WHAT IS A PRECONCEPTION CHECK UP?
A preconception check up helps your doctor make sure that your body is ready for pregnancy.
If you can, get your check up from doctor you want to take care of you during pregnancy.
WHEN?
You can get a preconception check up any time — even up to a year before you want to get pregnant.
WHY IS IT IMPORTANT?
Some medical conditions, like depression, diabetes, high blood pressure and not being at a healthy weight can affect pregnancy and your fertility (your ability to get pregnant).
Smoking,using street drugs and abusing prescription drugs can affect them, too.
Your doctor can help you manage health conditions and make changes in your life to help your baby be born healthy.
WHOM?
Get a preconception check up even if you’ve already had a baby.
Your health may have changed since you were last pregnant. If you had a problem in a past pregnancy, your provider may be able to help you avoid the same problem in your next pregnancy.
Get a preconception check up if you’ve had:
- Premature birth. This is birth that happens before 37 weeks of pregnancy.
- Baby with birth defects. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. They can cause problems in overall health, in how the body develops or in how the body works.
- Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy.
- Stillbirth. This is when a baby dies in the womb before birth, but after 20 weeks of pregnancy.
BLOOD TESTS recommended for all women who are pregnant or planning a pregnancy
Routine pregnancy screening tests:
1. Blood group and antibody screen
2. Rubella (German measles) antibody status
3. Syphilis serology
4. Midstream urine
5. Viral infections
6. Hepatitis B
7. Hepatitis C
8. HIV
Tests which may be considered at the first antenatal visit
- Cervical cytology (PAP smear)
- Vitamin D
- Screening for haemoglobinopathies(blood disorders)
- Chickenpox (Varicella)
BLOOD GROUP AND ANTIBODY SCREEN
All women should have their blood screened at the first antenatal visit (the first pregnancy check up which should occur before the woman is twelve weeks pregnant).
Blood screening enables the doctor to determine the woman’s blood type (whether she has type A, B, AB or O). Women who already know their blood type will not need to have this test.
BLOOD SCREENING FOR PREGNANCY
A doctor will also need to determine whether the woman has Rh- or Rh+ blood.
The partners’ of women with blood type Rh- should also have their blood type tested because foetuses conceived by Rh- women and Rh+ men may develop haemolytic disease of the newborn, a serious condition which can cause brain damage and infant death.
This disease occurs after an Rh- woman is exposed to the blood of her Rh+ foetus and begins producing antibodies which cause the body to reject Rh+ blood.
These antibodies are passed onto the foetus during pregnancy, and can cause a newborn baby with Rh+ blood to reject its own blood following childbirth.
This disease can be prevented by treating the pregnant woman and newborn baby with immunoglobulin, which prevents the formation of antibodies to Rh+ blood.
BLOOD ANTIBODIES
In addition to having their blood type tested, all women should be screened for blood antibodies.
This is important even if the woman had previously has a test for blood antibodies, as antibodies concentrations change over time.
For example, a woman who has previously been vaccinated and acquired antibodies for measles,mumps and rubella may require a booster vaccination is she has not been vaccinated for a long time, as antibody levels decline over time.
Ideally, antibody screening should be performed before the woman becomes pregnant, as many vaccines are not recommended for use during pregnancy because there are hypothetical concerns about their safety when used during pregnancy.
RUBELLA (GERMAN MEASLES) ANTIBODY STATUS
Women need to have their blood assessed to determine whether or not they carry antibodies for Rubella at the first antenatal visit.
It is necessary for a woman to undergo this test every time they become pregnant.
Women who have previously been shown to carry rubella antibodies should not assume that they have sufficient antibodies, even if previous tests have shown sufficient rubella antibodies.
Rubella immunity may decline over time, particularly in situations where women are immune due to vaccination (rather than natural infection).
Rubella vaccines are not recommended for use during pregnancy, and it is therefore important to screen for the disease and vaccinate if necessary prior to becoming pregnant.
SYPHILIS SEROLOGY
A blood test for syphilis infection should be performed at the first antenatal visit.
Syphilis is a sexually transmitted infection which is often asymptomatic, meaning that many women who carry the disease do not have any symptoms and do not know they are infected.
Syphilis can have serious negative effects during pregnancy, but is easily treated with antibiotics once detected.
MID STREAM URINE
A woman will usually also have her urine tested at the first antenatal visit.
VIRAL INFECTIONS
Doctors recommend that all women test for Hepatitis B, Hepatitis C and Human Immunodeficiency Virus (HIV) infection before or during pregnancy.
As these are diseases with serious implications for both the pregnant woman and her foetus, women should take the time to fully discuss any concerns they have with their doctor.
HEPATITIS B
As hepatitis B is highly infectious and can be easily transmitted to a newborn baby or hospital staff, it is recommended that all pregnant women are screened for Hepatitis B in the first trimester of pregnancy.
The babies of women who test hepatitis B positive will require Hepatitis B vaccination at birth to reduce their chances of becoming infected.
HEPATITIS C
Up to 80% of individuals in high risk groups (e.g. injecting drug users) carry this infection.
During childbirth there is a 5% risk of transmission to the newborn.
There is also a risk of infection for clinicians exposed to the body fluids, especially blood of hepatitis C carriers.
It is therefore recommended that all pregnant women are screened for Hepatitis C antibodies.
Individuals who test positive for hepatitis C will require a second test to determine whether they are infectious or chronic (non-infectious)carriers of the disease.
Knowing whether or not a pregnant woman can infect others with hepatitis C enables health workers to develop a management strategy to reduce the risk of the infection being transmitted during childbirth.
Having a caesarean section does not reduce the risk of hepatitis C transmission to the newborn, so hepatitis C carriers can deliver their baby naturally.
However,their babies should be screened for hepatitis C infection between 12-18 months of age. Hepatitis C carrying women should breastfeed, like all other women, as there is no evidence that Hepatitis C can be transmitted through breast milk.
HIV
Women should test for HIV during the first antenatal visit and again at 28 weeks pregnancy. .
The disease has serious consequences and can be transmitted from a mother to her newborn baby during delivery or breastfeeding.
The likelihood of a woman transmitting HIV to her baby is between 25-30% if she does not take any precautionary measures.
However, the likelihood of infection can be substantially reduced (to about 2%) if appropriate preventative measures are implemented during pregnancy, childbirth and breastfeeding.
All HIV positive women planning a pregnancy (and those already pregnant) should be referred by their general practitioner for consultation with an infectious disease specialist.
The infectious disease specialist will plan a series of preventative measures to reduce the woman’s risk of transmitting HIV infection to her baby.
Usually women will need to take antiretroviral therapy during pregnancy and their babies will also require antiretroviral therapy for six weeks following birth to reduce the likelihood of transmission.
A caesarean section delivery and intravenous antiretroviral treatment during delivery also reduces the chance of a woman transmitting the infection to her baby.
As HIV can be transmitted via breast milk, it is recommended that HIV positive women formula feed their infants.