GPs are regularly consulted by women or couples who want to start a family or to have more children, and are asking for advice.
This provides an opportunity to assess a woman’s and her partner’s health and provide information that can help the woman and her partner make choices.
This is particularly important if there is a known genetic condition within the family.
The following should be considered in preconception care:
General factors
General factors affecting conception and pregnancy should be discussed and the couple encouraged to be as healthy as possible. These include, smoking, alcohol intake, medications, diet, folic acid to reduce the chance of neural tube defects (400 micrograms / 0.4 mg) folic acid daily for a minimum 1 month preconception until the end of the first trimester), cervical screening, chronic disease which may affect pregnancy such as epilepsy and diabetes.
Folate
A higher dose of 5mg daily is recommended if there has been a previous child with spina bifida and for those with certain conditions such as coeliac disease, diabetes and people on folate antagonist medications, such as anti-epilepsy drugs.
Preconception advice
Couples may be unaware of potential risks to a pregnancy or the pregnancy may be unplanned and therefore they do not seek information before a pregnancy occurs.
Colleagues in Primary Care should be proactive in offering preconception advice to couples with conditions that could affect a future pregnancy, such as epilepsy, diabetes, sickle cell disease, thalassaemia or known genetic conditions in a family.
The patient.co.uk web site has a good discussion on preconception counselling and a patient information sheet on planning pregnancy:
Pre-pregnancy Counselling Planning to become pregnantInformed choices
The identification of couples who are at increased risk of having babies with a genetic condition or malformation and assisting them to make informed choices.
Screening Time Line
The UK National Screening Committee (UK NSC) screening timeline is a resource developed to offer a visual reference to recommended optimum times for antenatal and newborn screening tests to take place.
The screening timeline is available as a pdf download on the UK NSC site, here:
