The arrival of a child is truly a remarkable journey, though it remains unpredictable. As an obstetrician, I have witnessed firsthand how unplanned or poorly prepared pregnancies can lead to serious complications for both the mother and child.
However, by doing our best to optimise health before pregnancy, we can improve the quality of maternal care and pregnancy outcomes.
Maintaining A Healthy Lifestyle
Nutrition: Maintain a balanced diet with low glycemic index foods, in the right portions according to your caloric needs, including all necessary nutrients.
Avoid unhealthy fats and processed foods such as sausages and nuggets. Ensure adequate fluid intake as well.
Start taking prenatal vitamins, especially folic acid (at least 400 mcg daily), one month before conception to reduce the risk of neural tube defects (NTDs, birth defects of brain, spine, and spinal cord).
In certain circumstances, such as a previous history of NTDs, pre-existing diabetes, or obesity, a higher dose of folic acid may be necessary.
Exercise: Aim for at least 150 minutes of moderate physical activity each week (e.g., jogging, cycling, or swimming).
Start gradually and stay consistent—being active can help improve physical strength, manage weight, and reduce the risk of medical issues like high blood pressure and diabetes during pregnancy.
Sleep Habits: An adequate amount of six to eight hours of quality sleep per night is important. Poor sleep can affect fertility, hormonal balance, immune function, and overall health.
Stop Smoking and Avoid Alcohol Consumption: Smoking and drinking alcohol can cause significant impact like fetal abnormality, miscarriage, low birth weight, and learning difficulty in child in long-term.
Mental and Emotional Health: Mental health disorders are the leading cause of disability worldwide and contribute significantly to the global burden of disease.
It is estimated that around 10 to 20 per cent of women experience worsening mental health during pregnancy, with an even higher incidence of anxiety or depression during the postpartum period.
Early assessment, including recognising red flags, is essential. Strengthening the social and partner support, offering counseling sessions, and utilising cognitive behavioural therapy (CBT) can help reduce anxiety and promote emotional well-being during the preconception period.
Common Health Conditions Affecting Pregnancy
Certain pre-existing medical conditions can complicate conception and impact the pregnancy:
Essential Hypertension: Increases the risk of pre-eclampsia by 15 to 20 per cent and can lead to certain complications e.g. placental abruption, foetal growth restriction, and preterm birth.
Diabetes: Poorly controlled blood sugar can lead to miscarriage, birth problems like neural tube defects, having large-for-gestational-age babies, and even stillbirth in up to 50 per cent of cases.
High Cholesterol: High cholesterol can contribute to endothelial (cells lining blood cells) dysfunction, increase the risk of cardiovascular disease, and potentially affecting fertility and pregnancy outcomes.
In the past, statins (medications that lower cholesterol) were not recommended during pregnancy because they were thought to cause birth defects.
However, newer research shows that statins do not cause these problems. In certain cases, like when a woman has a genetic condition that causes very high cholesterol, doctors may decide it’s safe and necessary to continue statins during pregnancy.
But they are not used for cases where only triglyceride levels are high (isolated hypertriglyceridaemia).
Thyroid Disorders: If the disease is well-controlled prior to conception, pregnancy is usually uncomplicated.
Other Medical Conditions: Women with conditions such as bronchial asthma, heart disease, epilepsy, autoimmune disorders, thalassemia major, or renal disease require careful management before pregnancy to ensure a safer maternal and fetal outcome.
When To Start Medical Checkups
Ideally, women should see a health care provider at least three to six months before trying to conceive.
A comprehensive assessment is essential during preconception care and should include:
- A detailed personal history, covering previous obstetric outcomes, medical conditions, allergies, family history, past surgeries, and socioeconomic background.
- A thorough general and systemic physical examination.
- Monitoring of vital signs such as blood pressure and body weight.
- Pelvic ultrasound, when clinically indicated.
- Blood investigations to screen for anaemia, diabetes, infectious diseases (including HIV, syphilis, hepatitis B), thyroid function, and a Pap smear if indicated.
- Other screenings, e.g. breast cancer screening like mammogram or ultrasound breasts, ovarian cancer screening like tumour markers, are usually based on individual risk and are not part of the standard pre-pregnancy check-up. However, it is still important to consult a doctor to determine if any of these are appropriate.
The Importance Of Early Detection
Conditions like diabetes, hypertension when detected early, can be treated or optimized before embarking in pregnancy.
Early intervention can significantly reduce the risks of complications like miscarriage, fetal growth restriction, and maternal health crises during delivery.
Managing Chronic Conditions
For women with pre-existing medical conditions, it is essential to optimise their health before conception.
In addition to lifestyle modifications as mentioned, routine health monitoring, and adhering to prescribed medications are crucial. Specific attention should be given to certain conditions:
Diabetes: Aim to maintain HbA1c levels below 6.5 per cent before conception. Regular systemic evaluations, including assessments of the eyes, kidneys, and heart, are crucial due to the risk of diabetic complications.
It is also advisable to take five milligrams of folic acid daily for at least three months prior to pregnancy.
Essential Hypertension: Transition to pregnancy-safe anti-hypertensive medications and monitor blood pressure closely.
Early consultation with an obstetrician upon confirming pregnancy is important, as low-dose aspirin may be recommended in early pregnancy to reduce the risk of pre-eclampsia.
Additional Tips For Future Mothers
Vaccinations: Ensure immunisations (e.g., rubella, hepatitis B, influenza) are up to date.
Weight Management: Achieve a healthy Asian BMI (18.5–23.0) to improve fertility and reduce pregnancy risks.
Dental Care: Treat gum disease and cavities before pregnancy to avoid the unnecessary need of dental intervention during pregnancy.
Environmental Exposures: Ensure a hygienic environment with clean water and proper food sanitation. Minimise contact with harmful chemicals such as pesticides and limit exposure to radiation including X-rays.
In accordance with the perinatal care recommendations, pregnancy should be delayed, and appropriate birth control must be offered if there are any known or newly discovered health issues (like anaemia, heart disease, diabetes, or high blood pressure).
These conditions may need to be treated and well-managed before trying to conceive.
Any concerns about fertility or reproductive health should also be looked into. Follow-up is recommended every six to 12 months, depending on the patient’s condition, until she is considered medically fit for pregnancy.
Dr Chong Wen Kiat is a consultant obstetrician and gynaecologist at Columbia Asia Hospital Tebrau.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of Ova.
