Preconception Health_ For a Healthy Family !

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Preconception Health:

Preconception health refers to the health before pregnancy. Maternal lifestyle in the period prior to conception, as well as during pregnancy, is an important determinant of healthy pregnancy and normal fetal development. By the time most women have realised that they are pregnant and have taken the first contact with antenatal care, the fetal organs have already been developed. Interventions aiming to prevent adverse pregnancy outcomes related to organogenesis are thus often too late. Risk factors include insufficient nutrition, low levels of folate, overweight/obesity, medical conditions and its treatments, alcohol and tobacco use, and high age.

Maternal nutrition both preconception and during pregnancy can affect growth, development and later health outcomes of the fetus. To reduce the risk of neural tube defects (NTDs) in the fetus, women are advised an intake of 400 μg folic acid daily in good time before conception and up to 12 weeks after. As an increasing proportion of women of reproductive age use medications, and few medications are examined for possible teratogenic effects, women should discuss all usage of medications with their health care provider (HCP) if planning a pregnancy or becoming pregnant. Obesity (Body Mass Index, BMI, of 30 or above) is associated with increased risks both for infertility and complications during pregnancy, such as preeclampsia and gestational diabetes, as well as complications during delivery. Alcohol use in early pregnancy has been associated with increased risk for spontaneous abortion, preterm delivery and low birth weight. The association is evident even with low amounts of alcohol consumption, but binge drinking seems to be the most hazardous to fetal development

Smoking during pregnancy is a well-documented risk factor for adverse pregnancy and neonatal outcomes, and also snuff use increases the risk of stillbirth. Stopping or reducing tobacco intake during pregnancy strongly reduces the risks. One out of ten women aged 16- 29 smokes daily. Approximately 3% of women aged 16-84 use snuff, but snuff use is becoming more common and the increase is greatest among younger people, the proportion of women who smoked in early pregnancy was 6% and 1% used snuff. Except from lifestyle factors, female fertility can be impaired by a range of factors such as premature menopause, salpingitis, endometriosis, polycystic ovary syndrome and sexually transmitted infections (STI), but most importantly by physiological ageing.

The impact of age on fertility and pregnancy:

Approximately 10-15% of the population is estimated to have difficulty conceiving naturally and about half of these seek medical help for infertility. The possibility to use fertility and reproduce, the fecundity, is at its highest at the age of 20-24. Among heterosexual couples with women younger than 30 years, 90% become pregnant after one year of unprotected intercourses while the corresponding figure for women aged 35-40 is 50%. The chance of a live birth after a cycle of in vitro fertilisation (IVF) also decreases with age. For a couple to have a 90% chance of realizing a desired 2-child family without IVF, it is estimated that they should not postpone parenthood later than 27 years of age. The corresponding age if IVF can be considered is 31. Apart from decreased fecundity, older age at conception increases the risk for complications both for the mother and for the child. Risks for the mother include gestational diabetes, preeclampsia, multiple pregnancy, caesarean section and postpartum bleeding. Children born to older mothers have an increased risk of chromosomal deviations, being born prematurely or small for their gestational age. In addition, pregnancies among older women more often end in spontaneous abortion, extra uterine pregnancy and stillbirth

Family planning and postponed parenthood:

On a population level, fertility postponement should be understood as a result of a large number of factors with mutual interplay. From a life course perspective the transition into adulthood has become blurred and prolonged, and sequencing norms are today stronger than age norms for childbearing, that is, fulfilling all preconditions before childbearing is more important than not being too young/old. Indeed, six out of ten women answered they would choose to have an abortion if they became pregnant while they were a student.



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