Every woman desires to get pregnant without medical intervention and when a woman gets pregnant, we all desire to be having thriving pregnancy with a lot of fun, enjoying our pleasure foods along the way.

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A healthy woman is more likely to have a successful and complication free pregnancy and a healthy child.

Preconception care is a program of holistic mind-body related interventions that prepares a woman for happy, complication free (to the extent possible) through prevention and the control of risk factors that have an impact on pregnancy outcomes and the health of the child and future generations. Preconception care aims to enhance pregnancy outcomes and woman & child health in general.

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The World Health Organization (WHO) in 2013, emphasized the need of preconception treatment for all women of reproductive age. A significant element that affects the outcome of pregnancy is preconception care. Many women in the reproductive age group are ignorant of the importance of the following.

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High BMI / Excess weight / Normal weight & High fat (TOFI)

Pregnancy problems including preeclampsia and gestational diabetes are more likely to occur when a woman is overweight or obese or TOFI (Thin Outside Fat Inside) before conception.  Both issues are linked to an increased risk of maternal and new-born health (morbidity and mortality), as well as an increased risk of children developing metabolic disorders as adults.

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TOFI are people with a normal or below normal BMI with an above normal fat percentage.

When pregnant, having a high BMI or high fat raises the risk of several pregnancy problems, such as:

 

To mother

• Miscarriage

• Stillbirth and recurrent miscarriages

• Gestational diabetes

• A pregnancy complication marked by preeclampsia and injury to another organ systems, most frequently the liver and kidneys; (preeclampsia)

• Heart condition

• The need for C- section

• Possibility of complications from the procedure, such as wound infections

 

To child

• Congenital disorders

• Being significantly larger than average at birth (fetal macrosomia)

• Growth problems / Cognitive problems and developmental delay

• Childhood asthma

• Childhood obesity

 

Insulin resistance

Obese or overweight women, women with PCOS, women with type 2 diabetes, TOFI (Thin outside and fat inside) are at a risk of Insulin resistance. Excess insulin changes the sex hormone balance to favour the production of testosterone over oestrogen. Additionally, it has been shown to suppress ovulation, and rising average blood sugar levels have been linked to poor egg quality. According to studies, insulin resistance might delay egg maturation and result in smaller eggs. Poor outcomes are associated with these results, including delayed embryonic development, foetal growth limitation, birth abnormalities, and smaller foetuses.

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Insulin resistance can be fatal for the growing foetus as it impacts the nutritional absorption which at times, can lead to miscarriage at the initial stage and advanced stage of pregnancy as well. Many times this condition goes unnoticed as there are no accurate blood tests that gives information. There are however some markers that give clear indication of insulin resistance. Read Insulin resistance for more information.

 

PCOS and Gestational Diabetes

PCOS is a condition that can disrupt ovulation and lead to hormonal abnormalities. Women with PCOS most often experience fertility issues , which delays the chances of getting pregnant. If a woman with this illness does become pregnant, the risk of gestational diabetes is fairly high as PCOS is linked to insulin resistance and high blood sugar. Due to this risk, GTT and gestational diabetes testing may be required to be performed on PCOS-positive pregnant women earlier than the standard 24-28 weeks.

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It is advisable to have a HbA1C lesser than 5.5 with a fasting blood sugar of less than 85 for at least 3 months before conception to reduce the risk of gestational diabetes. Attempt to lower your blood sugar levels at least six months before trying to conceive. Some of the health complications that arise from type 2 diabetes including eye and renal damage, could manifest for the expecting mother. Babies born to diabetic mothers are more likely to be larger than average or to have birth defects. They might also be stillborn or born prematurely. Babies of gestational diabetic mothers have a higher pre-disposition to get type 2 diabetes at a young age. Long term sustainable lifestyle changes along with constant monitoring and appropriate medical intervention is a key to lowered HbA1C and ideal fasting sugar.

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Nutrient deficiencies

Nutritional deficiencies impact the functioning of body and therefore can cause many risks to an expecting mother, foetus and the new born child. Therefore, its crucial to have balanced meals with appropriate caloric intake as per NIN recommendation specific to the stage of the pregnancy and BMI. NIN recommends to focus on additional 70 to 85 kcal and 9.5 gms in 2nd Trimester and 17 gms in 3rd Trimester of pregnancy. Eliminating vitamin and mineral deficits, such as those in zinc, iron, calcium, vit d, b12, iron, ferratin and magnesium, is therefore advocated. The nutritional deficiencies and their consequences are listed below:

• Vitamin B12: Lack of vitamin B12 in the first trimester increases a woman's risk of having a child with neural tube abnormalities like spina bifida by up to five times.

• Vitamin D: Vitamin D is very important because its deficiency has been linked to various infertility issues. Thus, preconception care, including appropriate Vit D supplementation, is essential.

• Vitamin K deficiency: A lack of vitamin K can lead to bruising and bleeding issues because it takes longer for the blood to clot, which increases the dangers during childbirth when women lose a lot of blood.

• Iron deficiency: Low birth weight and early delivery are both made more likely by iron shortage. Anemia after delivery lowers breastmilk production and causes fatigue. Additionally, studies link iron deficiency to postpartum depression.

• Iodine deficiency: It may cause hypothyroidism in pregnant women. For the development of the foetus, a healthy thyroid is essential. Additionally, it causes cretinism, maternal and foetal goitre, congenital abnormalities, impaired IQ, and goitre