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Return to Maybe Baby? Get a Check-Up First Overview

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Maybe Baby? Get a Check-Up First

Breaking News - May 2006 - Week 1

(May 3, 2006)

Healthcare in  the News

-- Women should take stock of their health before trying to get pregnant, and improve their health if necessary, say new government recommendations on "preconception care."

Picture of expectant parents, smiling

That means quitting smoking, avoiding alcohol, making sure chronic conditions such as high blood pressure are under control, and dropping excess pounds, among other steps.

"We want couples to consciously think about being ready for pregnancy before pregnancy happens. We want them to know there are many things they can do to improve their health or their baby's health," said Dr. Hani Atrash, associate director for program development at the Centers for Disease Control and Prevention's (CDC) National Center on Birth Defects and Developmental Disabilities.

Dr. Atrash co-authored the report, which was published this month in the CDC journal Morbidity and Mortality Weekly Report (MMWR).

Recommendations Confirm Practices Already in Use

The recommendations themselves are not new, Dr. Atrash says. "We have known these things for many years, but they have really not been part of the health-care system."

Even women who are not actively planning to get pregnant should heed the recommendations, he adds. "About 49 percent of pregnancies in the United States are unplanned," Dr. Atrash notes.

One of the best steps a woman can take is to schedule a pre-pregnancy visit to her doctor to assess her health status (the CDC team urged that health insurance providers cover the cost of this visit).

Other key recommendations for women of childbearing age:

  • Take 400 micrograms of folic acid a day to reduce the risk of neural tube birth defects.
  • If a smoker, quit.
  • Reach and/or maintain a healthy weight.
  • Avoid alcohol.
  • Inform doctors of all medications, both over-the-counter and prescription.
  • Avoid exposure to toxic substances both at work and at home.
  • Along with your partner, craft a "reproductive life plan" that includes a discussion of how many children you want and when.

Multi-Agency Input Used

The new recommendations were compiled by experts at the CDC and more than 35 government, public, and private partners. The recommendations are aimed at reducing infant deaths and improving the health of both newborns and their moms.

According to the report, "Improving preconception health can result in improved health outcomes, with potential for reducing societal costs as well."

The recommendations seek to achieve these goals:

  • improve the knowledge, attitudes, and behaviors of men and women about preconception health
  • assure that all women of child-bearing age in the US receive the appropriate preconception care services that will enable them to be at an optimal health status at the time of conception
  • reduce pregnancy risks for women with previous adverse pregnancy outcomes using appropriate interventions
  • reduce the disparities in adverse pregnancy outcomes

The recommendations came about after two years of exhaustive data review involving various agencies. The experts looked at studies focusing on interventions that improved maternal health and pregnancy outcomes.

According to CDC statistics for 2000, there were about 62 million US women of childbearing age from 18 to 44 years old. By age 44, 85 percent of U.S. women have given birth, according to the CDC.

AT least two physicians in clinical practice welcome the new recommendations.

"Putting it all in one statement is always helpful," says Dr. Denise Sur, a family medicine physician at Santa Monica-UCLA Medical Center and an associate clinical professor of family medicine at the David Geffen School of Medicine at the University of California, Los Angeles.

"This provides an organized approach for giving advice to women. A lot can be done before pregnancy to be sure the baby is healthy," she says.

"None of this is anything new," agrees Dr. Richard Frieder, an obstetrician-gynecologist at Santa Monica-UCLA Medical Center and a clinical instructor of Ob-Gyn at the David Geffen School of Medicine at UCLA. "This is a formal statement, the same as what the American College of Obstetricians and Gynecologists [ACOG] has been recommending for a long time."

"It's a strategy to try to improve the quality of care to women before pregnancy and during pregnancy, so the end result is improving newborn outcomes," Dr. Frieder says.

Dr. Frieder urges women to follow the recommendations and also to alert their physician about their plans to try to get pregnant.

"Women don't always tell their doctor they are planning to get pregnant," he says. But, he says, they should, and the doctor should remember to ask about it at routine visits, so that planning can be done and the woman's health status evaluated.

The recommendations are being widely distributed, says Dr. Atrash, with many of the partner organizations providing links to them on their Web sites.

Always consult your physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.


Planning a Pregnancy

If you are planning to become pregnant, taking certain steps can help reduce risks to both you and your baby.

Proper health before deciding to become pregnant is almost as important as maintaining a healthy body during pregnancy.

The first few weeks are crucial in a child's development. However, many women do not realize they are pregnant until several weeks after conception.

Planning ahead and taking care of yourself before becoming pregnant is the best thing you can do for you and your baby.

One of the most important steps in helping you prepare for a healthy pregnancy is a pre-pregnancy examination (often called preconceptual care) performed by your physician before you become pregnant.

This examination may include any/all of the following:

  • family medical history - an assessment of the maternal and paternal medical history - to determine if any family member has had any medical conditions such as high blood pressure, diabetes, and/or mental retardation.
  • genetic testing - an assessment of any possible genetic disorders - as several genetic disorders may be inherited, such as sickle cell anemia (a serious blood disorder which primarily occurs in African Americans) or Tay-Sachs disease (a nerve breakdown disorder marked by progressive mental and physical retardation which primarily occurs in individuals of Eastern European Jewish origin). Some genetic disorders can be detected by blood tests before pregnancy.
  • personal medical history - an assessment of the woman's personal medical history to determine if there are any medical conditions that may require special care during pregnancy - such as epilepsy, diabetes, high blood pressure, anemia, and/or allergies; previous surgeries; or past pregnancies
  • vaccination status - an assessment of current vaccinations/inoculations to assess a woman's immunity to rubella (German measles), in particular, since contracting this disease during pregnancy can cause miscarriage or birth defects. If a woman is not immune, a vaccine may be given at least three months before conception to provide immunity.
  • infection screening - to determine if a woman has a sexually transmitted infection or urinary tract infection (or other infection) that could be harmful to the fetus and to the mother.

Other steps that can help reduce the risk of complications and help prepare for a healthy pregnancy and delivery include the following:

  • smoking cessation
  • proper diet
  • proper weight and exercise
  • medical management of preexisting conditions, such as diabetes or high blood pressure
  • preventing birth defects by taking in adequate amounts of folic acid daily, and avoiding exposure to harmful substances, such as alcohol and drugs
  • avoiding exposure to harmful toxic and chemical substances (i.e., lead and pesticides) and radiation (i.e., x-rays)
  • infection control
  • taking a daily multi-vitamin
  • identifying domestic violence situations

Always consult your physician for more information.


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