Do I need to see my GP before having a baby?
We love it when women come and see us before planning a pregnancy. It provides us with an opportunity to make sure you are in the best possible health to conceive and carry a child and that the baby itself will be born healthy.
So, what do we do?
Firstly, we check your immunisation status.
Immunity to preventable diseases that we are immunised against in our childhood such as rubella and chickenpox can wane as we age. At a preconception visit, your GP will order a blood test to check your immunity. If we find that your immunity is low we will offer you a booster dose, the cost of which is covered by the Government. It is important to do this before conceiving as these are live vaccines and we do not recommend falling pregnant within 28 days of receiving these vaccines and we do not administer them in pregnancy. We also know that pregnant women are more susceptible to these conditions as the immune system is suppressed during pregnancy.
The flu vaccine and COVID vaccine will also be discussed by your GP. Both are strongly recommended at any stage of pregnancy to protect both you and your baby. The whooping cough vaccine is recommended after 20 weeks of pregnancy primarily to protect the baby as it will not be fully covered until 6 months of age when it has completed the primary course of vaccinations.
We also run other blood tests to check your iron levels, vitamin B12 and D levels, blood group, thyroid function and whether or not you are carrying any infectious diseases which need to be treated.
This is important because if you have a thyroid condition such as hypo or hyperthyroidism, it may not only affect your ability to fall pregnant, but it will also affect the health of a pregnancy and can cause complications for you and your baby. Any thyroid issues discovered will need to be addressed prior to conceiving.
It is also very important to know your blood type; in particular to know whether you are Rhesus negative or positive. If you are Rhesus negative, it means there is a potential risk that you can develop antibodies to your baby. This is not so much a problem for a first pregnancy but in a second pregnancy a woman’s immune system will be stronger with more antibodies which may attack a baby either before birth causing still birth or during delivery causing jaundice and brain damage. Luckily, if we know about this condition early (via a blood test), we can give a woman injections to prevent her developing antibodies throughout the pregnancy and after the baby is born preventing these complications.
Iron deficiency and anaemia, or low red blood cell count will also need to be treated with iron supplements to make sure you are in the best physical health to carry a baby. It can put extra strain on your heart not to mention make you feel very lightheaded, short of breath and cause heart palpitations to be anaemic in pregnancy.
Pre-conception vitamins will also be discussed. The most important of these being iodine and folic acid for brain and spinal cord development, respectively. Supplements should contain 150mcg iodine and 500mcg of folic acid. There are some women who will require higher doses and your doctor can assess whether you are one of these women.
Food safety and exercise are other issues which will be discussed by your GP.
In general, we advise that you continue your regular exercise and not take up new sports. Due to a rise in hormones such as progesterone and relaxin, your tendons and ligaments become very relaxed during pregnancy and your center of gravity shifts making falls, and injuries more likely. Contact sports are also not recommended after the first trimester.
In terms of food safety, given pregnant womens’ suppressed immune system, we recommend avoiding salad bars, uncooked seafood, sushi, cold rice, smoked meats and unpasteurised cheeses due to the risk of listeria and food poisoning.
It is also important to make sure your pap smear is up to date and a breast check is done if appropriate as cervical and breast cancer, whilst very unlikely are much harder to treat during pregnancy and some breast cancers may grow rapidly during pregnancy due to the influx of hormones.
Finally, at your preconception visit, your GP will take a thorough family history to determine whether you or your partner need to be tested for any specific genetic conditions to prevent transmission to a baby. Even if nothing is identified, it is customary to be offered a referral for a genetic mouth swab to determine whether you carry a gene for serious childhood illnesses such as Muscular Dystrophy, Fragile X or Cystic Fibrosis. This is important because if you do carry a gene for this, your partner will need to be tested as well and if you both carry a gene, you may want to consider invitro fertilisation or IVF to prevent passing the condition to your child.
Once you have had a pap smear, breast check, genetic clearance, flu vaccine, been taking a preconception multivitamin for at least one month, had your immunity to preventable diseases assessed and boosted if needed and had your thyroid function and iron levels checked and optimized, you are all set for a successful and healthy pregnancy!
