weight for height. Optimal weight should be achieved through a well-balanced diet. If you have an earlier disorder, such as anorexia, bulimia, or pica (eating nonfood substances), this is the time to seek help from therapists and care providers skilled in these areas and to consider joining a support group. Little is known about whether the fatherís nutrition can affect the developing fetus. It is known, however, that four nutrients are essential sperm: vitamins A and E, linoleic acid (a type of fatty acid), and zinc. In general, a well-balanced diet will supply these nutrients. [an error occurred while processing this directive]