If you are planning to conceive, do prepare your body for this important event. This includes addressing chronic conditions in order to maximise chances of getting pregnant while protecting your health and that of your baby.
Thinking of getting pregnant and starting a family soon? To increase your chances of conceiving, it is important that you prepare your mind and body ahead of time. This also helps to ensure a smooth delivery and protects your health as well as that of your baby.
Dr Pooja Sachdeva, Consultant, Department of General Medicine, Sengkang General Hospital, recommends that you go for Preconception Counselling to learn to accept conditions that cannot be changed, and adopt some lifestyle changes for a better outcome for both mother and baby.
If you suffer from any condition listed in the table below, you do not necessarily have to get it cured, but you must mitigate it for a good outcome. For other conditions, do discuss with your doctor.
One condition that cannot be helped is your height. A short stature puts a woman at risk of developing cephalopelvic disproportion which makes it challenging for a vaginal delivery. “You will need to talk to your doctor about an alternative delivery method,” advises Dr Sachdeva.
What you can do something about is addressing any chronic condition you may have. The good news is there are very few medical conditions for which doctors will be completely against you getting pregnant.
“However, it’s better to optimise these conditions, especially if you’re planning to get pregnant in
the following one year,” says Dr Sachdeva.
Let’s focus on four common health conditions:
Diabetes Mellitus
This condition is characterised by high blood glucose levels caused by insufficient or ineffective insulin production. Dr Sachdeva warns that uncontrolled diabetes can cause congenital abnormalities, perinatal death or miscarriage. That is because high blood glucose interferes with the development of a foetus, causing birth defects.
It is important to monitor your HbA1c, a measure of blood glucose over a period of time.
“If this value is less than 7, you’re okay to go,” reveals Dr Sachdeva. In fact, as a preconception factor, HbA1c should be below 6.5. However, if your HbA1c level is higher than 7, it is advised that you bring it down to at least that level before trying for a baby. To achieve this, you are likely to be prescribed metformin (hypoglycaemic agent to lower your blood sugar level) and folic acid (a supplement for foetal growth and development).
High Blood Pressure (Hypertension)
This term is used when the pressure in your blood vessels is too high (140/90mmHg or higher). About 3% of Singaporeans have this condition, and many of them do not know they have it because they do not ‘feel’ any symptoms. The only way to know is to get your blood pressure checked.
“This is the second most common problem we encounter during pregnancy, especially with late-age pregnancies,” shares Dr Sachdeva.
Hypertension can be serious if untreated, especially for a pregnant woman. It can lead to pre-term birth, placental abruption, intra-uterine growth restriction, preeclampsia and foetal death. To keep your blood pressure between the healthy range of 110/70 and 130/85mmHg, you will likely be prescribed appropriate blood pressure medications before and during pregnancy.
“If you already have high blood pressure and you intend to get pregnant, highlight this to your doctor so that he can prescribe alternative medication that can safely maintain where you want to be,” advises Dr Sachdeva.
You will also be advised to make lifestyle changes, such as:
Switching to a low-salt diet
Including exercise in your daily schedule
Undergoing a weight management programme if overweight
High Blood Cholesterol (Hyperlipidaemia)
If you have too much fatty substances — such as cholesterol and triglycerides — in your blood, this could lead to these substances depositing in your arteries, blocking blood flow. A subset of this condition is hypercholesterolaemia, which refers to high levels of cholesterol in the blood.
It sounds counter-intuitive, but if you are already on medication to lower your cholesterol level, stop it when you become pregnant — but do inform your doctor.
“There is no evidence that we should treat cholesterol level during pregnancy because pregnancy will definitely affect your cholesterol level, whatever the baseline level,” shares Dr Sachdeva.
There are two reasons for this. Firstly, pregnancy will increase a woman’s triglycerides level (up to two times) and bad cholesterol (LDL, up to 50%) anyway. Secondly, drugs that lower either triglycerides or cholesterol levels are not harmless, regardless of whether you are at the preconception, pregnancy or lactation stage.
In fact, there have been reports that niacin – commonly prescribed to increase levels of good cholesterol (HDL) – may have safety issues; while other reports say statins - commonly prescribed to reduce cholesterol levels - are sources of teratogenecity and congenital malformations.
The only safe option for pregnant women to decrease their triglyceride level is for them to take omega-3 fatty acids.
Hypothyroidism/Hyperthyroidism
The thyroid, a gland located in the base of the neck, produces and releases four hormones into the bloodstream: thyroxine (T4), triiodothyronine (T3), reverse triiodothyronine (RT3), and calcitonin. These regulate several bodily functions, including metabolism, digestion and fertility.
The common way to monitor thyroid function is to measure the level of thyroid-stimulating hormone (TSH) in the blood. A healthy level of TSH during pregnancy would be between 0.5 and 2.5 mIU/litre. Produced by the pituitary gland, which is located on the brain roughly in line with the top of your nose, TSH stimulates the thyroid to produce T3 and T4.
If you are pregnant and have hypothyroidism, there is a risk of pre-term birth, low birth weight, placental abruption, foetal death, and cognitive impairment in the baby. In case of hyperthyroidism – 85 per cent of which are due to Grave’s disease – there is a risk of cardiac failure and arrhythmia in the foetus. As for the pregnant woman, “you actually can get heart failure,” warns Dr Sachdeva.
This is why thyroid issues must be addressed, preferably before you get pregnant. For hypothyroidism, thyroxine needs to be increased by 30% or more for 12 weeks of pregnancy. For hyperthyroidism, surgery would usually be suggested if the medication dosages required are higher than normal. In either case, doses of T4, a growth hormone, need to be increased for the mother-to-be because the foetus relies on maternal T4 in the first trimester.
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