While most women know that they should avoid smoking and drinking alcohol prior to pregnancy, there are several other steps they can take toward good health before becoming pregnant. Among the national recommendations recently released by the Centers for Disease Control and Prevention (CDC), women are now strongly encouraged to see their doctor about controlling existing medical conditions, take folic acid to help prevent neural tube defects, and develop a reproductive plan before becoming pregnant.
The recommendations for preconception care were published in a recent issue of Morbidity and Mortality Weekly Report (MMWR) Recommendations and Reports.
Alfred W. Brann, Jr. MD, professor of pediatrics at Emory University School of Medicine and director of the World Health Organization/Collaborating Center in Reproductive Health, is one of the pioneers of preconception care. Dr. Brann is also principal investigator of the Interpregnancy Care Project at Grady Memorial Hospital. Co-principal investigator is Anne Dunlop, MD, MPH, assistant professor at the Emory University School of Medicine, Department of Family and Preventive Medicine. Dr. Dunlop, who is a fellow with the WHO Collaborating Center in Reproductive Health, served with Dr. Brann on the Select Panel to draft the National Recommendations.
"This is the next wave of strategies for improving the outcomes of pregnancy," says Dr. Brann. "We now know there are anomalies that can be prevented if women take preventive steps before they become pregnant. For example, women just can't start taking folic acid to prevent neural tube defects once they are already pregnant. The organs have already been formed in the first six to eight weeks of pregnancy. A woman should start taking folic acid some two to three months before she becomes pregnant. Up until now, everything that physicians have done has been oriented towards improving the survival of the existing embryo and fetus when the woman comes for her first prenatal visit. We have never fully addressed the prevention of congenital anomalies as vigorously as we are attempting to do with these recommendations. We now know that preventive measures can be taken beforehand to prevent malformations from occurring."
Fifty-five percent of all pregnancies are unintended. Dr. Brann says the frequency of adverse outcomes is much greater in an unintended pregnancy than in an intended one. Because of this, he says that men and women should realize the importance of reproductive awareness and avoid the conception of a mistimed, and especially an unwanted, pregnancy.
"If a woman has a wanted pregnancy, chances are she will have a normal, full-term healthy baby," Dr. Brann says.
Dr. Brann also emphasizes the importance of smoking and alcohol cessation before and during pregnancy. Medical conditions such as seizures or hypothyroidism also must be treated and controlled by a physician, as well as any pre-existing conditions like diabetes or hypertension.
Through a two-year collaborative effort, the CDC convened a panel of experts from a variety of national organizations concerned about the health of women, infants and families.
Dr. Dunlop says the recommendations were drafted to raise awareness among providers about the importance of preconception care.
"The real importance of these national recommendations is that it puts forth the expectation to the healthcare community that preconception care isn't one single visit to the doctor," she says. "It has to be part of every healthcare interaction with women to get at this whole idea of reproductive planning. If providers are addressing this issue, they are helping decrease the number of unintended pregnancies, which will greatly improve infant outcomes."
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