Pre-Pregnancy Admission: How should we plan?
This planning, which includes a visit to the doctor for the purpose of preparation and information before pregnancy, has become increasingly routine. In addition to the women’s section of planning, there is also a section with a family history and a laboratory.
General lines of planning;
* Collection of family history and couple information,
* Gynecological examination, ultrasonography and pap smear
* If it is over the ideal weight, a slimming plan should be prepared according to the ratio of this height.
* Correction if there is abnormality in thyroid hormones
* Determination of Rubella immunity,
* Review of habits such as smoking and alcohol
* Precautions and preparations related to lifestyle
* Folic acid is started 3 months before cessation.
Family history and couple’s information should be collected, and if the family has a genetic transient disease or if the couple has previously had pregnancies, these possibilities should be reviewed in terms of recurrence risks and necessary preparations should be made for risk monitoring.
If there is an infection in the gynecological examination, it should be treated. It is known that certain infections such as ureoplasma, chlamidia and trichomonas can cause preterm labour. Pap smears should be made and information about the cervix should be obtained, and if there is a problem, it should be resolved before pregnancy begins and precautions should be taken. In gynecological ultrasonography, in addition to the presence of myoma, ovarian cyst or endometrial polyp, congenital anomalies (such as double uterus, uterine septum) can be determined. If these problems are determined in advance, problems can be corrected surgically before pregnancy begins. If it is decided that there are no surgical indications, at least the risk factors of pregnancy can be determined in advance and it can be decided whether the woman’s lifestyle and medical treatment is required. If the woman has anemia, it is treated before pregnancy.
Getting pregnant over the ideal weight, correlated to how high the weight is, can cause problems in pregnancies. Problems including pregnancy related diabetes, pregnancy hypertension, vaginal birth difficulties, wound healing problems in cesarean can make pregnancy and postpartum difficult. When it is targeted to lose weight, besides nutritional measures, cardio exercises such as walking or cycling can be supported, as well as exercises that increase muscle strength, such as pilates. It should become a habit to take at least two liters of fluid per day after this process.
Pre-pregnancy evaluation of thyroid hormones will help us avoid many problems during pregnancy. In hypothyroidism, thyroid hormones are released less and this may affect the mental development of the fetus. In hyperthyroidism, complications related to preterm delivery and hyperthyroidism may also occur in the fetus. The number determined as the target; TSH value is kept below 2.5 in the first 12 weeks and then 3. It is also important that the free T4 value remains within normal ranges.
Rubella infection, referred to as rubella, was passed in childhood in 85% of adults and immunity can be determined when IgG positivity is seen in the tests. If the remaining 15% of women get the infection in the first 12 weeks, 90% of the fetus the infection is found. Therefore, if the woman is not immune, she must be vaccinated before pregnancy. There is no harm in getting pregnant 2 months after vaccination.
Smoking can cause many problems such as preterm birth in pregnancy, development restriction in the fetus, and it seems to be related to crib deaths, learning and speech disorders in the child at a later age. Therefore, it is of great benefit to quit before pregnancy. Quitting during pregnancy is sometimes very difficult psychologically, but sometimes with nausea in the first weeks, the woman can naturally be disgusted with smoking. Postponing the smoking cessation to pregnancy period may cause psychological negative effects on quitting psychology.
Alcohol consumption: The most important word that can be said during pregnancy is the fact that the toxic limit of alcohol is not clear. Therefore, it should be known that a small amount of alcohol intake can negatively affect the brain development of the fetus. If alcohol is consumed as a habit, it should be reduced or stopped before pregnancy, and alcohol should never be used during pregnancy.
It will be appropriate to get help and discontinue medicines such as anti-depressant, anti-psychotic drugs, sleep medications and acne medications containing isotretionin before pregnancy by sharing with relevant doctors before pregnancy.
Attention should be paid to the use of painkillers and only paracetamol-derived painkillers should be used whenever possible.
Revising the pre-pregnancy lifestyle is an important concept and has many sub-components. If jobs dealing with chemicals (such as the paint industry), radiation-exposed jobs (such as radiology technicians, radiologists, and radiation oncologists) are involved in jobs that require heavy bodily power, reorganizations will be required when conceiving. It is useful to inform the workplaces early in case of pregnancy. Because workplaces are legally obliged to protect their employees. Unnecessary use of mobile phones should also be reduced and measures such as using headphones and keeping the phone out of the snow should be taken.
If an excessively sedentary life is lived, a form of exercise must be adopted and done regularly. Smoking and alcohol should be avoided and nutrition should be regulated. It is not appropriate to do sports that require excessive physical strength and take risks during pregnancy. With this in mind, the exercise plan will need to be changed before pregnancy.
The use of folic acid before pregnancy is now well established in our country, and most women are already aware of the use of folic acid. The use of folic acid should be started at 400 micrograms per day, one every day and 3 months before forgetting and stopping protection. Methyl forms of folic acid must be preferred. The pre-pregnancy period should continue to be used while conceiving and in the early period of pregnancy. If the woman has a history of fetus with a neural tube defect, then the dose can be increased up to ten times. We know that the use of folic acid at the right time and in adequate doses significantly reduces the frequency of neural tube defects in the fetus. At the same time, folic acid is used in iron metabolism in women and supports blood production.