The world has changed. In my day you fell pregnant, headed off to your GP, had a few blood tests, showed up at the hospital for your first pregnancy visit and away you went. The first ultrasound was the morphology scan at 20 weeks (if you were over 35, they talked about an amnio). And that was pretty much it.
It’s different today. There is a lot to discuss and there is a lot to do. At the moment we crowd it into a long first pregnancy visit, but:
- There is only so much you can take in in an hour or so, and
- Some things are best sorted out prior to pregnancy – is your thyroid functioning normally, are there any special tests you need, are you on the correct vitamins and medication? Etc.
I’d like to take this opportunity to recommend that you all come and see me for a visit prior to falling pregnant (I love that term – falling pregnant!) – even if that seems a comparatively remote possibility.
We can discuss any medical problems or concerns you may have. I can physically examine you (check your blood pressure etc) and make sure that things like your PAP smears (or whatever they are now called) and breast checks are up to date if appropriate.
We can optimise any medications you might be taking and ensure you are taking the correct supplements. We can refer you to other doctors or professionals if needed. In addition, we can talk about lifestyle factors including diet and exercise. If needs be, we can discuss your mental health for your pregnancy and afterwards and organise whatever support you might need.
More importantly though I think there are definite benefits in proactively testing for some issues prior to pregnancy rather than at a first pregnancy booking visit at, say 8 weeks – when fetal development is well under way. These matters are not necessarily important for everyone but they include:
- Checking your thyroid. I did obstetrics to avoid the thyroid gland but clever people tell me that the thyroid is important for fetal brain development from early in pregnancy. Many professional bodies don’t recommend routine testing of thyroid function in (or before) pregnancy but to me it makes sense to discover your thyroid is not functioning perfectly prior to your pregnancy, rather than – often – the end of the first trimester.
- Testing you for infections, particularly CMV. Once again, my professional bodies don’t recommend routine testing for CMV for everyone and I agree with that approach. However, if you are potentially at risk of contracting CMV (and in essence that means you are exposed to small kids (and not many of us aren’t)) it is much simpler to test you and address any problems well before you are pregnant.
- Genetic testing. This is the biggie these days. It is true that even in these exciting times we can’t begin testing for Down Syndrome and other serious chromosomal problems before 10 weeks gestation. However, these days more and more women are opting for testing for their genetic carrier status for other conditions (Cystic Fibrosis, Fragile X Syndrome and Spinal Muscular Atrophy are the most common but there are many more). We often do this in early pregnancy but these tests are far better performed prior to pregnancy so – again – any issues can be addressed and managed (including possibly testing your partner and if needs be seeing a genetic counsellor). Remember Ashkenazi Jews also need particular testing and other population groups warrant tailored testing (I’m thinking about thalassaemia testing for Mediterranean people and South East Asians here).
We can also talk about your plans and wishes for your pregnancy, birth and afterwards if you wish to begin addressing those matters before you are pregnant.
One more thing. It’s been a difficult year so all the more reason to enjoy the holidays.