Rishma Pai is the president of Indian Society of Assisted Reproduction (ISAR) and the president of Federation of Obstetric and Gynaecological Societies of India. She's a practicing consultant gynecologist at Lilavati Hospital in Mumbai. She talks to THE WEEK about the importance of pre-conception counselling, matching health profiles of both partners before marriage and various health conditions affecting pregnancy.
Why is there a need for pre-conception counselling?
We gynecologists and obstetricians would always prefer that a patient comes to us for a pre-conception counselling. Almost always people come to us after they are already pregnant. By then, it is very late for many things as they may be already carrying a pre-existing disease or have a problem which we cannot then change. For example, pre-existing diabetes, undetected thyroid problem, thalassemia, which both the partners may have and may not be aware.
Does it aggravate in case of marriages within the family?
Young girls must understand that even before they are planning marriage, just the way they match kundalis, they should be matching the health profiles of both partners. For example, if the girl is thalassemia minor, she should actually try not to get married to man who is also thalassemia minor, because on the face of it, both are completely normal and healthy, but when they get married there is a strong chance that their baby will be born with thalassemias major which is a life threatening condition. If both parents who suffer from or whose families suffer from minor genetic problems, come together, their offsprings can suffer from major genetic problems in the future.
Care must be taken to avoid this at all costs. That is why we don't advise marriages between relatives. Because when relatives get married, they often have similar gene problems with chances of similar chormosomal abnormalities, and then those genes get magnified, and the risk of abnormal children are much higher. This does not mean that one get full genetic analysis done before marriage. However, if there is some condition existing in the family, then it is better to get it checked.
Weight loss
It is important for one to be at one's ideal weight before pregnancy, because high weight in pregnancy will be the root cause of many problems such as development of diabetes and blood pressure. Also, at present, around 30-35 per cent of my patients, young women, have Polycystic Ovary Syndrome (PCOS). Women with PCOS have difficulty becoming pregnant, many of them are obese, are pre-diabetic or diabetic because the basic pathology behind PCOS and diabetes is insulin resistance. A large number of girls who fall prey to diabetes in pregnancy are PCOS girls who do not look after themselves well. So if we can treat or manage the PCOS before pregnancy, and then very carefully monitor and control the mother's health during pregnancy, then the incidence of diabetes in pregnancy will significantly reduce.
Thyroid
Unless one gets tested, one doesn't know that one has thyroid. So a woman can become pregnant without knowing that she has a thyroid problem, and so the first few weeks of pregnancy, which are very important for child development, will be at uncorrected thyroid levels and that may cause the baby to suffer, along with high chances for high rates of miscarriages, pre-term babies, abortions, all because of uncontrolled thyroid conditions. It is when the woman comes for pre-pregnancy counselling that we can ensure she becomes pregnant only after thyroid levels are made normal.
Supplements
Folic acid is extremely essential for early pregnancy. In the absence of severe deficiency of folic acid, there is a high incidence of neurological problems in the baby. So, if the woman becomes pregnant with very low folic acid, there is a much higher incidence of abnormality in the child. The most common problem is the neural tube defect arising from the low levels of folic acid in the mother.
Pre-existing diseases
Those who have high blood pressure or diabetes need to ensure that these are in check before becoming pregnant. Because there is something called PIH (pregnancy induced hypertension), which means a pregnant woman has a tendency towards high blood pressure and if a woman comes pre-disposed with blood pressure problems, the chances of abnormality in the child is even more. Uncontrolled sugar levels too can be very dangerous for the baby.
Infections
Something as common as a bad urinary infection, or herpes or hepatitis C or HIV can be transmitted to the baby. Hence, counselling before pregnancy assumes even more importance as these things can be taken care of at the start itself.
Many women have fibroids. It is as common as saying more than 20 per cent young women who come to me, have fibroids in their uterus. And most are unaware of it and get to know about it only after becoming pregnant. Later on, there are problems of miscarriage and pre-term delivery among others. Every fibroid does not cause a problem, but must be reported nevertheless. Sometimes, there are very small problems, which actually turn out to be severe during pregnancy. For instance, Septum, a birth defect, is a minor problem seen in some patients. It essentially is a curtain inside the uterus, dividing the uterus into two parts. This is not a healthy development because the uterus has to be one full part for the baby to nestle. Division of the uterus into two parts is unhealthy and dangerous. Yet, it is a very simple problem and can be treated with a fifteen minute surgery. But there is no way to diagnose it unless a gynecologist examines and finds out.
Young girls come up with cervical cancer, breast cancer and blood disorders which must be rectified before one becomes pregnant. Because the aim is to go into pregnancy very healthy so as to have a healthy delivery and a healthy baby. Also, many patients who come to us take drugs, some for depression, some for headaches, some for epilepsy. Now, a woman cannot go into pregnancy with all those drugs in place. We need to alter, modify and ultimately try to stop the dosage, and to be able to do that, we need to know the patient's condition and history and hence, pre-pregnancy counselling assumes very high importance.
Married couple need to plan a pregnancy. If you didn't want to plan, you should know how not to plan. You cannot be all the time ignorant about everything. If you can have relationship then you should also know how to deal with the consequences of an intercourse.