Preconception Care and Counseling

 

Preconception care and counseling (health care and counseling provided to a couple considering pregnancy before the woman becomes pregnant) are recommended for a woman with a disability who is considering having a baby. They can help to determine if the woman is in optimal health and physical condition before pregnancy. Care and counseling before pregnancy are also helpful to identify and address potential problems that may affect the woman with a disability once she becomes pregnant. The woman who is healthy before the pregnancy increases her chances for a healthy pregnancy and a healthy baby.

Preconception care provides an opportunity to address issues that may affect the pregnancy. Such issues are addressed in the pre-pregnancy checkup. A report issued in 1989 by a federal panel of experts on prenatal care states that "...the pre-pregnancy visit may be the single most important health care visit viewed in the context of its effect on the pregnancy". The panel recommended that a woman have a least one visit with her health care provider before conception. This visit is very important for a woman with a chronic health problem, such as diabetes, that may affect the pregnancy or increase the risk of having a child with birth defects. 

Nutrition is another important issue in preconception care.   For example, taking a B vitamin, folic acid, is important to prevent birth defects of the brain and spinal cord.  The US Public Health Service and the March of Dimes recommend that all women of childbearing age consume 400 micrograms of folic acid every day. It is important to begin taking folic acid at least one month before becoming pregnant since these defects occur in the first month after conception. The best way to get the recommended amount of folic acid is to eat a healthy diet and take a multiple vitamin supplement every day. Those vitamins labeled "prenatal" are not limited to use only when pregnant and they do include the perfect dose of folic acid.

It is important to note that some medications, such as antiepileptic drugs, cause a mild folate (folic acid) deficiency which can lead to abnormal fetal development. If you are taking antiepileptic drugs, address this concern with your health care provider and determine whether a folic acid supplement should be prescribed.

For more information:

http://www.modimes.org (March of Dimes)

Preconception care may include genetic testing and counseling to address genetic disorders (those that can be passed or transmitted to the baby). Counseling also provides an opportunity to talk over the need for treatment of the disabling condition during pregnancy and the possible effects of that treatment on the growth and development of the baby before birth. Ideally, these counseling sessions will include the future dad since his family may have genetic disorders and also he will be involved in providing care to the baby. In addition, discussing medications taken to treat underlying disabling or chronic health conditions is important while you are considering pregnancy. See Medications about the need to discuss with your OB health care provider the use of all medications that may be taken by women with disabilities, including herbs, prescription, and over-the-counter medications. 

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Questions to ask your health care provider during preconception care and counseling:

 

It might be helpful to write down questions and concerns you may have about pregnancy and disability. This serves as a reminder of questions you have and enables you to discuss them with your health care providers at your next appointment with them. The following are some examples of questions that you may want to ask:

  • What is known about the effect of pregnancy on my disabling condition (multiple sclerosis, rheumatoid arthritis, cerebral palsy, spinal cord injury, lupus, etc.)?
  • What is known about the effect of my disabling condition on pregnancy and the ability to be a parent to a child?
  • Should I undergo genetic testing or counseling before becoming pregnant?
  • What do I need to do to improve or maintain my health during pregnancy?
  • Are there any special risks to me during labor and delivery?
  • Are there any special issues regarding anesthesia for delivery because of my disability?
  • Are there any risks to my baby from the medications I may need to take to treat my disability?
  • Are there other problems that can be transmitted to my baby because of medications, other treatments, or secondary conditions associated with my disability?
  • Are there risks to me if I need to stop taking medications because of pregnancy?
  • Is there a risk of my baby developing the same disability I have? How much of a risk is there?
  • Is there anything I can do to reduce the risks to my baby?
  • Though I am not "disabled" now, the illness I have can result in that occurring. Will a pregnancy "invite" the disability to occur?
  • Have you (the health care provider) managed the care of women with my condition or disability throughout pregnancy? 

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Questions to ask yourself:

 

The following are some examples of questions that you may want to ask yourself if you are considering pregnancy:

  • What extra help or resources will I need during pregnancy or following my baby's birth?
  • Will I be able to take care of a new baby and growing child without help from others?
  • If other help will be needed, is that help likely to be available?
  • How will I deal with/react to negative comments from others because of pregnancy given my disability?

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08/05/2003 11:00 AM