Interview has been edited for clarity.
Why get preconception counseling?
Dr. Chen encourages anyone with a pre-existing medical condition to seek a medical consultation before they become pregnant for a number of reasons.
Reason #1: Make sure their condition is medically stable
According to Dr. Chen, it’s important to make sure that anyone who wants to become pregnant is in a medically stable condition, because otherwise:
- They will find it harder to get pregnant.
- The risk of pregnancy complications or poor outcome is increased.
And this relates to any condition. He provides some examples:
It’s recognized that people with well-controlled diabetes do much better with their pregnancies.
Another example is that people with pre-existing hypertension have much better pregnancy outcomes if their blood pressure is under control.
“And if they have any autoimmune conditions, such as rheumatoid arthritis, or inflammatory bowel disease such as Crohn's disease or Graves’ disease, it’s recognized that if these conditions are stable at the time of conception, it leads to a much better pregnancy outcome,” says Dr. Chen.
On the contrary, Dr. K. Chen says if someone enters a pregnancy with poorly controlled rheumatoid arthritis, it is quite likely that it will get worse during the pregnancy. This will lead to increased complications for them and their baby.
“The bottom line is that a healthy parent leads to a healthy baby. If someone isn’t healthy during pregnancy, then it’s quite likely that the baby will develop more complications and have poorer outcomes due to the fact that they’re developing in a stressful environment.”
Reason #2: Learn which medications are and aren’t safe to take during pregnancy and lactation
People with pre-existing conditions are often on a number of medications for these conditions, and it’s very important to discuss which ones they can stay on during pregnancy and which ones should be stopped.
Insulin, metformin, and sulfonylureas are the only diabetes medications deemed safe to take during pregnancy, according to Dr. Chen.
There are certain medications that should not be used during pregnancy, and it’s important to know about these early so that there’s time to switch to a safer medication before pregnancy.
“On the other hand, I also want to use this opportunity to explain that most medications are actually safe to take during pregnancy.
“As an example, I see a large number of people who have conditions such as asthma or epilepsy. And as soon as they get pregnant, they stop all the medications they take for these conditions, not because they want to do anything to harm the baby, but because they weren’t given appropriate counseling and are scared and worried that these medications may have detrimental effects on their babies,” Dr. Chen explains.
As an example, he says that if someone requires regular inhalers to control their asthma, and then they develop a bad asthma attack because they stopped using these inhalers, the prolonged lack of oxygen that results from the asthma attack may increase the risk of pregnancy loss, preterm labor, or other complications. In general, most asthma puffers or inhalers are totally safe to take during pregnancy.
And so, another key reason for going to preconception counseling is to find out which medications are safe to take during pregnancy and lactation.
Reasons #3: Get informed on habits to start
Dr. Chen finds that people who adopt good, healthy habits before they get pregnant are much more likely to have a successful pregnancy because they continue these habits during the pregnancy.
“Some supplements are important to consider. As an example, for diabetics, I do tend to give them a supplemental dose of folic acid because it has been shown that taking extra small doses of folic acid tends to reduce the risk of any neural tube defects in babies born to people who have diabetes,” says Dr. Chen.
“I also strongly consider prescribing a low dose of aspirin for certain people. There are certain conditions that increase the risk of preeclampsia towards the end of pregnancy, such as pre-existing diabetes, hypertension, or kidney disease.
“A number of large studies have shown that low dose aspirin given to these women reduces the risk of preeclampsia significantly.”
Reason #4: Get all your questions about pregnancy answered
Dr. Chen says: “I have found over the years that a lot of people have many questions about pregnancy, and I always like to try to cover all of these things for them before they get pregnant, so that they’re not scared of going into the pregnancy. And if they’re better informed, then they’re also able to look after themselves much better throughout their pregnancy.”
A preconception counseling visit is also useful for determining if any other referrals are needed prior to pregnancy, for example, a referral to a genetic counselor to check the risk of passing a genetic condition to the baby.
“And lastly, I want to point out that there are not that many conditions that have absolute contraindications to getting pregnant. But occasionally, I do come across a couple of conditions where it would actually not be safe for them to get pregnant,” Dr. Chen adds, giving an example:
“I have cared for some women who have had very extensive congenital cardiac defects with subsequent pulmonary hypertension. Usually, for those women, it is not safe for them to get pregnant because the risk of maternal mortality is very, very high. Some studies quote that it can be up to 50 percent or even more.
“It is important for these women to have this counseling session so that they know it’s safer for them not to get pregnant, but instead consider a surrogate or adoption to eliminate the risk of maternal death.”
According to Dr. Chen, starting to plan before conception is the best way to reduce complications during pregnancy. Through professional preconception counseling, people with chronic medical conditions can improve their pregnancy outcomes significantly.