Pre-conception counseling
Encyclopedia
Pre-conception counseling (also called pre-conceptual counseling) is based on the medical theory that all women of child-bearing years should be pre-screened for health and risk potentials before attempting to become pregnant. Physicians and baby experts recommend that a woman visit her physician as soon as the woman is contemplating having a child, and optimally around 3 to 6 months before actual attempts are made to conceive. This time frame allows a woman to better prepare her body for successful conception (fertilization) and pregnancy, and allows her to reduce any health risks which are within her control. Agencies such as the March of Dimes
have developed screening
tools that physicians can use with their patients. In addition, obstetricians (see Obstetrics
and General Practitioner
) have developed comprehensive check-lists and assessments for the woman who is planning to become pregnant.
In one sense, Pre-Conception Counseling and Assessment can be compared to a well-baby visit in which a baby is screened for normal health, normal development, with the benefit of identifying emerging problems that may have gone unnoticed in an infant. For a woman, the Pre-Conception Counseling Assessment and Screening is intended to assess normal health of a child-bearing woman, while at the same time identifying:
result from failure to use birth control
or failure to use it correctly; if a birth control method fails, there is no opportunity for pre-screening and assessment.
In the United States, for instance, over half of pregnancies are unintended. Half of unintended pregnancies result from not using birth control, and 45% of them from using birth control inconsistently or incorrectly.
The second most common obstacle to pre-conception counseling and assessment is that most women do not know, realize, or understand the benefits of visiting their physician before trying to become pregnant. Most women still take for granted the biological aspects of becoming pregnant, and do not consider the extreme value of pre-screening before becoming pregnant. Most women who want and anticipate having a baby are naturally prone to thinking in terms of having a well baby. In the majority of cases, women do not think about having a baby who has any kind of problem. Most women do not know how their own medical history could pose risks to a developing fetus
. Likewise, they may not understand that pregnancy carries a certain number of risks as well. When family history risks and pregnancy risks are considered together, it may point to potential problems for that particular woman, or to her unborn baby once she becomes pregnant.
The third most common obstacle to pre-conception counseling and assessment may be the lack of health insurance
. However, most insurances will cover this as a screening visit. Also, many physicians will do the pre-conception screening during a regular office visit or gynecological visit if the woman just informs the doctor of her desire to become pregnant. Most gynecologists will inquire about child-bearing intentions anyway.
, if available.
(Complete Blood Count) which can show anemia
. A CBC includes WBC
(White Blood Cell Count) which can show the presence of infection. Anemia and infection, indicating problems with the woman's overall health at that moment, can both affect a woman's ability to become pregnant at that time as well as affect the stability of the pregnancy and health of the fetus. Fortunately in the majority of cases both infection and anemia can be treated once the cause is identified. Anemia may require ongoing evaluation and iron supplement.
can reveal the presence of proteinuria
(protein in the urine), a possible indicator of infection or kidney disease, or the presence of blood which can indicate a urinary tract infection
. Urinalysis might also show the presence of glucose (glycosuria
), but women of child bearing age are unlikely to have undiagnosed diabetes (this is separate from gestational diabetes
that may occasionally develop during the course of a subsequent pregnancy).
The presence of Diabetes remains a huge risk for the unborn child, and a woman will be screened specifically for this condition. Known diabetics will need monitored closely. For more information, see this online article Diabetes and Diabetic risks.
March of Dimes
The March of Dimes Foundation is a United States nonprofit organization that works to improve the health of mothers and babies.-Organization:...
have developed screening
Screening (medicine)
Screening, in medicine, is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. Unlike what generally happens in medicine, screening tests are performed on persons without any clinical sign of disease....
tools that physicians can use with their patients. In addition, obstetricians (see Obstetrics
Obstetrics
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...
and General Practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
) have developed comprehensive check-lists and assessments for the woman who is planning to become pregnant.
In one sense, Pre-Conception Counseling and Assessment can be compared to a well-baby visit in which a baby is screened for normal health, normal development, with the benefit of identifying emerging problems that may have gone unnoticed in an infant. For a woman, the Pre-Conception Counseling Assessment and Screening is intended to assess normal health of a child-bearing woman, while at the same time identifying:
- Existing or emerging illness or disease which may have gone undetected before, and
- Existing risks for the woman who may become pregnant, and
- Existing risks which may affect a fetus if the woman does become pregnant.
Obstacles to pre-conception counseling
The most common obstacle to pre-conception counseling and assessment is that many pregnancies are still unplanned. Globally, 38% of pregnancies are unintended. Many unintended pregnanciesUnintended pregnancy
Unintended pregnancies are those in which conception was not intended by the female sexual partner. Worldwide, 38% of pregnancies were unintended in 1999 . Unintended pregnancies are the primary cause of induced abortion, resulting in about 42 million induced abortions per year...
result from failure to use birth control
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
or failure to use it correctly; if a birth control method fails, there is no opportunity for pre-screening and assessment.
In the United States, for instance, over half of pregnancies are unintended. Half of unintended pregnancies result from not using birth control, and 45% of them from using birth control inconsistently or incorrectly.
The second most common obstacle to pre-conception counseling and assessment is that most women do not know, realize, or understand the benefits of visiting their physician before trying to become pregnant. Most women still take for granted the biological aspects of becoming pregnant, and do not consider the extreme value of pre-screening before becoming pregnant. Most women who want and anticipate having a baby are naturally prone to thinking in terms of having a well baby. In the majority of cases, women do not think about having a baby who has any kind of problem. Most women do not know how their own medical history could pose risks to a developing fetus
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...
. Likewise, they may not understand that pregnancy carries a certain number of risks as well. When family history risks and pregnancy risks are considered together, it may point to potential problems for that particular woman, or to her unborn baby once she becomes pregnant.
The third most common obstacle to pre-conception counseling and assessment may be the lack of health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
. However, most insurances will cover this as a screening visit. Also, many physicians will do the pre-conception screening during a regular office visit or gynecological visit if the woman just informs the doctor of her desire to become pregnant. Most gynecologists will inquire about child-bearing intentions anyway.
Questionnaire
Pre-screening covers many body-system areas (not just the reproductive organs), as well as aspects of the woman's lifestyle, and family history information. It begins with basic information and becomes more in-depth, especially if the woman has had previous illnesses, diseases, etc. Pre-screening assessments begin with a questionnaire which the woman fills out, generally before seeing the physician. Some offices have the woman go over parts of the questionnaire with a Nurse PractitionerNurse practitioner
A Nurse Practitioner is an Advanced practice registered nurse who has completed graduate-level education . Additional APRN roles include the Certified Registered Nurse Anesthetist s, CNMs, and CNSs...
, if available.
Blood work
Certain blood work may be ordered. This often includes a CBCComplete blood count
A complete blood count , also known as full blood count or full blood exam or blood panel, is a test panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood...
(Complete Blood Count) which can show anemia
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
. A CBC includes WBC
White blood cell
White blood cells, or leukocytes , are cells of the immune system involved in defending the body against both infectious disease and foreign materials. Five different and diverse types of leukocytes exist, but they are all produced and derived from a multipotent cell in the bone marrow known as a...
(White Blood Cell Count) which can show the presence of infection. Anemia and infection, indicating problems with the woman's overall health at that moment, can both affect a woman's ability to become pregnant at that time as well as affect the stability of the pregnancy and health of the fetus. Fortunately in the majority of cases both infection and anemia can be treated once the cause is identified. Anemia may require ongoing evaluation and iron supplement.
Urine alysis
Urine sample or urinalysisUrinalysis
A urinalysis , also known as Routine and Microscopy , is an array of tests performed on urine, and one of the most common methods of medical diagnosis...
can reveal the presence of proteinuria
Proteinuria
Proteinuria means the presence of anexcess of serum proteins in the urine. The protein in the urine often causes the urine to become foamy, although foamy urine may also be caused by bilirubin in the urine , retrograde ejaculation, pneumaturia due to a fistula, or drugs such as pyridium.- Causes...
(protein in the urine), a possible indicator of infection or kidney disease, or the presence of blood which can indicate a urinary tract infection
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
. Urinalysis might also show the presence of glucose (glycosuria
Glycosuria
Glycosuria or glucosuria is the excretion of glucose into the urine. Ordinarily, urine contains no glucose because the kidneys are able to reclaim all of the filtered glucose back into the bloodstream. Glycosuria is nearly always caused by elevated blood glucose levels, most commonly due to...
), but women of child bearing age are unlikely to have undiagnosed diabetes (this is separate from gestational diabetes
Gestational diabetes
Gestational diabetes is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy . It is widely accepted as a disease only in the United States, there is some question whether the condition is natural during pregnancy...
that may occasionally develop during the course of a subsequent pregnancy).
Physicians
The areas a physician will assess are too numerous to include here. When women have pre-existing illnesses / conditions / diseases, these may add to pre-natal risks and will need ongoing evaluation. Also any medications which are used to treat these conditions will need monitored and possibly reduced or increased.The presence of Diabetes remains a huge risk for the unborn child, and a woman will be screened specifically for this condition. Known diabetics will need monitored closely. For more information, see this online article Diabetes and Diabetic risks.