In the previous article, we talked about what preconception care is and what you need to be aware of regarding maintaining appropriate body weight through a well-balanced diet and exercise (A. Diet and nutrition B. Skinniness C. Obesity D. Anemia E. Osteoporosis).
In this article, we will move to “II. Evaluation and improvement of chronic diseases” (F. Diabetes mellitus G. Thyroid dysfunction H. Hypertension I. Bronchial asthma J. Kidney disease K. Collagen disease/antiphospholipid antibody syndrome L. Medications).
Evaluation and improvement of chronic diseases
- Diabetes mellitus
If you have diabetes, it is advisable to control your blood glucose adequately before planning a pregnancy. Glucose and ketone bodies, which are increased in diabetes, are considered teratogens. During the first nine weeks of pregnancy, the major organs of the baby’s body are being formed, and poor blood sugar control during this period is said to increase the incidence of congenital anomalies due to the effects of teratogens.
It is said that the incidence of congenital anomalies does not decrease even if blood glucose control is started after pregnancy is established, so it is important to maintain HbA1c less than 6.5% if you are considering pregnancy.
It is also important to check before pregnancy for diabetic retinopathy and diabetic nephropathy, which are likely to worsen after pregnancy. Blood sugar control during pregnancy is based on insulin injections rather than oral hypoglycemic drugs. Consult with your doctor beforehand about the management of complications and the drugs that can be used.
- Thyroid dysfunction
The thyroid gland is an organ located in the front part of the neck, just below the throat, that promotes the growth of our bodies and stimulates metabolism. Thyroid hormones are also necessary for the growth of follicles, and without sufficient thyroid hormones, follicles will not grow and ovulation will not occur. An overactive thyroid gland tends to shorten the period until ovulation, while an underactive thyroid gland prevents follicle growth, resulting in anovulation and amenorrhea.
One of the indicators of thyroid function is the level of the hormone TSH. A high TSH level indicates a low thyroid function and a low TSH level indicates a high thyroid function, and the TSH level tends to be high in patients with infertility. It has been pointed out that low thyroid function increases the risk of miscarriage and premature birth.
Thyroid hormones are important for the development of the baby’s brain and nervous system. In early pregnancy, when the baby’s thyroid gland is not functioning, the mother’s thyroid hormones are transferred to the baby through the placenta.
For this reason, thyroid hormones in the early stages of pregnancy play a very important role in the development of the baby, especially in the mental, nervous and intellectual functions. Therefore, if a screening thyroid function test is performed prior to pregnancy and you are diagnosed with subclinical hypothyroidism or hyperthyroidism, you need to be managed appropriately.
If you have an underlying thyroid condition, you should be careful not to consume too much iodine in your daily diet. Thyroid hormones are made from iodine, so too much iodine-rich foods may worsen your symptoms. Seaweeds such as kelp and wakame, processed kelp products, and flavor seasonings including kelp dashi contain iodine, so it is advisable to refrain from taking these foods.
One of the complications that can occur during pregnancy is gestational hypertension. Gestational hypertension is defined as the presence of hypertension, proteinuria, systemic organ damage, or placental abruption from 20 weeks of pregnancy until delivery. If the disease occurs at less than 34 weeks of gestation, called the early-onset type, it is more likely to be severe and requires attention. In severe cases, mothers may suffer from elevated blood pressure, proteinuria, convulsions (eclampsia), and cerebral hemorrhage.
In addition, gestational hypertension can cause the baby’s growth to deteriorate (fetal growth retardation), the placenta to detach from the uterine wall, preventing the baby from receiving oxygen (premature separation of the placenta normal), the baby’s condition to deteriorate (fetal dysfunction), and in some cases, the baby to die (fetal death). In some cases, the baby may die (fetal death).
Those who already have high blood pressure before pregnancy are said to be at a higher risk of developing gestational hypertension. For this reason, it is important to monitor your blood pressure before pregnancy. Some antihypertensive medications cannot be used during pregnancy, so if you are already being treated for high blood pressure, consult your doctor.
If you have asthma, you need to make sure that your asthma is well controlled before pregnancy. Uncontrolled asthma is known to increase complications, especially gestational hypertension, preterm birth, and low birth weight babies. Hypoxemia caused by asthma attacks during pregnancy can affect the fetus and cause complications. It is important to manage the disease before pregnancy to avoid attacks during pregnancy.
- Kidney Disease
As the baby grows in the mother’s abdomen, the mother’s blood volume increases, placing a greater burden on the kidneys. Kidney disease can be a risk for gestational hypertension and premature birth. Blood and urine collection is a good test for the early detection of kidney disease.
- Collagen Disease and Antiphospholipid Antibody Syndrome
Collagen disease and antiphospholipid antibody syndrome are autoimmune diseases in which antibodies attack the body and may cause habitual abortion or fetal death. Antiphospholipid antibodies cause an abnormality in the autoimmune system, making it easier for blood clots to form. During pregnancy, the formation of blood clots in the placenta can prevent the delivery of nutrients to the baby, resulting in miscarriage or stillbirth.
If you have a pre-existing medical condition and are taking medication internally, consult your doctor. It is important to know what to do with that medicine for pregnancy, whether it can be continued or should be changed before conception.
Maintaining an appropriate body weight through a well-balanced diet and exercise is also very important for you and your baby to have a healthy body. Most of them are things that you can prevent before getting pregnant, so please check your condition.