I am a mom to 2 girls. My youngest was born when I was 1 week shy of my 39th birthday. I am also a family physician and treat patients of all ages including many women who are trying to conceive. As a family physician one of my goals is to prevent disease and to help my patients attain optimal health in preparation for pregnancy. For those planning to conceive after age 35 or having difficulty conceiving, a basic medical check up is recommended. The initial history and physical examination should include a blood pressure check, body max index, and indicated laboratory testing.
Over 35 moms have higher rates of hypertension and diabetes, and sometimes these problems are already in place before conception or may develop early in pregnancy. For women struggling with weight gain and pre-diabetes, a weight loss plan prior to pregnancy may cut down on potential complications during pregnancy. I advise all my patients to start a regular exercise routine well in advance of pregnancy, especially if they are of “ advanced maternal age.” I did the same prior to having my first daughter at 34 and was able to keep exercising and working up until delivery day with both pregnancies. Women with high blood pressure should be treated prior to and during pregnancy. Only certain blood pressure medicines are recommended during pregnancy. It is important to discuss your childbearing plans with your doctor so medications can be adjusted if necessary prior to conception. Women with diabetes should ideally have excellent glucose control prior to pregnancy and would need to continue close monitoring throughout.
All of my female patients get a TSH test as part of the testing. TSH, or thyroid stimulating hormone, is a screening test for thyroid disease. Thyroid disease can affect fertility and fetal development. It is a very common problem in women and is relatively easy to address if detected. I have had several patients in recent years who were having difficulty getting pregnant due to undiagnosed hypothyroidism and conceived once it was treated.
A CBC, or complete blood count, can screen for anemia. Iron deficiency is often encountered in women of childbearing age and may affect fertility. Anemia may also prompt workup for uterine fibroids which are benign growths in the muscular layer of the uterus. These can cause excessive bleeding or even interfere with conception or implantation. They may be detected on routine pelvic exam or by ultrasound. Of course age is a risk factor for fibroids, however they can also be seen in younger women as well. Iron deficiency can be corrected with iron supplementation improving general health status. If fibroids are detected, assessment for whether conservative or surgical management is indicated is necessary.
Another common nutritional deficiency that may impact fertility is Vitamin D deficiency. We actually make most of our own vitamin D in response to sunlight exposure. Because of increased awareness of skin cancer prevention, use of sun screens is widespread and many of us work and exercise indoors. In addition, food sources of Vitamin D are relatively scarce in the typical American diet. Especially affected are people with darker skin tones, overweight and obese individuals and those avoiding the sun due to health or cultural reasons. Vitamin D deficiency affects fertility in mammalian studies, and in at least one study of human IVF, vitamin D deficiency lowered success rates of IVF. The lab test is costly but may be worth getting for aspiring mamas over 35. Treatment, if necessary, it relatively simple.
All women should be up to date on routine immunizations prior to pregnancy. Rubella and varicella immunity and Hepatitis B status are among the routine prenatal tests at the first obstetric visit. Especially important to remember are the yearly flu vaccine and a pertussis booster, both of which can also be given during pregnancy. There is nothing more miserable than a pregnant woman with the flu, and pregnant women are at higher risks of complications such as pneumonia. Newborns can die of pertussis or whooping cough, which unfortunately has been making a comeback in recent years. A vaccinated mom protects herself and also her newborn.
Cancer screening should be up to date for all women planning pregnancy. A pap smear is indicated for all women ages 21 to 65. The screening frequency has changed with advent of liquid based pap smears and HPV testing, but it may be a good idea to repeat pap testing prior to conception if it has been over 1 year since the last pap smear. In addition, I start routine yearly mammography on all my female patients at age 40. Higher risk women may start earlier if indicated. Finally, screening colonoscopy is advised every 10 years starting at age 45 in African Americans and age 50 in other ethnicities. For those with first degree relatives with colon cancer, screening should start 10 years before the affected family member’s age at diagnosis.
Mental health disorders and work and family stress problems should ideally be addressed prior to conception. Antidepressant use is very wide spread among our population. Some drugs have been implicated in adverse pregnancy outcomes and may increase the incidence of birth defects. Women taking any prescription antidepressants are advised to discuss their child bearing plans with their treating physicians in order to minimize risk and to have time to wean off of medications that may be contraindicated in pregnancy. Overall, it is very important that mental health disorders be treated adequately and safely prior to conception and during pregnancy; a healthy mom means a healthy baby. There are many medications available that can be used safely during pregnancy.
Infectious disease screening for HIV, syphillis, hepatitis and sexually transmitted diseases should be part of a preconception check up. Chlamydia and gonorrhea infection can both affect a newborn and permanently impact fertility and are easily detected with a cervical swab or a urine test and can be done along with cervical cancer screening with a pap test.
Pregnancy is not a disease, but it is a time of increased physiological stress requiring optimal wellness. As older moms we run the risk of accumulated health problems. We may also be juggling other responsibilities such as careers, aging family members, other children, and community and social responsibilities. It is very important to take the time out for self care and getting a check up with your family doctor or OB/GYN.