A positive pregnancy outcome is the desire and expectation of every pregnant woman but only desire and expectation is not enough. Having a positive pregnancy outcome requires making preparations even before conception. Such preparation is what is referred to as ‘preconceptional care’.
Preconception care has been defined as a set of interventions that aim to identify and modify biomedical, behavioral and social risks to the woman’s health or pregnancy outcome through prevention and management. The goal of preconceptional care is to ensure a safe pregnancy and healthy baby while the objectives are to protect maternal and fetal health, prevent maternal and fetal morbidity and mortality and to prevent any form of Complications. But since it takes a man and a woman to produce baby, preconceptional care is for both the man and the woman in order to maximize health outcome. In fact all women and men in their reproductive age can benefit from preconception health, whether or not they plan to have a baby since not all pregnancies are planned and also because preconceptional care helps individual to achieve overall better health
In order to identify biomedical, behavioral and psychosocial risks that could impact pregnancy negatively, assessments must be done on the different aspects. And in order to modify these risks, health education, counselling and specific interventions such as vaccination, vitamin supplementation must be done.
The process of preconceptional care can be divided into three (3) which are:
- Specific interventions
Biomedical, behavioral and psychosocial assessments of the intending parent should be done to identify associated risks. This step determines the unique interventions/care for each couple.
- Biomedical assessments
This involves looking out for the presence of disease conditions or susceptibility to certain diseases. This is done through:
- Taking family health history e.g history of hypertension, diabetes in the family
- Taking past medical and surgical history. Does any of the couple suffer from conditions like asthma, diabetes etc.
- Taking past obstetrical history, that is past pregnancies experience
- Screening for infectious diseases e.g hepatitis, HIV.
- Observing the presence of any physical deformity that can be a hindrance to successful pregnancy outcome e.g hip deformity.
- Carrying out laboratory test like genotyping, blood grouping, full blood counts.
- Behavioral assessments
This involves identifying unhealthy behaviors that can pose dangers to the mother and baby. Examples of these risky behaviors include smoking, alcohol abuse and drug abuse.
iii. Psychosocial assessments
This involves assessing the couple’s Psychological readiness and other social factors that could impact pregnancy. This includes domestic violence, occupational exposures and nature of job etc.
Counselling is adopted in modifying identified behavioral and psychosocial risk factors by providing information and influencing the couple to make informed choices and to adopt healthy behaviors.
Counselling focuses on:
- Influencing the couple to stop unhealthy behaviors such as smoking, alcohol abuse, and drug abuse.
- Risky sexual behaviors and sexually transmitted infections including HIV.
- The effects of over the counter drugs on pregnancy outcome
- Fertility control and pregnancy spacing
- The importance of nutrition and maintaining a healthy weight.
- The importance of the parent’s genotype and rhesus factors on pregnancy outcome.
- Specific interventions
- Treatment of disease conditions and infections. An example is starting the couple who were tested HIV positive on antiretrovirals.
- Vaccination against infectious diseases e.g human papilloma virus vaccine.
- Vitamin supplementation: 400ug of folic acid (a types of vitamin B) is prescribed daily to prevent major birth defects of the baby’s brain and spine. Iron supplement can also be prescribed for those with low haemoglobin level.
- Centres for Disease Control and Prevention. Recommendations to improve preconception health and health care—United States. MMWR Recommendations and Reports. 2006;55(RR-06):1–23.
- Moos, Merry-K, et al. Healthier women, healthier reproductive outcomes: recommendations for the routine care of all women of reproductive age. AJOG Volume 199, Issue 6, Supplement B , Pages S280-S289, December 2008.
- Good health before pregnancy: preconception care. ACOG Patient Education. American College of Obstetricians and Gynecologists. January 2007.