What subjects are covered in pre-pregnancy counselling? Information on chronic illness, medicines, vaccines, folic acid and genetic screening options.
Pre-pregnancy counselling is a consultation in which the health, medicines, vaccines and habits of a person planning a pregnancy are reviewed with the doctor before becoming pregnant. The aim is to reduce health risks for the mother, the baby and the newborn, and to address modifiable risk factors before pregnancy. The consultation is not an examination but an opportunity to prepare. Preparation does not mean that the pregnancy will go without problems; it helps to reduce risks and to make informed decisions. Subjects such as chronic illnesses, medicines, vaccines, folic acid and habits are addressed in the consultation.
For whom is pre-pregnancy counselling suitable?
It is recommended that everyone planning a pregnancy receive this counselling. The consultation is suitable regardless of your identity, marital status and orientation.
Can the counselling consultation be repeated?
Counselling should not be thought of as a one-off procedure. It is recommended that it be repeated several times in the reproductive years; the consultation can be held again after a new illness, a change of medicine or an earlier pregnancy.
How are your chronic illnesses and medicines assessed?
The aim is for ongoing conditions such as diabetes, hypertension and thyroid disease to be brought under the best possible control before pregnancy. All your prescription and non-prescription medicines, your supplements and your herbal products are reviewed with your doctor. For this reason do not stop a medicine you use regularly without consulting your doctor; share your plan for pregnancy with the doctor who prescribes the medicine, because some medicines may need to be changed before pregnancy.
Why are vaccines and your immune status reviewed?
Your immunity against vaccine-preventable diseases is reviewed before pregnancy. Your vaccination card guides you in this conversation. Which vaccine is needed and when it will be given varies from person to person.
What is discussed about your family history and genetic carrier status?
It is recommended that the genetic disease screenings offered to pregnant women also be offered before pregnancy. If there is an inherited disease in your family, telling your doctor helps to determine which screening is meaningful for you.
Are infections and your travel plans addressed in the consultation?
Whether a test is needed for sexually transmitted infections, whether you have been exposed to certain infections such as toxoplasmosis, and travel precautions to be taken because of Zika are counted among the headings recommended to be discussed before pregnancy.
Why are you asked about your earlier pregnancies and your plan to try again?
If there was a problem in an earlier pregnancy, this history is discussed before trying again. Planning the interval between pregnancies and family planning are also among the subjects of the consultation.
Why is folic acid recommended before pregnancy?
According to the current medical view, people planning a pregnancy are recommended to use a supplement containing daily folic acid; the aim is to reduce the risk of neural tube defects. Your doctor determines the dose and when to start. Do not adjust the medicine or supplement on your own.
How are you prepared with regard to diet and activity?
Your diet, your vitamin intake, your body weight and your level of physical activity are also addressed in the consultation. The goal is to reach a body weight regarded as healthy before pregnancy and regular activity. Recommendations specific to you are determined by your doctor according to your situation; it is appropriate not to turn on your own to supplements or diets of unclear origin.
Why are you asked about smoking, alcohol and substance use?
It is recommended that the use of alcohol, nicotine and drugs (including the non-medical use of prescription opioids) be asked about routinely in the pre-pregnancy consultation. The purpose of these questions is to identify risks and, if necessary, to direct you to support for quitting.
How are your mental health and safety addressed in the consultation?
Conditions such as depression and anxiety need to be addressed within the plan for pregnancy; you can share changes in your mental health with your doctor. It is recommended that screening for partner violence also be part of the pre-pregnancy consultation. If you are experiencing violence, you can talk about it with your doctor.
If trying for pregnancy gives no result, is a separate assessment needed?
If trying for pregnancy has given no result for some time, fertility may need to be assessed separately. The timing of this varies with age and personal risk factors; it is discussed with the doctor.
How can you prepare for the consultation, and what can you ask your doctor?
- Bring your vaccination card and, if you have them, earlier immunity test results.
- List the medicines, vitamins and herbal products you use regularly, with dose information.
- Try to find out whether there is a history of inherited disease, pregnancy loss or congenital problems in your family.
- You can ask which of your illnesses need to be brought under control before pregnancy.
- Which of the medicines I use should be reviewed according to my plan for pregnancy?
- Which genetic screening options may be considered for me?
Frequently Asked Questions
I am not thinking of pregnancy but I could become pregnant; do I need folic acid?
Yes, this recommendation covers not only those planning a pregnancy but everyone who could become pregnant. Talk with your doctor about when to start the supplement and the dose.
Which vaccines are discussed before pregnancy?
Tetanus-diphtheria-pertussis, measles-mumps-rubella, hepatitis B, chickenpox, influenza and HPV vaccines are counted among the vaccines addressed in pre-pregnancy immunisation. Some vaccines may need to be given before pregnancy and then a wait observed; your doctor determines which is suitable at what time by looking at your vaccination card.
I have a mental health condition; how is it handled in this consultation?
It is recommended that psychiatric conditions such as depression, anxiety, bipolar disorder and schizophrenia be managed in the best possible way before pregnancy and that the plan for pregnancy be made within this framework. It is enough to review your treatment plan together with the doctor who follows you.
Should my partner also attend the consultation?
Attendance is optional. Because subjects such as genetic carrier screening and some infections can concern both people, if you have a partner, their attending may make it easier to discuss these subjects together. Preparation is not the responsibility of the woman alone.
Does preparation before pregnancy guarantee a problem-free pregnancy?
No. The aim is to reduce modifiable risks and to help you make informed decisions. Having prepared does not mean that the pregnancy will go without problems.
If I have had counselling before, can I meet again?
Yes. The consultation can be repeated after a new illness, a change of medicine or an earlier pregnancy. Counselling should not be thought of as a one-off procedure.
Should I stop my regular medicine because I am planning a pregnancy?
Do not stop your medicine without consulting your doctor. Share your plan for pregnancy with the doctor who prescribes the medicine; some medicines may need to be changed before pregnancy.
Should I also mention my herbal products and non-prescription medicines?
Yes. Your prescription and non-prescription medicines, your vitamins, your supplements and your herbal products are reviewed together. You can list them with dose information.
Can I decide the dose and start time of folic acid myself?
You should determine the dose and start time with your doctor. Folic acid is recommended to reduce the risk of neural tube defects; do not adjust your supplement on your own decision.
If there is an inherited disease in my family, should I share it at the consultation?
Yes. Your family history helps to determine which genetic screening is meaningful for you. The genetic disease screenings offered in pregnancy can also be discussed before pregnancy.
Are the problems I had in my earlier pregnancy also addressed?
Yes. Your earlier pregnancy history, your plan to try again and the interval between pregnancies are discussed at the consultation.
If my attempts to become pregnant are not giving a result, is this consultation enough?
Fertility may need to be assessed separately. When this will be done is discussed with your doctor according to your age and personal risk factors.
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