Pre-Pregnancy Planning Can Be Tough: Know All About Counselling, Tests, Complications And More

Are you planning a baby? If yes, then you will have a lot of questions in your mind. Read on to know how to go about it the right way.

Today's fast-paced life has made it difficult for most couples to successfully plan a pregnancy. This has been made worse by the COVID-19 pandemic and the accompanying isolation and stress. The current situation also makes it difficult for couples to get access to a good hospital or doctor. But if you know what to do, then it is not as difficult as you think. Looking at all those hopeful young couples anticipating a baby, we reached out to Dr Prathima Reddy, Director and Lead Consultant, Obstetrics and Gynaecology, Sparsh Hospital for Women and Children, to know exactly what to do when planning a pregnancy. Here is the excerpt of the interview.

What are some of the important aspects to bear in mind before planning a pregnancy? Why is pregnancy counselling important?

Planning a pregnancy in today's fast paced life is very important. The most important aspect associated with this journey is to choose the right gynecologist and hospital that is backed up with a team of specialists in maternal critical care, neonatal intensive care, fetal medicine, pediatric emergency and infrastructure support to take care of any eventualities that could happen related to the mother and child as the couple takes the baby to term. Preparing for a pregnancy would include -

• Gathering as much information about the family of both the husband and wife for up to two generations to ensure that all aspects of health in the family can be shared with the doctor.
• It's also important to correct habits like smoking, drinking alcohol in addition to weight management (to correct obesity in women), mental preparation for an extended family, etc.
• Most importantly, it is important to ensure that you share all the information with the doctor with complete honesty to avoid issues at latter stages.
• If needed these aspects can be discussed in private with the doctor and not necessarily with the extended family members

What are some of the important pre-pregnancy tests? Why is it important to share information regarding habits, medications (Allopathy, Homeo, Ayurveda, etc.), extended familial history, etc.

The doctor will ask the couple to undergo select tests based on age and risk factors gathered from the initial discussion. The tests could include:

• Screening for Sexually transmitted infection and communicable disease
• Assess BMI - advice appropriate weight management
• Assess Diabetes status and advice optimal glycemic control if already a known diabetic
• Check usage of teratogenic drug usage, substance abuse, etc.
• Update immunizations- Rubella, COVID, Hepatitis, TDAP (Tetanus, Diphtheria, and Pertussis) vaccinations.

What are some of the lifestyle and dietary amendments necessary for a healthy pregnancy?

Planning a pregnancy would also include lifestyle and dietary modifications that is necessary for managing and maintaining a healthy pregnancy. A detailed coverage of meeting the needs of the mother and child will be regularly evaluated with the help of a nutritionist in discussion with the couple.

• To maintain a healthy pregnancy, approximately 300- 400 extra calories are needed each day.
• These calories should come from a balanced diet of protein, fruits, vegetables and whole grains.
• While protein intake includes meat, it should be kept in mind that processed meat should be avoided as much as possible as it may contain harmful additives.
• Consumption of sweets and fats should be kept to a minimum.
• A healthy, well-balanced diet can also help to reduce some pregnancy symptoms, such as nausea and constipation.
• Fluid intake is also an important part of pregnancy nutrition. A woman planning to get pregnant must take in enough fluids by drinking several glasses of water each day, in addition to the fluids in juices and soups.

What are some factors for high risk pregnancy? Can you also shed some light on how rising obesity in pregnancy increases the risk of gestational diabetes?

Some of the most common pregnancy related complications are pre-eclampsia, eclampsia and gestational diabetes. These conditions can affect the mother as well as the baby and, if not recognised early and treated appropriately, can have grave consequences for the mother and the baby. Growth restriction in the fetus and lack of blood flow to the fetus, complications associated with COVID are some of the other problems faced in pregnancy.

Obesity has been a growing concern over the last year due to the increase in the sedentary lifestyle followed by improper food habits. Many women that face complications during pregnancy fall in the 80kg to 100+ kg range. Therefore, it is important to get obesity under control before and during the pregnancy. Obesity has also been correlated with gestational diabetes. This has also been on the rise over the last two years.

What are some COVID complications risks for expecting mother and foetus

Pregnant women who test positive for COVID are more prone to complications as opposed to their non-pregnant counterparts. They are at higher risk of requiring oxygen, admission to ICU, requiring ventilator support, etc. Unfortunately, they can also succumb to the disease. The incidence of the new-born baby becoming positive is low and most babies do well. However, in recent times, a condition known as multi-system inflammatory syndrome has emerged in new-borns, which can have poor outcomes. COVID vaccination of the mother before or during the pregnancy definitely helps reduce the complications.

How can one find out about family history of congenital abnormalities/ genetic issues?

A detailed family history is the right way to proceed in order to identify the possible genetic issues that a young couple may have to encounter. The most common issue that gynaecologists face is the lack of information that the young couple may have about their extended family and cause of loss of family members due to a particular illness in the past. In cases of genetic testing, the gynaecologist could prescribe select tests that could help in identifying issues in the child early on during the 1st trimester. These tests can be done during certain weeks of the pregnancy to screen for diseases like Down syndrome, chromosomal problems, blood disorders, etc.

What are some of the causes of increasing postpartum depression in young mothers?

Today Gynaecologists understand that depression is a long term process and this is known as perinatal depression. This is a serious illness and can affect everyday life with serious consequences. The illness itself adds to the existing load the couple has to go through in their regular life and therefore has to be identified and managed early on. Fortunately, early identification of the problem, seeking the help of a psychologist/psychiatrist and the right medication can help alleviate this problem.

The current pandemic and resultant isolation due to work from home and lockdowns in addition to the extended familial expectation from an ideal mother has only added to the chances of this illness. Therefore, it's important to meet a gynaecologist who can identify the problem and provide the right kind of intervention in discussion with a psychiatrist, if required.