Optimising preconception health: Medical tests, gynaecologists' role, and appointment guidelines

In his second article of a two-part series on preconception care, Dr Panicos Shangaris gives us his insights. He talks about the medical tests and screenings that are recommended to assess a woman’s overall health and identify potential risks, the role of a gynaecologist during preconception care and how often women should schedule appointments with them.

What medical tests and screenings are typically recommended during preconception care to assess a woman's overall health and identify potential risks?

Preconception care includes several medical tests and screenings to assess a woman's overall health and identify potential risks. These assessments vary based on the individual's medical and family history, lifestyle, and age, but generally may include:

1. Full blood count (FBC): This is a basic test to check for anaemia and other blood conditions.

2. Blood type and Rh factor: Knowledge of blood type is crucial in case a blood transfusion is needed during pregnancy. Rh factor is important as well since an Rh-negative woman carrying an Rh-positive fetus may require special care to prevent complications, especially if they carry a Rh+ fetus.

3. Blood glucose test: This test checks for pre-existing diabetes or prediabetes, which, if left uncontrolled, can lead to complications during pregnancy.

4. Thyroid function test: Undiagnosed thyroid conditions can affect fertility and pregnancy outcomes. A simple blood test can check thyroid function.

5. Sexually transmitted infection (STI) screening: Tests for STIs, including HIV, syphilis, gonorrhoea, chlamydia, and hepatitis B and C, are important since they can impact pregnancy and the health of the baby.

6. Pap smear and HPV test: These tests check for cervical cancer and human papillomavirus (HPV), which can cause cervical cancer. The tests are routinely done as part of the NHS cervical screening program, so ensure you are current.

7. Genetic carrier screenings: If the woman or her partner has a family history of genetic disorders or if they belong to certain ethnic groups at higher risk for specific genetic diseases, carrier screenings can be done for conditions like cystic fibrosis, Tay-Sachs disease, sickle cell disease, or thalassemia.

8. Immunisation status: A check on the woman's immunisation status for diseases like measles, mumps, rubella, chickenpox, hepatitis B, and others. Some diseases can harm the fetus, and some vaccines are unsafe to get during pregnancy, so it's better to ensure immunity before conception.

9. Tuberculosis (TB) test: If a woman is at risk for TB (due to travel, work, or exposure history), a TB test may be recommended, as it can cause complications during pregnancy.

10. Urine analysis: A urine test can reveal kidney problems or urinary tract infections, which need to be treated prior to pregnancy.

11. Mental health screening: This is used to identify untreated depression, anxiety, or other mental health conditions.

12. Substance use assessment: Screening for alcohol, tobacco, and drug use is crucial as these substances can harm the developing baby.

13. Review of current medications: Some medications are unsafe during pregnancy, and a review can help decide if any changes need to be made.

The results of these tests can provide valuable information about potential risks and can guide the management of health conditions prior to pregnancy, increasing the chances of a healthy pregnancy and baby. These tests and screenings should be conducted in addition to routine medical care. It's also important to remember that preconception care involves both partners. Men's health and lifestyle also affect pregnancy outcomes, so preconception care for men is equally important.

What role does a gynaecologist play in providing preconception care, and how often should women schedule appointments for preconception consultations?

A gynaecologist plays a crucial role in preconception care as they are typically the primary provider for women's healthcare needs and can address a wide range of health issues that affect women.

1. Health assessment: The gynaecologist can perform an overall health assessment to identify existing medical conditions that may affect pregnancy. This includes checking the woman's weight, blood pressure, and overall physical health.

2. Laboratory tests and screenings: The gynaecologist orders necessary tests and screenings, such as blood tests and STI screenings, to evaluate the woman's health status and detect potential issues that could affect pregnancy.

3. Medical history review: The gynaecologist reviews the woman's personal and family medical history to identify potential genetic or hereditary conditions that could affect the pregnancy.

4. Lifestyle counselling: The gynaecologist provides counselling about healthy lifestyle changes, including diet, exercise, substance use, and mental health.

5. Vaccination review: The gynaecologist checks the woman's immunisation status and recommends necessary vaccinations to protect the mother and baby.

6. Medication review: If the woman takes any medications, the gynaecologist reviews these and recommends changes if necessary to ensure that the medications are safe during pregnancy.

7. Fertility counselling: The gynaecologist can provide fertility counselling and recommend treatments or interventions if necessary for women who have difficulty getting pregnant.

8. Education: The gynaecologist provides education about what to expect during pregnancy and childbirth, potential risks and complications, breastfeeding, newborn care, and more.

The frequency of preconception care visits varies based on the individual's health status, age, lifestyle factors, and reproductive plans. Generally, women planning to become pregnant should schedule a preconception care visit with their gynaecologist at least three months to a year before they start trying to conceive. This allows enough time to address any health issues, start making healthy lifestyle changes, take prenatal vitamins, and adjust any necessary medications.

For women with existing health conditions, such as diabetes or hypertension, or those who have had complications in previous pregnancies, more frequent visits may be necessary. It's also recommended that all women of reproductive age have regular check-ups, regardless of their plans for pregnancy, to monitor their health and address any issues early.

Dr Panicos Shangaris is an esteemed consultant obstetrician with over 15 years of experience. You can schedule an appointment with Mr Shangaris on his Top Doctors profile.