Alcohol and Smoking During Pregnancy
For your protection and health care and preconception care, research has consistently shown that alcohol and smoking during pregnancy pose significant risks to the health of the mother and fetus. The data reveal that 52% of women consume alcohol during pregnancy, with 17% participating in this practice throughout the entire gestation period. Smoking is also widespread, about 50% of women smoke at some point, and 33% maintain a persistent smoking habit.
The combined risks of alcohol consumption and smoking are particularly alarming. Women who drink alcohol and smoke are at three times the risk of stillbirth compared to those who abstain from both. Even smoking alone increases the relative risk of stillbirth by 1.6 times. In addition, smoking is associated with intrauterine growth restriction, low birth weight, increased likelihood of sudden infant death syndrome, asthma, and childhood obesity. Smokeless tobacco, which delivers nicotine similarly to cigarettes, can lead to low birth weight and a shorter gestational age.
Mental Health and Tobacco Use in Prenatal Care
Incorporating routine screening for tobacco use and mental health, including depression, into prenatal care is essential. Women should receive comprehensive support to quit smoking, which includes both behavioral therapy and pharmacological options. Untreated depression during pregnancy is linked to preterm birth, low birth weight, and long-term developmental issues in children.
Despite its importance, depression screening is not yet routine in many low- and middle-income countries. The Perinatal Mental Health Project in Cape Town serves as an exemplary model, integrating depression screening into prenatal care and demonstrating improved outcomes for maternal mental health. Early detection and intervention can significantly enhance maternal well-being and mitigate long-term complications for both mother and child.
Healthy Weight and Pregnancy
Achieving and maintaining a healthy body mass index (BMI) before pregnancy is crucial for reducing risks. Women are advised to aim for a BMI between 18.5 and 24.9. Obesity during pregnancy is associated with an increased risk of gestational hypertension, diabetes, pre-eclampsia, and cesarean delivery, in addition to stillbirth, birth defects, and neonatal complications. Preconception counseling is vital for educating women on the risks of obesity, the importance of a healthy diet, and weight management strategies.
Fetal Programming and STI Screening
The concept of fetal programming underscores that adverse conditions during pregnancy can elevate the risk of chronic diseases such as diabetes and cardiovascular issues later in life. Routine screening for sexually transmitted infections (STIs), including HIV, syphilis, and hepatitis B, is critical to reducing perinatal risks like preterm birth and infection transmission. Programs such as the Prevention-of-Mother-to-Child-Transmission (PMTCT) in South Africa have successfully decreased HIV transmission to infants.
Congenital Syphilis and Glycemic Control
Screening for syphilis and timely treatment with penicillin can prevent severe complications such as stillbirth and neonatal death. Women with pregestational diabetes must maintain optimal glycemic control, with HbA1c levels kept below 6.5% before conception, to minimize the risk of fetal structural abnormalities.
Teratogenic Medication Avoidance
It is crucial to minimize exposure to teratogenic medications, which contribute to 10-15% of congenital anomalies. Medications such as ACE inhibitors, statins, and warfarin should be avoided during pregnancy due to their association with birth defects.
Preconception and Pregnancy Care
The effectiveness of maternal behaviors, mental health management, weight control, and avoidance of harmful substances is pivotal in optimizing pregnancy outcomes.Comprehensive care during the preconception care and prenatal periods, including mental health support and routine screenings, is essential for preventing adverse effects on both mother and child. Expanding research and care delivery, particularly in low-resource settings, remains a priority for improving overall health outcomes.
Preconception Counseling
Preconception counseling serves as a preventative measure, assessing a woman’s health prior to pregnancy. This counseling covers clinical, environmental, and psychosocial factors, aiming to identify and address potential risks. It is generally recommended to start preconception care three months before conception, though this timing can vary based on individual health needs, such as achieving an ideal body mass index.
Key interventions in preconception care focus on optimizing maternal health through proper nutrition, managing chronic conditions (like diabetes and hypertension), mental health support, substance use avoidance, and ensuring up-to-date medication and vaccinations (e.g., rubella immunity).
Importance of Preconception Care
The Developmental Origin of Health and Disease (DOHaD) emphasizes the significance of the period around conception for future offspring health. Poor maternal conditions can increase the risk of non-communicable diseases and adverse birth outcomes. Proper preconception care can mitigate these risks, and this care is equally important for adolescents, focusing on life skills, healthy nutrition, and sexual health education.
Risk Factors to Address During Preconception
A comprehensive health assessment should include medical, reproductive, and family history, nutritional habits, psychosocial profile, and drug exposures. Women with chronic conditions like hypertension or diabetes face higher risks but can achieve successful pregnancies with careful management. Adjustments to medication may also be necessary before pregnancy.
Core Preconception Wellness Measures
Planned pregnancies tend to result in better health outcomes.Key preconception care wellness measures include ensuring multivitamin and folic acid intake to prevent neural tube defects, avoiding tobacco and substance use, maintaining a healthy weight, controlling glycemia (especially for women with diabetes), screening for STIs, and addressing mental health issues, particularly depression.
Antenatal Care (ANC) Post-Conception
The WHO’s 2016 ANC model recommends a minimum of eight antenatal visits starting in the first trimester and continuing throughout the pregnancy. The visit schedule includes one visit in the first trimester, two visits in the second trimester, and five visits in the third trimester. Increased visits during the third trimester are crucial for monitoring maternal and fetal well-being and detecting potential complications.
Unintended Pregnancies
Unintended pregnancies are linked to increased risks of low birth weight, miscarriage, stillbirth, neonatal death, and long-term child health issues. Contributing factors include poor family planning, inadequate contraception, and a lack of reproductive education.
Why preconception care and health care is important
preconception care and prenatal care is essential to reduce risks and improve health outcomes for both mothers and their babies. Proactive preparation, comprehensive monitoring and support throughout the pregnancy journey can lead to healthier pregnancies and better long-term health for future generations.
