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A big misconception: Prenatal care follows pregnancy

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Dr. Al Fleming perinatologist

Dr. Al Fleming, a perinatologist, says getting checked early is the best advice he can offer for prenatal care. The photos are displayed outside his office in the new Maternal-Fetal Medicine Center at St. Luke's Regional Medical Center.

It's never too early to get good advice from a physician when it comes to prenatal care.

It should even come before you need it.

A preconception office visit, that is.

"The best piece of advice to give somebody who is planning a pregnancy is to actually be seen (by a doctor) before they get pregnant. That way they can assess their fitness for pregnancy," said Dr. Al Fleming, a perinatologist with the Maternal-Fetal Medicine Center at St. Luke's Regional Medical Center who has more than 20 years of experience.

The center offers services to women referred by their doctors for various reasons such as prenatal diagnosis, genetic counseling and expecting multiples.

Women often see their OB/GYN with medical conditions already existing that could be harmful to a developing fetus. Maybe they are taking certain medications which should be switched before they are pregnant if they knew the dangers, Fleming said.

"Taking additional vitamins can be helpful to prevent some of the damage from certain medications," he said. "I'm speaking specifically for women who have seizure disorders. Some of the medicines can cause spina bifida. But with additional Vitamin B supplement -- folic acid, in particular -- they can lessen the likelihood of that happening."

Unfortunately, the preconception visit doesn't happen nearly enough

"The ones that should, don't," he said. "But the ones who are very conscientious, do. And sometimes you find out things that they didn't even know they had. They might find out they're diabetic and not know it."

A preconception visit is especially advisable for smoking cessation or women who find out they have high blood pressure.

"It's better to know that before you get pregnant because there's sometimes diet and exercise that can lower your chance for developing high blood pressure or diabetes in pregnancy," Fleming said.

Usually the women who need to do this, women who have seizures or diabetes or other things that put them at risk know enough to come in before getting pregnant, he noted.

"Then their diabetes can be adjusted or made to be well controlled, so that when they get pregnant, there won't be that risk of malformation. It's the same thing with the anti-epileptic drugs that can take additional folic acid to prevent things like spina bifida from occurring," he said.

Women should always take prenatal vitamins as long as possible to prevent birth defects.

"It's a big deal," he said, noting that even women without a history of spina bifida or diabetes will normally get enough folic acid through the prenatal vitamins they take to prevent birth defects. They are available over the counter, but they can be bad for you if you take too many, he added; and if you just need more folic acid, take folic acid specifically and not more vitamins.

"So knowing to take a single prenatal vitamin every day as long as you're capable of becoming pregnant is a good idea," he said. "But avoid excessive amounts of Vitamin A because that could be damaging to a developing embryo."

Women with very serious cardiac disease should probably avoid pregnancy.

"And it's really specific on the type," Fleming said. "It they have valvular heart disease, that's something that should try to be repaired before they get pregnant. Metal (heart) valves are not good in pregnancy because of the blood thinners you need to take, which can be associated with birth defects. And if you don't take a blood thinner and you've got a heart valve, it can lead to stroke, throwing off a clot to the brain."

Additionally, women who have been treated for cancer should be tumor-free for at least three years before getting pregnant, he said.

The ideal body weight for a mother-to-be should be close to her normal Basal Metabolic Index (BMI). Women who are overweight can have adverse pregnancy outcomes, getting diabetes of hypertension. So an average woman should gain about 28 pounds during pregnancy for a single baby, 30-35 pounds for twins. And women who are starting a pregnancy overweight should probably gain 15 pounds, Fleming said, because if they are overweight and gain 50 pounds, they are more likely to have a big baby more likely to get diabetes orĀ other complications. Conversely, underweight women should gain 40 pounds because they risk having a smaller, growth-restricted baby.

All of these things, of course, can -- and should -- be addressed before pregnancy.

As for gestational diabetes, if you have a tendency to develop Type 2 diabetes when you are 50 or 60, sometimes it it shows up because of the stress of pregnancy on the pancreas.

In some cases, he noted, this can serve as a wake-up call: Women should pay attention to their diets and lose weight before the onset of diabetes again at 50 or 60.

Hair dyes used to get a lot of press, but that is not a major concern. And fluorocarbons in the workplace are equally hazardous to all women, pregnant or not, he said.

One exception would be radiation exposure, but even folks working in radiology today are protected to the extent that what exposure they get is not likely to harm them.

"Even diagnostic chest X-rays and things like that are safe in pregnancies. There's a shield anyhow. So very minimal exposure would not cause any fetal damage," he said.

Women should also pay special attention to family history.

"A woman who's pregnant for the very first time, if her family history is strong for diabetes, it's not surprising to see her develop it while she's pregnant. And she doesn't necessarily have to be overweight," Fleming said. "A family history and genetics play a role in that, too. The same thing goes for hypertension."

Genetic history is important when it comes to such diseases as cystic fibrosis and Tay-Sachs disease.

It's one more reason to get that pre-pregnancy testing.


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