• Rebecca Genuis

An unrecognized need


One of the big challenges with preconception care is that couples often do not recognize the need for this kind of care prior to attempting to conceive. Or if they do, and ask a general practitioner, they may be given little advice beyond a recommendation to take a few vitamins and avoid cigarettes and alcohol. I was reminded of this while reading a recent article from the Netherlands. The authors make the point that if we are going to improve outcomes of pregnancy, then we must start before conception.


It is both an evidence-based recommendation, as well as a traditional concept, that couples seek adequate preconception care. There’s a few reasons for this.


Change takes time. Over the course of comprehensive preconception care, women and their partners are often asked to make significant changes to their lifestyle, their diet and their home environment. These changes can take both time and effort. Asking women to do this after they’re already pregnant is suboptimal for numerous reasons.

  • If they’re in the first trimester, fatigue, nausea and a whole host of symptoms may make this difficult, if not entirely impossible.

  • Making changes takes time, and is often much more successful if this is appreciated and planned for.

  • By the time women are seen by a healthcare provider, their developing child has often undergone significant development that may already have been affected by the risk factors being addressed


Exposures occurring in the preconceptional period count. Repeated study has shown that a couple’s exposures and deficiencies in the period of time even before conception can affect the development of their future child.

  • For example, higher phthalate exposure (from soft plastics) in males in the preconceptional period has been associated with lower birth weight babies while exposure to certain pollutants in the mother in the month before conception are associated with an increased risk of birth defects.

  • Deficiency of folate in the months leading up to pregnancy, before the fetus has been conceived, has been associated with a higher rate of brain abnormalities

  • For women with pre-existing health problems, their health status prior to conception can make a big difference. (For example, women diagnosed with diabetes optimize their pregnancy outcomes if sugar levels are controlled in the 3 months before conception occurs.) So if these women are only seen once they have already conceived, a real opportunity to improve outcomes has already been missed!

Optimizing nutrient stores. An excellent article from the Lancet noted that nutrient requirements during pregnancy and lactation are so high that an ordinary diet probably can’t meet them. In order for mum to meet the requirements that growing and feeding a child will require of her, she needs to be intentional about the food that she eats. There is a wide range of nutrient levels that are often considered “normal” when assessing a person’s nutritional status, but when pregnancy is imminent, it’s important that women be on the high end of normal to ensure that after giving up lots for her child’s growth and development, she won’t be left vulnerable to deficiencies.


Convincing women of the need to seek out preconception care remains one of the biggest challenges facing our healthcare system, and research continues to show this is the case. Please feel free to share this post with those that you know are in the preconception period.




References

Oudijk, M. (2017). Reduction of preterm birth rates starts at preconception. BJOG: An International Journal of Obstetrics & Gynaecology, 124(11), 1717-1717. doi:10.1111/1471-0528.14692


Messerlian, C., Braun, J. M., Mínguez-Alarcón, L., Williams, P. L., Ford, J. B., Mustieles, V., . . . Hauser, R. (2017). Paternal and maternal urinary phthalate metabolite concentrations and birth weight of singletons conceived by subfertile couples. Environment International, 107, 55-64. doi:10.1016/j.envint.2017.06.015


Ren, S., Haynes, E., Hall, E., Hossain, M., Chen, A., Muglia, L., . . . Defranco, E. (2018). Periconception Exposure to Air Pollution and Risk of Congenital Malformations. The Journal of Pediatrics, 193. doi:10.1016/j.jpeds.2017.09.076


Stephenson, J., Heslehurst, N., Hall, J., Schoenaker, D. A., Hutchinson, J., Cade, J. E., . . . Mishra, G. D. (2018). Before the beginning: Nutrition and lifestyle in the preconception period and its importance for future health. The Lancet, 391(10132), 1830-1841. doi:10.1016/s0140-6736(18)30311-8

©2018 by Dr. Rebecca Genuis