Pregnancy - conception to first visit with your GP
Whether you’re planning pregnancy or already pregnant I love to see you and this can be one of the most exciting consultations I have in my day. I like to make sure you are all up to date with your pre pregnancy planning and answer any questions you have early on to ensure you have a healthy pregnancy. Alternatively though if you’ve been trying to conceive for more than 6 months, I also love to see you and make sure your fertility and health is optimised to provide the perfect environment for conception.
One of the most important things to take away from pre pregnancy planning is to ensure you start folic acid supplementation at least 1 month prior to falling pregnant. Folic acid is a naturally occurring vitamin found in foods such as spinach, potatoes and green beans. Obviously if you haven’t started folic acid, don’t stress, you can start as soon as you find out you’re pregnant and continue folic acid for at least the first 3 months of pregnancy to prevent neural tube defects such as spina bifida. The dose recommended is 500mcg unless you have a family history of spinal cord problems or are on medications for epilepsy, it is then recommended that you increase this to 5mg a day. Iodine at 150mcg is the other important supplement for pregnant women to ensure healthy development of the newborn. This is fortified in our breads in Australia so most women should be receiving it in their diet. You are likely to find it is included in pregnancy multivitamins if you do want to ensure your levels are adequate.
Another important prenatal advice is to check your immunisation status. Pregnancy planning can start with an initial visit to discuss your fertility including periods and family history of pregnancy concerns. You will get bloods done to ensure you are immune to sinister infections that can cause issues for the baby during your pregnancy, specifically measles mumps and rubella(MMR) and varicella (chickenpox). If you’re not immune to MMR or varicella we recommend you get these live booster vaccines at least 6-8 weeks before trying to conceive.
For pregnancy to occur it's vital that all health aspects of both male and female partners are optimal including nutrition, exercise, sleep, mental health. Limiting alcohol, cigarettes and illicit drugs and improving your overall health will all contribute to providing the right environment for sperm to fertilise an egg effectively.
We may consider checking your thyroid function may and iron studies if you have had issues with heavy or regular periods. Vitamin D and B12 are also vital in nurturing a pregnancy from conception to birth and through breastfeeding. Vitamin D is obtained naturally from sunlight so in winter and if you avoid the sun, you may actually be low in this vitamin and need supplementation to help grow a newborn.
Trying to conceive can be stressful for sure and you may find that it can become a strong focus of a relationship. It’s important to make sure you are happy and healthy and, with time, pregnancy commonly occurs within 12 - 18 months after starting to try in healthy individuals. If you are having concerns and it is making you very anxious or stressed please come to see me or your GP for further advice and discuss referrals if needed.
After you get that special faint line or positive, first of all congratulations! Enjoy this special time when only you and your partner need to know the miracle that is happening inside. You can generally stay well in early pregnancy without seeing your GP until approximately 6 weeks. Early signs of pregnancy can include nausea and morning sickness, breast pain and swelling, fatigue and frequent urination. If you experience any pain or bleeding it is important that you seek medical review as soon as possible and of course if you’re not sure if everything is normal - make an appointment to discuss any questions.
Miscarriage can be a devastating complication of early pregnancy and unfortunately it is often not a black and white answer but I am always here to help whenever I can to comfort a couple having bleeding in early pregnancy as it can take time to get a definite answer.
At the 6 week mark it's time to get some more blood tests done! An ultrasound scan is not 100% required but it can confirm a single intrauterine pregnancy or twins and help with estimating a due date! Going too early for this dating scan can also cause some distress as you may not be able to see a heartbeat. It is usually recommended to wait until 6-8 weeks as long as there are no other complicating features or symptoms.
Standard early pregnancy blood test should include reviewing your serology for MMR, Varicella, Syphilis, HIV and Hepatitis B and C. We usually check your B12 status and iron levels including your haemoglobin for evidence of anaemia as this is prone to worsen during pregnancy. It is important to know your blood group and antibodies to ensure we know if you require any injections of Anti-d antibodies, which is given to prevent haemolytic disease of the newborn. If your blood group is negative you will have an injection at 28 and 34 weeks as well as for any bleeding or sensitising episodes throughout your pregnancy.
Each stage of pregnancy, from planning, early pregnancy and so on, requires careful attention and review. Once you have fallen pregnant it can be the most exciting time of life. I will have to write more on early pregnancy in a new blog otherwise I will be writing all day!
If this article has brought up any questions at all please make an appointment to discuss with me or your GP. This information is from my own research and experience and other doctors' opinions on what is or isn’t required prenatal and antenatal may differ and is not necessarily wrong. Each patient is very different and your own needs will be different to others as we individualise your care.
Dr Hannah Bourke
MBBS, FRACGP, DIP. CHILD HEALTH
Caring, honest, calm and genuine, Dr Hannah is here for all your health needs.
