Whether or not pregnancy is planned within the next year, every person should be thinking about their health because about 50% of all pregnancies are unplanned. In addition, despite our modern-day medical advances, about 1 in 8 babies are born prematurely. While physicians and researchers are still working to find the cause of and develop preventive strategies for preterm birth, experts agree that people need to be healthier before becoming pregnant. By addressing health issues and risks before pregnancy, problems that could affect the pregnancy can be prevented. The goals of preconception counseling are to improve maternal, fetal, and neonatal outcomes by optimizing health, address modifiable risk factors, and provide education about pregnancy.
Sometimes, due to pre-existing medical conditions, complications experienced in prior pregnancies, or other factors, person is considered high-risk even prior to pregnancy and may be referred to a high-risk pregnancy specialist for preconception counseling. An MFM, Maternal-Fetal Medicine Specialist or “perinatologist”, is a high-risk pregnancy specialist who partners with the expectant parent, their family and medical team to navigate the out-of-the-ordinary and attain the best possible pregnancy outcomes for the pregnancy. Before pregnancy, MFMs can provide guidance for people with chronic medical conditions or those who have experienced pregnancy complications in the past. In a preconception consultation with an MFM, the patient’s medical and pregnancy histories will be reviewed to help create an optimal strategy for the next pregnancy.
-Canavan disease
-Familial dysautonomia
-Fragile X
-Spinal muscular atrophy
-Tay-Sachs disease
-Women over the age of 35
-People related by blood who want to have children together
-Growth disorders: intrauterine growth restriction (IUGR) or macrosomia
-Infections (CMV, Toxoplasmosis, Parvovirus, Herpes, Varicella)
-Prior stillbirth
-Alloimmunization: maternal antibodies (Anti-D, anti-Kell, etc) that can cross the placenta and cause fetal anemia
-Neonatal Alloimmune Thrombocytopenia (NAIT): maternal antibodies that attack fetal platelets and can cause fetal bleeding
-Non-immune hydrops: swelling or excess fluid in the heart, lungs, and abdomen
-Spina bifida or central nervous system abnormalities
-Congenital heart disorders or lung/chest disorders
-Gastroschisis or omphalocele
-Urological (kidney / bladder) problems
-Chromosomal disorders (Trisomy 13, 18, or 21) or syndromes
-Recurrent pregnancy loss or multiple miscarriages
-Preterm birth due to spontaneous preterm labor or the spontaneous breaking of her water too early (PPROM)
-History of shortened cervix or prior need for a cerclage (surgical stitch placed to strengthen the cervix and sew it closed)
-Mullerian anomalies or a misshapen uterus
-A prior history of preeclampsia, HELLP, or eclampsia
-Hepatitis A, B, C
-HIV
-Gonorrhea, chlamydia, syphilis, trichomonas
-Rare infections
-Lupus (SLE)
-Antiphospholipid syndrome
-Seizure disorders / epilepsy
-Chronic / migraine headaches
-Berry aneurysms / AV malformations
-Multiple sclerosis
-Pseudotumor cerebri
-Spinal cord injury
-Smoking and/or drugs of abuse
-Depression / anxiety
-Other psychiatric disorders
-Domestic violence
-Nephropathy or chronic renal insufficiency
-History of kidney transplant
-Iron-deficiency anemia and hemoglobinopathies
-Sickle cell disease
-Von Willebrand disease
-Thrombotic thrombocytopenia purpura / hemolytic uremic syndrome(TTP/HUS)
-History of blood clots on anticoagulant therapy
-Inherited thrombophilia
-Hyperemesis gravidarum
-Intrahepatic cholestasis of pregnancy
-Ulcerative colitis and Crohn’s disease
-Gallstones and gallbladder infections
-Pancreatitis
-Wilson’s disease
-History of liver transplant
-Diabetes mellitus
-Addison’s disease
-Thyroid disorders
-Parathyroid diseases
-Asthma and other restrictive lung diseases
-Lung infections: pneumonia, influenza, or tuberculosis
-Cystic fibrosis
-Congenital heart disease
-Arrhythmias: abnormal heart rhythms with or without pacemakers
-Disease of the heart valves or history of valve replacement
-Pulmonary hypertension
-Coronary artery disease or history of a heart attack
-History of a heart transplant
In summary, MFMs offer expert guidance on multiple aspects of pregnancy, including recommendations on optimizing health before the journey of pregnancy begins. They can suggest medications that can be safely used in pregnancy to manage medical and psychiatric conditions with minimal risk to the developing fetus so that the ideal outcome can ultimately be achieved. A healthy parent and a healthy baby (or babies) is the best outcome for everyone!!
For more information on MFMs and what issues can be addressed with preconception counseling, please see:
Dr. Holly Dunn is a board certified Ob-Gyn who specializes in Maternal Fetal Medicine. She earned her medical degree from the University of Texas Medical Branch in Galveston where she also completed her residency in Obstetrics and Gynecology and a fellowship in Maternal Fetal Medicine. She is currently in private practice in Abilene, TX where she lives with her husband and two children, Carter and Emory. Her medical interests include multifetal gestations, cardiovascular disease in pregnancy, and extending superior healthcare to underserved areas of Texas. Her interests outside of medicine include running, reading John Grisham novels, and spending precious time with her family.
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