1ST CITY CLINICAL HOSPITAL

15.05.2023

According to a study under the auspices of WHO (2020), every fourth pregnancy is unplanned, which leads to 25 million unsafe abortions and 47 thousand deaths of women every year. WHO experts believe that the main reason for this situation is the inaccessibility of information on family planning.

The family is the most important environment for the preservation and transmission from generation to generation of cultural values ​​and national traditions.

In our country, family, motherhood, paternity and childhood are the subject of special protection by the state, since they are an integral condition for the preservation and development of the Belarusian people. That is why, on International Family Day, I would like to pay special attention to the issues of pregnancy planning.

According to a study under the auspices of WHO (2020), every fourth pregnancy is unplanned, which leads to 25 million unsafe abortions and 47 thousand deaths of women every year. WHO experts believe that the main reason for this situation is the inaccessibility of information on family planning.

Why do you need to consult an obstetrician-gynecologist before planning a pregnancy? The goal of prenatal preparation (preparing for pregnancy) is to reduce the risk of adverse health consequences for the woman, fetus and newborn by working to eliminate risk factors, compensate for chronic diseases and educate about healthy pregnancy.

Every woman planning a pregnancy should consult an obstetrician-gynecologist in advance. The doctor will collect an anamnesis, conduct an examination, prescribe a diagnostic and clinical laboratory examination, consult with specialists (cardiologist, endocrinologist, urologist, surgeon) if necessary, and also recommend medications, the use of which is important at the stage of pregnancy planning.

It is worth dwelling on some points in a little more detail.

There is such a concept - intergenetic interval - the period between successive births. Thus, in accordance with the guidelines of the World Health Organization in 2018, the optimal interval between births is considered to be 24 + 9 months (the period of time after the last birth until the onset of a new pregnancy + the duration of the new pregnancy) both in the case of vaginal birth and in the case of delivery by cesarean section.

An interval between the last birth and the new pregnancy of less than 6 months is associated with:

• increased risk of premature birth;
• low birth weight of the child;
• risk of developing anemia in the mother;
• risk of uterine rupture after a previous caesarean section.

Women aged 35 years and older, taking into account the reduced chances of spontaneous pregnancy, can begin trying to conceive 12 months after birth.

If a woman is not currently planning a pregnancy, then she should be told about such a concept as ovarian reserve (a reserve of eggs in the ovaries). Each girl is born with a certain supply of eggs, and their number does not increase during life, but only decreases. A considerable part of the eggs die before the onset of puberty. The process of decreasing the supply of eggs occurs throughout a woman’s reproductive period, and especially quickly during the 10 years preceding menopause - the last menstruation in a woman’s life. Age, poor environment, smoking, chronic stress, obesity - all this reduces not only the quantity, but also the quality of eggs, and therefore the ability to conceive. Information received by the doctor about the ovarian reserve of each individual woman can help determine the possibility of postponing pregnancy or resorting to egg cryopreservation. Especially, this information may be relevant for women whose mothers had early or premature menopause, women planning/undergoing ovarian surgery, or those who are undergoing chemotherapy/radiation therapy.

Next, I would like to draw your attention to the fact that many chronic diseases, such as diabetes mellitus (DM), arterial hypertension (AH), kidney and thyroid diseases affect the onset, course and outcome of pregnancy. These diseases must be treated or their maximum compensation achieved at the stage of pregnancy planning. Thus, if a woman has arterial hypertension, the risks of developing such severe pregnancy complications as preeclampsia, eclampsia, premature placental abruption, placental insufficiency, and fetal developmental delay increase. Low thyroid function (hypothyroidism) can result in children being born with mental retardation.

Uncompensated diabetes mellitus is dangerous due to the development of complications such as:

• fetal macrosomia (large fetal size), which can lead to injury to mother and child during childbirth;
• polyhydramnios;
• premature placental abruption is a serious complication leading to the death of both mother and fetus;
• bleeding during childbirth and the postpartum period;
• intrauterine infection of the fetus;
• the birth of children with low blood sugar levels, which requires careful monitoring of the child after birth by a neonatologist.

When planning a pregnancy, you should review all medications a woman is taking, as some of them can cause congenital malformations of the fetus. Such drugs include antiepileptic drugs, some antibacterial drugs, and high doses of vitamin A. Drugs high in vitamin A are often used to treat acne and other dermatological problems, so women should be warned about the need for contraception during the treatment period. Taking combined oral contraceptives reduces reserves of B vitamins (folic acid, B6, B12). A deficiency of these vitamins can lead to congenital malformations of the fetus, hyperhomocysteinemia, macrocytic anemia in the mother, and toxicosis in the first half of pregnancy.

What else is important to remember when preparing for pregnancy? About screening for sexually transmitted infections. Some infections can lead to infertility, and their presence during pregnancy can lead to premature birth, premature rupture of amniotic fluid, intrauterine infection of the fetus, and postpartum infectious complications. Sexually transmitted infections include: syphilis, gonococcal infection, chlamydial infection, mycoplasmosis caused by mycoplasma genitalium, urogenital trichomoniasis, HPV infection, HIV infection, viral hepatitis B and C. Most of them are easy to treat, which should be completed before the onset of pregnancy. Treatment is prescribed by either an obstetrician-gynecologist, a dermatovenerologist, or an infectious disease specialist. The topic of HIV infection is still taboo in our society. Tabooed due to ignorance and fear. However, since the introduction of antiretroviral therapy, HIV infection has become a manageable chronic disease. With this disease, you can now live for many years without losing your quality of life and maintaining social activity. The probability of transmitting HIV infection from mother to child without preventive measures is up to 40%. Intrauterine infection occurs in 15–25% of cases, infection of a child during childbirth in 60–85%, and during breastfeeding in 12–20% of cases . Antiretroviral therapy as a method of preventing mother-to-child transmission of HIV was first recommended in 1994 after the successful completion of a clinical trial conducted in the United States and France. This work showed the high effectiveness of prescribing antiretroviral drugs to an HIV-infected woman during pregnancy, childbirth and a newborn.

Next, a few words about diseases that can be protected against by vaccination at the stage of pregnancy planning.

Measles and rubella. Even if a woman is vaccinated against measles and rubella, but 5 years or more have passed, there may be no protective antibodies left in the blood or their number may be extremely low. How can you find out? It’s very simple to determine the level of specific Ig G for measles and rubella viruses. In the absence or low concentration of antibodies, it is worth deciding on the need for vaccination/booster vaccination against the above infections. If a woman has not had chickenpox, she should also think about vaccination. Why do we pay attention to these particular infections? Because if you are infected with measles, rubella, or chickenpox during pregnancy, there is a high risk of birth defects in the fetus. Well, and because you can protect yourself from them in advance by vaccination. You can plan a pregnancy 3 months after vaccination, since these are live vaccines.

Since we are already talking about vaccination, it would not be amiss to recall the possibility of seasonal flu vaccination for both non-pregnant and pregnant women. In accordance with Order of the Ministry of Health of the Republic of Belarus No. 1257 dated October 12, 2021 “On vaccination against COVID-19 infection of women during pregnancy and during breastfeeding”, it is advisable to vaccinate against COVID-19 infection to women of reproductive age at the stage of pregnancy planning , including in preparation for infertility treatment using assisted reproductive technologies. These recommendations are justified by the high risks of infection with coronavirus during pregnancy, and the likelihood of a more severe course of the disease in pregnant women, especially in the presence of chronic diseases. Planning a pregnancy can no longer be postponed after vaccination against COVID-19.

What else is important to remember?

Families in which spouses have genetic diseases, or if there have been pregnancies or births of children with congenital malformations or genetic diseases, should be aware of the possibility of early consultation with a geneticist followed by screening for genetic diseases. You can be examined for carriage of monogenic diseases (spinal muscular atrophy, cystic fibrosis, etc.).

And finally, I would like to note that the chances of successful conception, pregnancy and the birth of a healthy child increase when partners give up bad habits, normalize body weight, and eliminate vitamin and microelement deficiencies.

Now you know why and how to prepare for pregnancy.

Obstetrician-gynecologist

(head of consultation) of the 4th antenatal clinic                                            Shkarupa Alexandra Sergeevna.