Episode 01: Preconception
Hi! Thanks for being a part of our community. We would so love to hear from you. Have you ever had a preconception visit? If so, did you schedule it or was it brought up in a general annual visit? Do you regularly give preconception counseling? Or, have you been exposed to it in your training?
In our experience, preconception counseling is really lacking and an area where we can improve! Especially when you consider that 50% of pregnancies are unplanned. It’s important that we’re not only talking to women about a healthy lifestyle but also engaging in conversation about reproductive goals and how to help our clients achieve them. We know that women are less likely to have babies that are born prematurely or have low birth weight when they are healthy prior to becoming pregnant. (CDC)
Take a moment and imagine yourself sitting across from a women in a preconception visit. What are you going to talk about? Why is it important?
It goes without saying, every person wants to have a healthy baby. Preconception health is the foundation. Women optimize their chance for a healthy pregnancy and healthy baby when they enter pregnancy as healthy as possible. How can you help a women achieve optimal health?
There are a number of broad topics to cover in a preconception visit. These include lifestyle, current health, family health history, medications, and the overall goals of the person you’re talking to.
Labs offer a great snapshot of a person’s current health. What labs would you run and why?
Here are the preconception labs that we came up with. Test yourself by answering why each of these labs is important and what you would recommend / next steps if a lab comes back abnormal. Add to the conversation by putting your answers in the comments of this blog.
Preconception labs:
CBC
Blood typing and antibody screen
Rubella immunity
Hepatitis B and C
HIV
Hgb A1C
TSH
Carrier screen
Screen for STIs and communicable diseases
Pap
When exploring lifestyle, it’s very important to first establish safety and a non-judgmental tone. Throughout your visit, check-in on your body language and that of the person across from you. Without trust, you’re not likely to have an open and honest conversation. A big piece of lifestyle is exploring the nutritional habits of the person you’re meeting with.If you’re counseling a woman that wants to get pregnant, what if any, supplements will you recommend and why?
Nutrition / supplement recommendations:
400 mcg folate daily for the month prior to pregnancy and the first month of pregnancy. (prevents neural tube defect)
2.6 mcg of B12 per day if vegetarian or vegan.
Recommend beginning a prenatal vitamin at least one month prior to trying to conceive
When discussing a person’s diet, keep in mind that several studies have shown that most women are not getting enough Vitamins A, C, B6, and E, folic acid, calcium, iron , zinc, or magnesium in their diet. These are areas to explore and give recommendations so that women are meeting the daily recommended levels of vitamins and minerals.
We find that people are much more likely to make lifestyle changes when they understand the WHY behind recommendations. When it comes to nutrition, you can confidently counsel women that there is a positive association with having a healthy pregnancy and improved birth outcome if she has a healthy diet prior to pregnancy. A well-balanced diet including vegetables, fruits, and protein sets the foundation for a healthy pregnancy and life. This also helps people achieve a healthy weight. Ideally, women should be at a healthy weight prior to becoming pregnant.
Another important piece of lifestyle is exercise. What do you say when counseling a woman on the appropriate amount and types of exercise? In pregnancy, the recommendation is that women get at least 2 hours and 30 minutes of aerobic activity every week. Regular physical activity can help reduce the risk of pregnancy complications and ease pregnancy discomfort. A preconception visit is a great time to discuss why establishing an exercise routine prior to pregnancy will help a woman feel better when she is pregnant.
During a preconception visit you should also discuss cycle tracking: Encourage women to track their cycles, especially LMP. This will help ensure that pregnancy dating is accurate and know when they’re ovulating.
Medications are another important topic to cover in a preconception visit. Check for use of teratogenic medications as part of preconception care, and change to safer medications if possible. It is ideal for people to use the fewest medications and at the lowest dose needed to control disease. Every medication has a FDA category associate with it. Below you’ll see the category breakdown.
Favorite Resources:
Our favorite free resource that enables people to track nutrition & exercise.
A great free resource for women to use to track their periods and ovulation.
FDA pregnancy categories for medication.
Motivational interviewing is an evidence-based approach on how to help people make change. Here’s a great video on motivational interviewing.
There are a number of topics to cover in a preconception visit. We hope this article is helpful and that it sparks a conversation around preconception visits. What are you talking about in your preconception visits? What do you think about our first “podcast show notes” blog? Is it helpful? Want to see something different? Leave us a comment!
Sources:
https://www.aafp.org/afp/2013/1015/p499.html
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm