Pre-pregnancy Preparation

​​​P​regnancy​ is an exciting and rewarding experience for any woman. Pre-​pregnancy preparation is essential in the journey of pregnancy. 

Being well prepared would optimise your chance of a smooth pregnancy and healthy baby​. It prepares you both physically and emotionally. 

​Now that you have decided to embark on the journey of motherhood, let us see how you can prepare yourself for a healthy pregnancy. ​​​

Ideally, you should start at least three months before you conceive​, but it is never too late either. ​​

Start Young 

The prime of your fertility is when you are 20–24 years old, with a sharp decline from 35 years old onwards. On average, there is a drop of 3% in fertility with each increasing year of the woman’s age (Figure 1.1). 

The chance of genetic abnormalities like Down Syndrome​ as well as complications​ in pregnancy​ like miscarriages, high blood press​ure and dia​​​betes​, increases as you grow older, particularly beyond 35 years of age. So, start young if you are able to!

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​Pre-pregnancy Supplementation ​

It is important to take a diet balanced in calories, carbohydrates, proteins and fibres​. 

Folic acid is a type of vitamin B that is needed for the formation of blood cells and the development of baby’s nervous system. It has been shown to reduce the chance of a baby having neural tube defects (spinal cord and brain abnormalities) (Figure 1.2). A simple way is to take a folic acid supplement of at least 400mcg once a day from three months before conception till the first 12 weeks of pregnancy. Folic acid capsules are sold at your local pharmacy. ​Some women may require higher doses of folic acid of up to 5mg a day (e.g. women with diabetes, BMI 30 or more, or if they are on certain anti-seizure medications etc). Do speak to your doctor for more advice on the appropriate dosage.

Pre-conception Check-up 

Visit a g​ynaecolo​gist​ to discuss: 

• your chance of conception,
  
• previous medical problems that may affect your pregnancy,
  
• family history of genetic problems​ and
  
• immunisation history​. 
  

Your check-up may include: 

• a PAP Smear test/Human Papilloma Virus (HPV) test,
  
• thalassemia(genetic blood disorder) test and​
  
• Screening for immunity to rubella​ (German measles) screening.
  
• A pelvic ultrasound scan may also be performed to check for ovarian cysts or fibroids in the womb. 
  

Optimise Your Medical Conditions 

Medical conditions such as ​diabetes ​mellit​us, ​hypertension or thyroid disease can affect pregnancy outcomes especially if they are not well controlled. If you have a pre-existing medical condition, do visit your obstetrician or your usual doctor to ensure that these are well-controlled prior to conception, as this will improve the chances of having a smooth and healthy pregnancy. Other pre-existing medical conditions that could affect or be affected by pregnancy include: 

• ​Auto-immune diseases such as syste​​mic lupus erythematosus and rheumatoid arthritis
  
• Epilepsy
• Asthma
  
• Anemia such as i​ron-deficiency anemia or thalassemia​
• Kidney disease
• Heart disease​​
• Deep vein thrombosis or pulmonary embolism (blood clots in legs or lungs)​
  
• Depression​

​It is possible to have a successful pregnancy even if you have one of the above chronic condit​ions​, but it may be considered a high risk pregnancy and and some additional precautions may have to be taken. If you are on chronic medication for these conditions, your gynaecologist will want to review them for safety in the pre-pregnancy and pregnancy period. For example, if you have pre-existing diabetes on oral medications, you may need to switch to insulin injections once your pregnancy is confirmed. 

Avoid High-risk Activities 

It is advisable to stop smoking​. Substance abuse and smoking are associated with an increased risk of miscarriages, slowing of baby’s growth in the womb, pre-mature delivery and bleeding in the placenta. Avoid excessive alcohol and binge drinking as well. This can lead to congenital malformations and mental impairment of your baby. 

Frequently Asked Question

What are some problems that older mothers may face during pregnancy? 

​It is important to reiterate that most pregnancies in older mothers have a good outcome. Traditionally, an older mother is defined as any expectant mother who is 35 years old or more at the time of pregnancy. 

There is an increased incidence of chromosomal problems with advancing maternal age as the quality of the egg may deteriorate. In particular, there is an increased risk of Down’s Syndrome compared to a younger age group. There is also an increased risk of twin pregnancy (see Chapter 22). In addition, older mothers have an increased risk of miscarriages. 

Overall, there is an increased tendency to medical conditions complicating pregnancy such as pregnancy-induced hypertension and gestational diabetes. It is important for any mother with advanced maternal age to see an obstetrician early so that proper follow-up and tests can be performed.​

Acknowledgement

​​Source: Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John, The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.