Advice before pregnancy

Pregnancy counseling is what is commonly called preconception counseling, a set of recommendations and information that is given to a woman so that she can reach pregnancy in the best possible physical, mental, and environmental conditions.

The purpose of these tips is to sensitize the woman - and also, if appropriate, her partner - to protect them from risk and teratogenic factors, that is, the factors that can cause malformations in the embryo or the fetuses capable of compromising fetal development, as well as encouraging them to take care of themselves by paying attention to their own body (food, exercise, leisure) and the care received by the environment (friends, family, work ), as a first step towards healthy motherhood.

During the pre-season visit, which assesses the possible risks and informs of the measures to be applied in each case, different aspects are taken into account:

• The woman's personal and family background, and also, where appropriate, the couple.
• The consumption of toxic substances (tobacco, alcohol, drugs) by the woman and, where appropriate, the couple.
• The sexually transmitted diseases of the woman and, where appropriate, the partner.
• The vaccination status of the woman.
• Nutrition status and weight balance of women and type of diet.
• Maternal age.
• The physical activity of women.
• The risk of birth defects, that is, they are linked to some maternal or paternal genetic or chromosomal problem. Congenital defects may be due to hereditary factors, environmental factors, or both. Spina bifida, for example, is caused by a deficiency of folic acid in the periconceptional stage, in 95% of cases, so it is advisable for all women who want to get pregnant to supplement their diet with 400 micrograms of folic acid daily 3 months before conception and during the first trimester of pregnancy.
• Regular exposure to teratogenic agents, such as chemicals, anesthetic gases, ionizing radiation, etc.

1. Teratogenesis

Teratogenesis is called the appearance of congenital abnormalities caused by environmental factors. Some drugs, ionizing radiation, maternal infections, diseases and drugs may act as teratogenic or teratogenic agents.

Fetal involvement by teratogenic agents depends on the time of gestation at which the exposure occurs. The first trimester of pregnancy is the most sensitive, since during this period the formation of the fetal organs (organogenesis) takes place.

1.1 Drugs

It should be borne in mind that drugs that are administered to the mother are substances that will reach the embryo or fetus and which can cause a more or less significant defect depending on the drug, the dose, the time of administration. and the time of pregnancy.

That is why every woman taking the medication should consult her doctor about possible effects in order to replace it before pregnancy.

1.2 Radiations

The effect depends on the dose absorbed and the time of gestation.

In general, it is recommended:

• For pregnant women and women who think they may be pregnant, do not undergo x-rays if not essential.
• For women of childbearing age, undergo radiological examinations in the menstrual or postmenstrual period.
• When in doubt, do a pregnancy test.
   

1.3 Infections

There are infections that can affect the fetus and the newborn baby, depending on the time of year. That is why serological tests are performed and preventive measures are recommended according to the specific immune status.

For women who regularly work with children and do not know if chickenpox has passed, it is advisable to determine the presence of antibodies (serology) before pregnancy.

1.4 Maternal illnesses

It is recommended that every woman with a chronic illness pay a pre-season visit to plan her pregnancy. This should be agreed with the medical specialist. Good pregnancy control and evaluation of its treatment are essential for pregnancy.

• See 'Suffering from a chronic illness'

1.5 Maternal hyperthermia

Before the 16th week of gestation, a maternal temperature of 38,9oC or higher, either due to fever or due to external factors (saunas, baths, etc.), can lead to congenital abnormalities such as mental retardation, delayed fetal growth , etc. From the 16th week on, at the same temperature, no alterations occur.

1.6 Drug Addiction

Any drug use (legal or illegal) during pregnancy can have an obstetric and / or fetal impact.

2. How to avoid teratogenic risk: recommendations

2.1 Before pregnancy

• It is recommended that all women who wish to become pregnant, and especially those who have a chronic illness, and all couples in which any of the parents have hereditary health problems are informed and given the advice before pregnancy or it is called preconceptional counseling.
• In relation to drug consumption and administration, it is necessary:
  • a pre-season vaccination of the rubella;
  • avoid self-medication, especially if you want to become pregnant or are already pregnant;
  • if you have a chronic illness that requires medication, consult your health care team about the possible effects on the fetus and, if necessary, the possibility of reducing or changing it.
• Both legal and illegal drug use should be avoided.
• It is recommended supplementation with folic acid to prevent defects in the neural tube (DTN) baby:
  • The supplementation of 0,4 mg folic acid daily one or two months before conception and the first XNUMX weeks of pregnancy, the risk of a fetus having a defect in the neural tube decreases.
  • Women who have a previous child with DTN and who are on anti-convulsive medication or are diabetic should take a supplement of 5 mg folic acid daily one or two months before conception and the first XNUMX weeks of pregnancy.

2.2 During pregnancy

• In relation to food, it is necessary:
  • eat cooked meat instead of raw;
  • consume pasteurized milk;
  • wash hands thoroughly after handling raw meat or touching the ground;
  • wash fruits, vegetables and legumes well;
  • use, as cooking salt, iodized salt;
  • consume fish of marine origin avoiding the consumption of fish rich in mercury: swordfish, bluefin tuna, shark and hake (lucio)

• Spanish Agency for Consumer, Food Safety and Nutrition
• Health Tips: Nutrition in each phase of pregnancy

• In relation to sexuality, it is necessary:
  • Extend protective measures in all sexual intercourse to reduce the risk of transmitting sexually transmitted diseases (STDs);
  • use barrier methods of contraception (male or female condom).
• If you need to undergo a radiological study, it is advisable to notify your health care team about the possibility or certainty of pregnancy so that the risk is minimized.
• As far as possible, contact with at-risk populations, that is, people who may be infected and contagious, should be avoided; Therefore, it is not advisable, for example, to visit hospitals or clinics.
• In gardening, gloves should be worn and contact with pets, especially cats and their faeces, be avoided.
• Exposure to high temperatures, such as those in saunas, hot baths, etc., should be avoided, especially during the first trimester of pregnancy.

"Advice before pregnancy", d'Virtual Nurse, content under license CC BY-NC-ND 3.0 ES, with modifications made by the Gynecology and Obstetrics Service of the Hospital de Sabadell