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Ready or not?

Nov 3, 2009 | Susan Glairon | The Daily Times-Call

Preconception health care for women is just as important to a baby as prenatal care

The physician stared at her, then told her to wait until she missed her menstrual period, then make an appointment for eight weeks later, she said. Goodchild was stunned.

"In eight weeks, you really miss the window to save a baby from birth defects," said Goodchild, 42, the state director for the Colorado March of Dimes, a nonprofit whose goal is to prevent birth defects.

Unlike Goodchild, most women don't think about receiving medical care before conceiving a child, and most doctors don't offer such visits.

But the Centers for Disease Control and Prevention say "preconception" care is critical for babies to receive the best chance for a healthy outcome.

Preconception visits include reviewing a woman's prescription and nonprescription drugs; helping her get chronic illnesses, such as diabetes, under control; and counseling women about not drinking or smoking while trying to get pregnant. Such visits would reduce the number of low birth weight and premature babies, as well as those born with birth defects, the CDC said.

Preconception visits would also include prescribing folic acid to prevent conditions such as neural tube defects.

Preconception care isn't just for women who are thinking about getting pregnant. Many experts say it's important for all sexually active women to consider a preconception checkup, because more than 50 percent of pregnancies are unplanned.

"We know breast cancer is a problem, but a lot of people don't know that this is as big a problem," said Jane Gibbs, a member of the roughly two-year-old Healthy Women-Healthy Babies Roundtable in Denver. The group includes care providers, legislators and policy maker.

In an average week in Colorado, 1,333 babies are born and 162 are born pre-term, after less than 37 weeks in the womb, according to the March of Dimes. Eight babies die before their first birthday, and 118 babies are born weighing less than 5.5 pounds. Between 1994 and 2004, the rate of pre-term infants born in Colorado increased 18 percent.

"Some of them die; some have permanent damage in terms of developmental disability, physical disability, vision, hearing, lung problems and intestinal problems," said Dr. Anna M. Kelly, ob/gyn clinical faculty member of the University of Colorado Health Sciences Center. "The ramification of babies who may have been born just a few weeks premature goes on and on."

Studies show that taking folic acid before conceiving prevents about 70 percent of birth defects of the spine and brain (neural tube defects), including spina bifida. But most women don't start taking it until their first prenatal visit, which is usually after the fetus is 11 weeks or older, and by then, fetal organs have formed, Kelly said.

"By the time we see women for their first prenatal visit, often problems have already developed that are too late to change," Kelly said. "It's a very sensitive time. If a woman does not have enough folic acid in her diet, things can go wrong, and there's no way to undo that problem down the road."

Controlling diabetes - high blood sugar that also can cause life-threatening malformations in the brain or heart - and switching to medications that are safe for developing babies before conception also are important for healthy outcomes.

"Most women understand not to have an X-ray if pregnant," Kelly said. "But I think that most women don't realize that if they are diabetic, the sugar that they take in might be equally damaging to that early fetus."

The earliest published reference in the United States to the term "preconception health" was in 1978. Guidelines for preconception care have been around since the early 1990s, but most doctors still have not incorporated such counseling into their practices, said Dr. Hani K. Atrash, associate director for program development for the CDC's National Center on Birth Defects and Developmental Disabilities.

The reason for the lag is that doctors can't be reimbursed for providing "preconception care" services because there is no billing code for it, Atrash said.

It's also because clinical practice guidelines aren't available for a "package" of preconception-care services, including prescribing folic acid, managing chronic diseases such as obesity and diabetes, and counseling against alcohol, drugs and tobacco, he said.

In addition, consumers have not been educated about preconception health care, so the demand for such services is practically nonexistent, Atrash said.

Optimally, all women of child-bearing age would receive such counseling in a routine that would be as regular and accepted as getting a pap smear, Kelly said.

Dr. Ronald S. Gibbs, professor and chairman of the department of obstetrics and gynecology at the University of Colorado School of Medicine said there is a very strong medical rationale for all women to have preconception counseling, instead of waiting until a woman is pregnant to deliver health care.

"Health care should be lifelong, should be a continuum and should not be episodic," Gibbs said.

Susan Glairon can be contacted at 303-684-5224 or sglairon@times-call.com.

For your health

Before getting pregnant:

• Take 400 mcg of folic acid daily for at least three months to reduce the risk of birth defects.
• Stop drinking alcohol and quit smoking.
• Get medical conditions under control, including asthma, diabetes, oral health, obesity and epilepsy.
• Update your vaccinations.
• Discuss with your doctor over-the-counter and prescription medicines you are taking, including vitamins and dietary or herbal supplements.
• Avoid exposure to toxic substances or potentially infectious materials at work or at home, such as chemicals or cat and rodent feces.

Source: Dr. Hani K. Atrash, associate director for program development for the CDC's National Center on Birth Defects and Developmental Disabilities.