Are you planning to become pregnant in the next year?
This is a question that few women hear during their annual wellness exam. Several organizations, including the March of Dimes and the American College of Obstetricians and Gynecologists, are trying to change this. Evidence is mounting that this single, direct question could have a huge health impact for both individual women and our national health as a whole.
Unintended pregnancies make up about 50 percent of pregnancies in the United States. They are associated with depression, domestic violence, late prenatal care, financial stressors, fetal exposure to medications, birth defects, low birth weight, and poor mental and physical childhood development. There are many and diverse reasons for these problems, which is why organizations are pushing for this One Question to be addressed in the setting of a direct interaction with a healthcare provider, who can tailor solutions, pregnancy planning and any appropriate contraception to that individual woman.
Small steps increase pregnancy health substantially. When addressed prior to pregnancy, they are both easier to accomplish and more effective.
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▪ Social support. In our culture that admires science and technology, this vital component of pregnancy and family building is often forgotten. If you would like to become pregnant in the next year, how extensive are your support systems? Do you have extended family nearby? Do you have a healthy living environment? Is your job stable? Do you have supportive co-workers? If you were to lose your job or your partner lost their job, what is your backup plan? Do you live in a tobacco-free home? Will you need child care? Is that child care safe?
▪ Safe relationships. We talk a lot about sex ed in our schools: Biology, sexuality, contraception and sexually transmitted infections. But safety comes in many forms. Few young women or young men have been taught how to have psychologically safe relationships. Are you in a relationship where you feel obligated? Obligated to look a certain way, help your partner avoid anger, have certain friends, use (or not use) contraception? Do you have sex because you want to or because you feel obligated to? Are you ever afraid of your partner?
▪ Prenatal vitamins. Prenatal vitamins became universal when folic acid deficiency was linked to neural tube defects in babies. However, the neural tube closes by about 4 weeks after conception, and many women do not know they are pregnant yet. This means that folic acid should be taken before a woman conceives for optimum benefit.
▪ Healthy weight. In pregnancy obesity is associated with a wide variety of complications. As we learn more about obesity in pregnancy we are increasingly able to counteract these complications. However, the healthier a mother’s weight before pregnancy, the lower her risk of pregnancy complications. Disordered eating, such as anorexia and bulimia, should also be controlled before pregnancy. The drastic body changes of pregnancy can be emotionally and psychologically difficult for a woman that has not had time to heal from an eating disorder.
▪ Optimal control of health conditions. As an obstetrician I am used to pregnant patients with medical conditions, and generally it’s straightforward to continue their care through pregnancy. There are several benefits to optimal control of medical conditions prior to pregnancy. First, usually we can minimize medications and treatments when a condition is controlled. For example, asthma that is under control might require a daily inhaler with an “as needed” inhaler that is rarely needed. These have minimal exposure to the fetus. But uncontrolled asthma might require oral steroids, which creates an additional set of factors that can complicate the pregnancy and birth. Since it turns out to be in the best interest of the fetus to have its mother be able to breathe, we clearly must use these medications. But it is much better to be in a situation where the extra medications are not needed.
One of my biggest sources of anxiety with pregnant patients who have other medical problems is when they stop all their medications and treatments when they discover they are pregnant. Often this is not safe for either them or their fetus. A discussion with a knowledgeable healthcare provider ahead of time can help them avoid unsafe interruptions in their care.
▪ Adjustment of medications. A small number of medications should be avoided in pregnancy. When a mother plans ahead with her health care provider, often these medications can be changed. For example, hypertension is a relatively common health condition, and many blood pressure medications are acceptable in pregnancy. However, a common class of blood pressure medication, ACE inhibitors, are clearly not advisable in pregnancy. A woman can usually be switched to a safer class of medication prior to pregnancy.
My friend: Are you planning to become pregnant in the next year? If so, please talk to your health-care provider. We want the very best for your health, and for your pregnancy health if that’s what you choose!
Dr. Kasper earned a bachelor’s degree from the University of Oregon, followed by an MD from Oregon Health & Science University. After graduation she diversified her education locale by completing her residency in Obstetrics & Gynecology at the University of New Mexico, and is now board-certified. She currently practices obstetrics & gynecology at Saltzer Medical Group in Nampa. She lives in Nampa with her husband (a dairy farmer) and their three small children. Her current free time is taken up by snowboarding, seed catalogs and cross stitch.