By Katie Toussaint Thurston, Novant Health Healthy Headlines
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There’s a lot for a woman to consider when she’s trying to get pregnant. Like whether to increase exercise during her first year of trying, or when her fertility window might be open.(Period tracker apps are one way to pay attention to that.)
Dr. Salvemini
But what about before all of that? Dr. Philomena Salvemini, an OB/GYN at Novant Health Southeast OB/GYN in Matthews recommends women schedule a preconception visit before even going off birth control, even if they’ve had children before.
Not only can the risk of birth defects go down when a woman is following doctor recommendations before conceiving, but women may need to shop around before they choose which provider is best for them.
“You want to make sure you feel comfortable with your provider, and sometimes that takes time,” Salvemini said. “And then you want to make sure that you understand the things that are unique to you regarding potential pregnancy and preconception.”
Everything that happens during a preconception visit is the woman’s choice, Salvemini said. “As doctors, we’re kind of like your guide. This is a dialogue.”
Here are six reasons you might want an up-front doctor visit.
1. Genetic screening
Genetic screening is a process that helps a woman understand her risk of passing certain disorders to her baby. Depending on her results, her partner may be recommended for screening as well.
“We would want to screen the mother for cystic fibrosis, muscular dystrophy and muscular atrophy,” Salvemini said. Blood tests provide the information.
2. A discussion about lifestyle
“Lifestyle is a big one,” Salvemini said. “The epidemic of obesity and poor nutritional habits is becoming more and more pervasive. And I think part of that is causing issues during pregnancy.” Issues can include:
– High blood pressure.
– Preeclampsia, a pregnancy complication caused by high blood pressure.
– Gestational diabetes.
– Higher baby birthweights.
– Great chance of delivery by C-section.
Doctors and other providers recommend that women have a healthy weight and eliminate alcohol, cigarettes and illicit substances. No one wants future mothers to feel overwhelmed by advice – but it’s important to embrace as healthy a lifestyle as possible before conceiving.
3. Talk to your provider about the meds you’re on
The most surprising realization for some women during preconception visits is finding out that medications they take could be harmful to a baby during pregnancy, Salvemini said. “If you are on a medication and you are not sure whether it is safe or not with pregnancy, or could hurt a baby or cause some sort of defect, you should definitely be using contraception.”
During a preconception visit, you can talk to your doctor about oral medications, topical medications (yes, what you put on your skin matters!) and supplements.
“It’s just about risk mitigation,” Salvemini said. “Oftentimes, the medication is not necessarily being prescribed by their obstetrician, it’s being prescribed by a different provider who’s not necessarily clued into the fact that she’s thinking about getting pregnant in the near future.”
Your provider may also ensure you’re up to date with vaccines, including the DTaP vaccine to prevent infections like tetanus, and MMR to protect against measles, mumps and rubella. The flu shot is recommended if it’s flu season, and the COVID vaccine is recommended and considered safe for most women considering getting pregnant.
4. Get screened for infections or STDs
To reduce the risk of miscarriage and pre-term delivery, it’s important for women to be screened for infections and sexually transmitted diseases.
“Any time you’re pregnant, regardless of your psychosocial situation, we always as standard of care do HIV, hepatitis, syphilis screening, gonorrhea, chlamydia, trichomonas screening,” Salvemini said. “Preconceptually, we do encourage STD screening particularly if you’re younger than 25, because that’s the demographic where you have a higher likelihood of having an STD.”
5. Review your medical, surgical and family history
Be prepared to bring information about your family’s medical history and your own so your doctor can advise about any medical conditions that pregnancy may negatively affect.
“When we talk about family history, one of the big things that we want to know about is cystic fibrosis, muscular dystrophy and pediatric cardiac anomalies,” Salvemini said. That spans the woman’s siblings and parents, as well as her partner’s.
6. A discussion about fertility testing and intervention for women 35 and older
Female fertility is affected by age, Salvemini said, and a significant decline in fertility happens at 35 and older. “That’s because as we age, our eggs age with us.”
That simply means your provider may handle your care a bit differently. Typically, a woman wouldn’t be tested for or diagnosed with infertility until 12 months of trying to get pregnant have passed.
For women 35 and older, Salvemini said, “One of the biggest things I talk to my patients about, in addition to gathering a really good gynecologic history and lifestyle history, is how long am I going to let you try to conceive on your own before we talk about maybe doing some testing and having a fertility specialist intervene. And it’s usually three to six months, tops. We don’t want to do a disservice to our patients by holding on to them too long.”
A woman can also opt in for ovarian reserve testing to get an idea of the quality and quantity of her eggs left, and her likelihood of conceiving without intervention.
No matter what happens during a preconception visit, Salvemini said, she wants to help her patients pursue the healthiest possible life while trying to conceive a baby.
“That’s why those preconception visits can be so important, because that’s our jam” as OB/GYN doctors, she said. “That’s what we do all day, every day. We love to make sure that we’re optimizing your health, medications, lifestyle, all of those things – before you’re going to be a vessel for a human being.”
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