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Early Confirmation of Pregnancy and Implementing Behavior and Lifestyle Changes Promote Healthier Babies

All health care professionals have known for many years that optimal healthcare for a child starts before the child is conceived. For over 25 years, American women have been instructed to supplement folic acid before conception, to substantially reduce the risk of neural tube defects in their offspring. We know that certain medications taken for chronic conditions, such as hypertension, can be detrimental to a fetus, and we know that chronically elevated blood glucoses in poorly controlled diabetics lead to a significant increase in fetal malformations.

It is because of information such as this that many organizations such as the March of Dimes and the American Congress of Obstetricians and Gynecologists strongly recommend preconception counseling for all women. Many issues such as general health, medications, family and genetic history, health habits, and environment are reviewed at such visits to optimize a pregnancy outcome.

However, all healthcare professionals also realize that many women do not plan pregnancies. Indeed, in the United States, slightly less than half of all pregnancies are unintended. Although a proportion of women in this category will terminate the pregnancy, many women will continue their unplanned pregnancy. The women with unplanned events have not optimized their health prior to conception. A logical hypothesis would be to ask if women who had not planned a pregnancy would improve their health habits if they knew sooner rather than later that they had conceived.

Such an exact question was asked by the authors of a recent paper in the journal Obstetrics and Gynecology.* (ref). Their objective was “to evaluate whether women planning a pregnancy are less likely to use alcohol in early pregnancy than those with unintended pregnancy.” Their database was a community-based pregnancy cohort of over 5,000 women. They questioned the women at seven weeks gestation, and then again at the near end of the first trimester as to their alcohol consumption.

They found that slightly over 50% of both the women with intended and unplanned pregnancies were drinking alcohol at the earlier survey. However, both groups significantly decreased their alcohol ingestion by the end of the first trimester. They concluded that “early pregnancy awareness could prove more effective than promoting abstinence from alcohol among all who could conceive.”

In discussing the paper, senior author Dr. Katherine Hartmann of Vanderbilt University commented that changing drinking habits is most effective the earlier women know they are pregnant. (**HealthDay)

Given that considerable fetal tissue differentiation occurs even before the first missed period (separation of fetal tissue layers into ectoderm, mesoderm and endoderm is accomplished by about day 12 after conception), it would be helpful for women to know that they are pregnant very early. Most women do home pregnancy testing to see if they are indeed pregnant.

Not all home pregnancy test kits are the same. Although all measure HCG, other key molecules in early pregnancy detection include hyperglycosylated HCG, free beta subunit HCG, free beta subunit core fragments, and other HCG degradation products. The most sensitive kit available currently is the First Response Early Result kit, which can detect pregnancy as early as six days before the missed period, at a time of active tissue differentiation.

In the best of all possible worlds, all women would plan for their wanted pregnancies, seek medical consultation as they start to plan for these pregnancies, and follow through with the recommendations of their providers to optimize pregnancy outcomes. However, studies such as the recent Obstetrics and Gynecology survey show that even with planned pregnancies, good health intentions are not necessarily actuated.

But, the hope is that confirmation of a pregnancy as shown in this study will lead to major changes in maternal health habits which can have a significant impact on the developing fetus. In the experience of most health professionals, a positive pregnancy test is a very powerful motivator for significantly improving the health of an embryo in utero. And, the earlier a pregnancy is confirmed, the earlier the woman can improve her child’s health. Given that this type of information is available, it is incumbent upon health educators and providers to encourage excellent health habits in those women who are planning pregnancy. We also need to acknowledge that despite the best of intentions, women may not adhere to these recommendations, and that if at risk for pregnancy, early detection is crucial for reinforcement of the best habits to optimize a healthy outcome.

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Mary Jane Minkin, M.D. LLC is a Clinical Professor of Obstetrics, Gynecology and Reproductive Sciences at Yale University School of Medicine, author of MadameOvary.com and has offices in New Haven, Guilford, and Essex, CT. With a special interest in reproductive health and menopause, Dr. Minkin has written several books for women, including A Woman’s Guide to Sexual Health and A Woman’s Guide to Menopause and Perimenopause (Yale University Press, 2005). Dr. Minkin is also the women’s health advisor to Prevention Magazine.

 

REFERENCES:

*Pryor J, Patrick SW, Sundermann AC, Wu P, Hartmann KE. Pregnancy Intention and Maternal Alcohol consumption. Obstet Gynecol. 2017 Apr: 129 (4): 727-733.

**Web article from HealthDay. Most Women Stop Drinking after Positive Pregnancy Test, Study Finds. (Thursday, March 9. 2017 (Health Day News) author: Robert Preidt.

Minkin MJ. Embryonic development and pregnancy test sensitivity: the importance of earlier Pregnancy detection.  Women’s Health (2009). 5 (6): 659-667.