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The Preconception Exam
A number of years ago, the American College of Obstetricians and Gynecologists began recommending that all women see their doctor for a pre-conception exam -- a physical that takes place prior to trying to conceive and focuses on the key factors necessary for a healthy pregnancy.
Among the most important features of that exam, say experts, is testing for several infections that may not only interfere with conception but also affect your pregnancy.
"You should be checked for common sexually transmitted diseases (STDs) linked to pregnancy complications, such as chlamydia, and you also need to make sure you are protected against the rubella (measles) virus, either through prior exposure or by vaccination, which you should get prior to conceiving," says Bates.
Also important: Obtaining your doctor's help in controlling any pre-existing medical conditions before getting pregnant.
"If you are overweight, try to lose the extra pounds; if you have a blood sugar problem, make sure it is under good control; if you have high blood pressure, be certain that it is treated. Whatever the problem is, your pre-conception exam should address it because the better control you have over your health, the healthier your pregnancy and your baby will be," says Silverstein.
In addition, if you are using any medications for chronic health concerns -- including migraine headaches, diabetes, autoimmune disorders, seizure disorders, high blood pressure, depression, stress, or chronic pain -- experts say check with your doctor before attempting conception.
"Certain medications are very safe to use during pregnancy, others are very unsafe, but even those which are not recommended can often be switched with less toxic treatments, so you don't have to sacrifice relief in order to have a safe pregnancy," says Silverstein.
Finally, in certain instances, you may also benefit from an extended preconception exam -- one that includes genetic testing.
"One of the things we're seeing in the dawning of the 21st century is a tremendous amount of new information on genetic risk assessment -- and obviously the time to be aware of any potential genetic risks is before you conceive," says Hecht.
Other experts agree. "One thing that many patients don't think about it is that certain ethnic groups may be at risk for certain types of genetic disorders -- African Americans are at risk for sickle cell anemia, eastern Europeans need to be checked for Tay-Sachs disease, Mediterranean people and southeast Asians have to watch out for thalessemia, while Caucasians of northern European extraction should be screened for cystic fibrosis, all before getting pregnant," says Williams.
Regardless of what your exam uncovers, doctors say that by knowing the potential trouble spots ahead of time, you can be better prepared to deal with any problems that might develop during your pregnancy, regardless of the cause.
Says Silverstein: "If you optimize your health prior to getting pregnant, ultimately, you can have a healthier pregnancy, which is not only good for you, but important to your baby."
Colette Bouchez is the co-author of Getting Pregnant: What You Need To Know Now and the author of the forthcoming book Your Perfectly Pampered Pregnancy.
Published Dec. 15, 2003.
SOURCES: Michael Silverstein, MD, assistant professor of obstetrics and gynecology, New York University Medical Center, New York City. Bryan Hecht, MD, professor and chairman, department of obstetrics and gynecology, Northeastern Ohio Universities College of Medicine, Rootstown; medical director of women's services, Mercy Medical Center, Canton, Ohio. Carol Bates, MD, assistant professor of medicine, Harvard Medical School; primary care physician, Beth Israel Deaconess Medical Center, Boston. John Williams III, MD, director of reproductive genetics, division of maternal-fetal medicine, department of obstetrics and gynecology, Cedars-Sinai Medical Center.