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PRE PREGNANCY SCREENING

Also known as Preconception screening, preconception screening is an opportunity to review any potential risk factors that may jeopardise future pregnancy and baby, as well as to optimise the woman’s health before pregnancy.

Potential risk factors that may negatively affect pregnancy include:

  • Existing illness that the woman already has.
    • For example, pre-existing conditions like diabetes, thyroid disorders, epilepsy, autoimmune disorders should be identified and well-controlled before pregnancy occurs. This would not only increase the chances of conception but also decrease the risks of miscarriage.

  • Existing medications that may harm the fetus
    • Certain medications that the woman is taking on a long term basis may cause abnormalities in the baby. A review of her current medications should identify such teratogenic medications. If so, safer alternatives should be used before the woman conceives.

  • Risks for the woman after she gets pregnant
    • For example, if a woman has thrombophilia (a condition which increases her risks of forming blood clots within the blood vessels spontaneously), then she should be advised to start blood-thinning medications soon after she conceives. This would reduce the risk of formation of blood clots which may potentially be fatal to both her and her fetus.

  • Risks for fetus after she gets pregnant
    • For example, if a woman has had previous late miscarriages or if she has had operations to her cervix, she may have a condition known as ‘incompetent cervix’. In such case, the cervix may dilate and open up before the baby is matured and ready to be delivered, resulting in either late miscarriages or very premature delivery. If a woman has been identified to have risk factors for incompetent cervix, then she should have regular scans throughout pregnancy to monitor the length of the cervix. If there are any evidence of incompetent cervix, treatment with a cervical cerclage (stitch) should be done in a timely manner.

As part of preconception screening, tests can be done to check if the woman is in optimal health for pregnancy. If she has anaemia (or low blood counts), for example, then investigations should be done to establish the cause and appropriate therapy should be instituted. In addition, tests can be done to check if her vaccines against infections against diseases that are detrimental to fetus are up to date. For example, all women should be immunised again rubella, hepatitis B and chicken pox before pregnancy wherever possible.

Last but not least, advice on optimal nutrition and lifestyle changes before conception would be discussed as part of preconception screening.

It should be evident that the above tests, modifications to medications and vaccinations, if necessary, would need time. Hence, for all women who are planning to conceive soon, do plan ahead and come for preconception screening at least three months ahead.