Pre-conception care is crucial for every woman who plans to get pregnant

Sussy* is a 37-year-old woman who has just found out that she is pregnant.

She is a single mother of a 14-year-old boy who was born with spina bifida occulta, a congenital disorder that affects the spinal cord, and has left him with weak legs. Persistent physiotherapy and follow-up has enabled him to live a fairly full life, but it may have cost Sussy her marriage.

After 14 years of focusing on raising her son and climbing the career ladder, she has finally settled down with a new partner and they are expecting a baby, but the pregnancy evokes several emotions. She is excited and happy to be experiencing parenting again, but at the same time she is scared. She is fearful that her baby may be born with an abnormality, considering her previous history, and may not know how to communicate this to her new partner. She isn’t even sure she would know how to handle it herself.

Congenital disorders are abnormal conditions existing in a foetus before they are born. They may be obvious physical anomalies that may or may not be compatible with life, or may be less subtle genetic abnormalities that interfere with normal functioning of the baby at the metabolic level, resulting in physical symptoms.

OPTIMAL HEALTH

Mitigation of these complications is the premise on which pre-conception care exists. Unfortunately, over 95 per cent of women in Kenya get pregnant without the benefit of this service, due to ignorance. It is commonplace to have people go for an annual medical check-up for employment purposes, get vaccinated for travel purposes, get malaria prophylaxis for their children prior to travel to the village, but never visit the doctor when contemplating conception.

With over 40 per cent of pregnancies in Kenya being unintended, the absence of pre-conception care is compounded even further. Some of the unintended pregnancies occur in young girls and women, who take time to acknowledge their pregnancy and delay even further in initiating pre-natal care.

Preconception care is the provision of biomedical, behavioural and social health interventions to women and couples before conception occurs. It aims at improving their health status and reducing behaviours and individual and environmental factors that contribute to poor maternal and child health outcomes. Its ultimate aim is to improve maternal and child health, in both the short and long term.

This care provides for an opportunity to fully optimise a woman’s state of health before conception. It also allows for reduction of risks that result in poor outcomes for both the mother and the newborn.

It involves full evaluation of a woman’s health and any medical conditions present that require correcting in advance, such as diabetes, high blood pressure, thyroid dysfunction, obesity, cardiac disease and fibroids.

It is also important to review any long-term medicines the woman may be taking and their impact on the foetus in the womb, such as anti-convulsants (medication for seizures), anti-coagulants (blood thinners), anti-microbials, and many others.

MASSIVE EFFORTS

Infections, such as syphilis, that have been shown to have direct impact on the foetus, are treated and eradicated before conception. This vigilance is heightened during times of epidemics that come with devastating effects, such as the Zika virus.

Discussions around inherited disorders such as sickle cell disease are initiated via genetic counselling for affected couples during this period. The couples may require to be tested for carrier states, and the information used to advise appropriately on expected outcomes and risks.

The importance of pre-conception care cannot be over-emphasised. Massive efforts have gone into ensuring that every woman is able to access pre-natal care and now we can proudly boast that 96 per cent of women who have delivered a baby in the past five years had at least one pre-natal care clinic visit (Kenya Demographic Health Survey 2014).

We must strive to match these figures at pre-conception care level. It is a powerful tool in improving maternal and neonatal health outcomes as a major contributor to meeting the third Sustainable Development Goal.

*Name has been changed for confidentiality