Where to Start with Family Planning

Considering starting a family can be a very exciting time, but it can also bring a lot of questions — the first being, when and where do I start?

One of the most important things you can do is bring your OB/GYN into the discussion as early as possible to help guide you with a personalized (and healthy) family plan.

“For any reproductive age woman who has the potential to get pregnant, any time is the perfect time to talk to her OB/GYN, especially if she plans to get pregnant,” says Subhia Rehman, MD, AdventHealth Medical Group OB/GYN at Celebration.

Dr. Rehman adds, “OB/GYNs have a prime opportunity to improve fetal and maternal outcomes with pre-conception counseling for women prior to pregnancy.”

How Pre-Pregnancy Counseling Helps Improve Outcomes

Dr. Rehman explains that pre-conception counseling begins with getting a complete history of each woman, including her menstrual, medical, surgical and family histories.

“Based on that information, we give our input about what to do to help optimize the health of the woman and her potential baby. We might suggest different interventions or treatments to help improve pregnancy outcomes, or counsel how a mother’s genetic history or current health status could affect maternal and fetal health if she did get pregnant,” notes Dr. Rehman.

Assessing for Pregnancy Risk Factors

From the pre-conception assessment, Dr. Rehman explains that she can identify any risk factors that should be addressed prior to a woman getting pregnant. Lowering these risk factors prior to pregnancy could protect the health of mother and baby.

Here are some of the risk factors that Dr. Rehman says are important to know.

Obesity and Chronic Conditions

“If a woman has a BMI greater than 30, considering weight loss prior to getting pregnant is a good idea,” advises Rehman.

This is because obesity is associated with significant chronic conditions, such as diabetes, polycystic ovarian syndrome (PCOS), hypertension (high blood pressure), thyroid disorders, kidney conditions and others that can negatively affect pregnancy outcomes.

Dr. Rehman adds, “We work on optimizing these health conditions prior to pregnancy for the health and safety of both mom and baby.”

“Treatment for these conditions may help regulate a woman’s menstrual cycle, which can improve fertility,” Dr. Rehman explains.

History of Genetic Conditions

Some women or their family may have a history of genetic disorders. If this is the case, Dr. Rehman explains that they may choose to see a genetic counselor or do genetic testing prior to conceiving.

“This can give a woman more information to inform her family planning. It can help predict the likelihood that her baby would have a genetic disorder, so she can make decisions that she is comfortable with,” says Dr. Rehman.

Medications and Supplements

Prior to getting pregnant, your OB/GYN will likely discuss any medications you are currently taking, including both prescription and nonprescription drugs.

Dr. Rehman notes, “It’s even important to talk about any herbal products or nutritional supplements because some have effects can influence pregnancy outcomes. Sometimes the prescription medications may need adjustments to optimize pregnancy outcomes.

Medications can also include contraceptives. Your OB/GYN can advise you when to stop any birth control pills or other means of contraception and help you time your family planning for optimal success.

Smoking and Alcohol Use

“We know that women who smoke during pregnancy have a greater chance of having preterm delivery, premature rupture of the membranes and even lower birth weight babies. There are also adverse effects when it comes to alcohol— there’s no safe level of alcohol in pregnancy,” advises Dr. Rehman.

Alcohol exposure, especially in consistent and higher quantities, can cause what is called Fetal Alcohol Syndrome, which is a condition of structural and developmental abnormalities in the baby.

That said, she explains that part of her pre-pregnancy counseling is discussing healthy lifestyle changes.

Immunization Status and Infectious Diseases

Immunizations help protect mother and baby during pregnancy, so this is a critical risk factor.

Dr. Rehman says, “We check if women are up to date with their immunizations such as MMR, hepatitis B and varicella, for example, as well as screen for other infections like STIs that could affect the baby.”

Nutritional Status

Nutrition plays a vital role in both maternal and fetal health.

“We look at a woman’s nutritional status to see if she is getting enough nutritional requirements, including taking enough folic acid supplementation, which should start with 400 micrograms of folic acid once a day at least three months before getting pregnant. In fact, all reproductive age women should be on folic acid because supplementation reduces the risk of neural tube defects,” recommends Dr. Rehman.

She also suggests correcting any major nutritional deficiencies prior to planning a pregnancy. This is especially important for women who may have a previous history as well as in women who have had a recent weight loss surgery.

Activity Level

Regular physical exercise is a factor that can boost your health lifelong, but prior to pregnancy, it can help reduce obesity, improve heart health, optimize other medical comorbidities and improve the management of other chronic diseases, all of which help promote the best possible outcome during pregnancy.

Cycle Regularity and Structural Abnormalities

One of the ways that OB/GYN’s like Dr. Rehman assess fertility is understanding the regularity of a woman’s monthly cycle.

“For a woman to get pregnant, she must be ovulating. If she isn’t (or it isn’t regular), we can look at the potential reasons why and address those so that her chances of getting pregnant are greater,” Dr. Rehman says.

She adds that some medical conditions can cause a woman’s cycle to be irregular, such as thyroid conditions, PCOS and a wide variety of chronic conditions. There are also conditions like endometriosis, uterine fibroids or endometrial polyps that may influence the woman’s chance of getting pregnant. Some conditions can be addressed with an OB/GYN, while others many need a referral to specialist for assessment and care.

Social and Emotional Health

Starting a family is a big life-changing step for any woman. So, it’s important to assess a woman’s readiness in the social and emotional aspects of health as well.

“Part of my assessment is to talk openly with women about their support network and home environment to ensure that it is safe and secure for her and a potential baby. We have mental health and other community resources to help women who may need it,” says Dr. Rehman.

Pregnancy Spacing

If a woman is planning for another pregnancy, OB/GYNs also counsel on pregnancy spacing.

Dr. Rehman explains, “There are optimal intervals between pregnancies — pregnancy intervals shorter than six months can increase the risk of preterm birth. If women have a history of a cesarean section, it’s important to space pregnancies at least 18 months apart.”

When Infertility is a Concern

“Assessing infertility actually depends on the age of the woman,” says Dr. Rehman.

“In women younger than 35 who have regular periods and have not achieved pregnancy after 12 months of trying, we can start looking into what might be affecting their fertility with a work-up,” she says.

“In women older than 35, six months of trying is plenty of time to start an assessment if they haven’t achieved pregnancy.”

A fertility assessment includes understanding if a woman is ovulating, if she is having a normal cycle every 25 to 35 days, as well as if she is aware of the timing of her cycle as it relates to increasing the odds of conceiving.

“Each month, a woman under age 35 with a normal cycle has only a 20% chance of getting pregnant, so we can help women increase these odds by advising them on how to time their cycles the right way,” advises Dr. Rehman.

She says that sometimes, a woman might have an undiagnosed malformation of the uterus or structural abnormality that can affect fertility. “This could require imaging like a pelvic ultrasound to diagnose and inform treatment.”

Treatments for Infertility

Dr. Rehman notes, “The good news is that we have a lot of successful treatments for infertility, including medications and other procedures to treat common causes of infertility like endometriosis or fibroids.”

As far as PCOS, women can often benefit from hormone treatments that can regularize periods, in addition to lifestyle changes. Dr. Rehman explains that even losing 5% body weight can increase a woman’s chances of getting pregnant.

In women with endometriosis we have different management options, including medical and surgical recommendations. Sometimes these women are referred to the care of a specialist such as a reproductive endocrinologist who may have more insight into infertility from endometriosis and can offer other treatments that may include invitro fertilization (IVF).

“There are also medications that may improve the chances of getting pregnant by increasing ovulation, but these medications do have side effects and contraindications, so they are carefully reviewed with each patient,” advises Dr. Rehman.

Whole Health Care from Preconception and Beyond

Helping women achieve whole health through every stage of life is our focus — from the very start of family planning through pregnancy and every step thereafter. Contact our women’s health navigator today for personalized guidance and support along your health journey or give us a call at Call407-720-5191.