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Pre-Marital and Pre-Conception Counseling

Marriage is a wonderful thing to plan for, but it is also a great thing to plan for a healthy marriage. Pre-marital and pre-conception counselling enables couples to be aware of their physical, emotional and reproductive health prior to entering into marriage.

At these consultations, health professionals can recognize health conditions, genetic risks, nutritional deficiencies, vaccinations required for pregnancy, nutrition for pregnancy, lifestyle habits and mental health issues that may impact pregnancy or the health of the baby.

This article provides easy-to-understand answers to questions that couples typically have to understand the importance of planning prior to becoming pregnant. It also adds innovative concept of digital tracking of fertility, genetic carrier testing, telehealth counselling and individual planning of pregnancy, which are increasingly becoming a part of healthcare.

Marriage is a new journey that for many couples leads to parenthood. Wedding planning can last for months, but many couples do not know that they have to prepare for pregnancy as well.

Premarital counselling aims to help couples understand their health, lifestyle, family history and future reproductive plans before marriage or before planning a baby. Preconception counselling takes a step beyond that, helping both partners to get to a healthy preconception state.

Healthy parents are more likely to have healthier pregnancies and healthier babies. If diabetes and other conditions like thyroid disorders, high blood pressure, obesity, anaemia, infections and some medicines are not diagnosed early they can affect pregnancy. Other lifestyle factors (smoking, alcohol consumption, diet, exercise, and stress) may also affect fertility and pregnancy outcomes.

Women are not the only ones who need preconception counselling. Men health also is important since there are a number of factors that can impact the quality of the sperm, lifestyle, chronic conditions, and some medications can all impact the health of the future baby and its fertility.

What is Pre-Marital Counselling?

Premarital counselling is a type of therapy that helps couples take the next step in their relationship, resolve issues in their relationship before they commit to marriage, or set relationship goals.

The counselling is usually done by licensed marriage and family therapist or religious leaders who serve as counsellors. Many couples attend premarital counselling as a preventative measure, similar to going to your primary care provider for an annual checkup.

Couples attend premarital counselling to avoid any issues that may exist in their relationship. Premarital therapy can be an asset to help couples avoid marriage counselling down the road.

What is Pre Conception Counselling?

Preconception counselling is a medical consultation before pregnancy. A health care provider checks the health of both partners and offers suggestions for a healthy pregnancy during this visit.

In this they Review medical history, checking for current medicines they are taking for any disease, screening chronic diseases, giving suggestions for optimal weight, asking for ongoing folic acid supplements, Discussion about healthy lifestyle behaviours, Proper time for planning pregnancy.

Preconception counselling is beneficial not only for couples with concerns about their health but also for healthy couples as some health issues may not present symptoms.

Why is Pre Conception Counselling Important?

It is best to prepare for pregnancy to minimize health risks for the mother and baby.

It includes:

  • To Reduce chances of birth defects.
  • Improved control of chronic diseases.
  • Obtaining better fertility.
  • Decrease complications during pregnancy.
  • Healthier fatal growth.
  • For proper maternal nutrition.
  • In some cases, a lower risk of miscarriage.
  • Enhanced emotional readiness to be a parent.

When should a couple start Pre Conception Counselling?

In general, experts suggest booking a preconception appointment at least three months prior to attempting to conceive, and preferably three to six months ahead of time.

This time frame enables time to be: –

  • Advising for healthy diet.
  • Achieve a healthy weight.
  • Start taking folic acid supplements.
  • Don’t smoke or drink alcohol.
  • Updating for vaccinations.
  • Adjust medications as necessary.
  • Take care of long-term health issues.

Who should be involved in the counselling session?

Where possible both partners should attend. The health of both individuals, not just the woman, is crucial to pregnancy.

In this counselling, health care professionals can explore: –

  • Medical history of both parents needed to ask, diagnosis of any disease, are they currently taking any medications for treatment, any antibiotics, sleeping pills, any surgery they have gone through.
  • Family history of both partners, whether any genetic or hereditary conditions they had any current medications their family are taking regarding any disease.
  • Fertility concerns include PCOS problem, tubal aur uterine issues, low sperm count and poor sperm motility in male.
  • Lifestyle habits matter the most, what kind of diet you are taking, kind of exercise you are doing, daily habits.
  • Diet which is more healthy, proper nutrition rich food.
  • Performing Exercise daily which is helpful during pregnancy.
  • Asking for any Mental health issues, any anti-depressant pills are they taking, any anxiety are they facing.
  • Occupational exposures.

What are some diseases to be managed before pregnancy?

It is best to have several health problems controlled before conception, as they may impact the course of the pregnancy.

These includes: –

  • Diabetes
  • High blood pressure.
  • Thyroid disorders.
  • Asthma
  • Epilepsy
  • Kidney disease.
  • Heart disease.
  • Autoimmune disorders.
  • Anaemia
  • Obesity

With good disease control prior to conception, there are fewer complications for baby and mother.

What Vaccines should be received before conceiving pregnancy?

The mother and baby are protected from serious infections if they get vaccinated before    becoming pregnant. Your health care provider might suggest a checkup to see if you are immune to:

  • Rubella (German measles)
  • Chickenpox (Varicella)
  • Hepatitis B
  • Influenza (flu)

Collect and record all the following information on the student’s certificate of attendance:

  • Vaccination against tetanus.
  • Diphtheria and Pertussis (TDAP) based on your vaccination history and pregnancy timing.
  • Certain vaccines, particularly live vaccines, should be administered before pregnancy, and women may be advised to postpone pregnancy for a certain period of time.

Be sure to talk to your healthcare provider regarding your vaccination history.

Which Blood tests might be necessary before Pregnancy?

Not all couples require the same tests. Investigations suggested will depend on your personal risk factors, medical history, family history, and age.

Typical tests include:

  • The blood group and Rh factor are both examined.
  • Complete blood count (CBC) for checking anaemia.
  • Testing Blood sugar of couples which includes fasting and post meal.
  • Thyroid Function tests of both parents.
  • Screening for hepatitis B and C, HIV, and syphilis.
  • Urine examination should be carried for estimating any past history of diseases.
  • Vitamin D or Vitamin B12 tests in specific persons.
  • Screening for inherited blood disorders (thalassemia) based on family history or regional prevalence.

Does family history matter before planning a pregnancy?

Yes. Your family history is most important for providing information regarding inherited health conditions and provide right guidance before conception.

Tell your healthcare provider if either partner has a family history of:

  • Thalassemia
  • Sickle cell disease.
  • Cystic fibrosis.
  • Muscular disorders.
  • Intellectual disability of unknown cause.
  • Congenital heart disease.
  • Recurrent miscarriages.
  • Genetic syndromes.
  • Birth defects.
  • Diabetes
  • Blood pressure.

How does father history affects Pregnancy?

Absolutely. A healthy pregnancy depends on both partners. The father’s health can influence:

  • Quality of Sperm.
  • Fertility
  • Time to conception.
  • Pregnancy outcomes.
  • The baby’s long-term health.

Men should also prepare before conception by:

  • Keeping a healthy weight.
  • Exercising habitually.
  • Eating a healthy diet.
  • Avoiding smoking and amusing drugs.
  • Limiting consumption of alcohol.
  • Getting enough sleep of 8 hrs.
  • Proper discussion of medications before pregnancy.
  • Chronic illnesses management.

Healthy lifestyle changes by both partners can improve the chances of conception.

How does fertility affect by Weight?

Harmone levels and fertility in both parents affect by being underweight and overweight. An ideal BMI range is between 20-25 for obtaining optimal fertility.

In the case of ‘Women Overweight and Obesity’

Excess fat cells create an excess of the estrogen hormone that causes the body to mistake it for a birth control pill.

This can have a negative impact on the number of eggs that are produced or on the quality of the eggs. Women with a BMI greater than 27 have a triple risk of becoming infertile.

Additionally, obesity might impair the efficacy of fertility treatments such as IVF (In Vitro Fertilization), which involves a lower likelihood of embryo implantation.

If a woman is underweight (BMI < 18.5), the body is deprived of sufficient energy reserves, which may result in irregular or no menstruation at all.

In men,

Excess weight (High body fat) causes an increase in estrogen levels due to the conversion of testosterone to estrogen, which decreases the number of sperm cells.

Too much fat around the groin can also raise the temperature of the testicles, which can affect the motility and structure of the sperm.

If one is very underweight, it can also be a problem of nutritional deficiency and negatively affect general function.

What are New Approaches to Preconception Counselling?

Healthcare is becoming more and more personalized and technology enabled. Some newer methods are:

Digital Fertility Tracking

There are smartphone apps that track menstrual cycles, ovulation patterns, symptoms and reminders for medication. They should be only used as supportive measures and not as a replacement for medical advice.

Telemedicine Preconception Visits

For a lot of couples, one initial consultation with a counsellor can be carried out safely via video, so that professional advice can be available to all—particularly those living out of the way.

Electronic Health Records (EHRs)

DMRs can enhance continuity of care by allowing healthcare providers to view vaccination histories, chronic conditions, lab results and medication more efficiently.

Personalized Nutrition Plans

Depending on the nutritional requirements, medical issues, and dietary preferences, dietitians and health care providers can create an individual nutrition plan according to the patient’s weight.

Wearable Health Devices

Activity tracking, sleep tracking, and heart rate tracking are all available with smartwatches and fitness trackers. Such devices can help promote positive behaviours, but are not a substitute for medical assessment.

Premarital and preconception counselling prepares the couple not only for a healthy pregnancy, but a healthy married life as well.

It is a time to screen and address medical conditions, catch up on vaccines, follow up on medications, optimize nutrition, develop healthy lifestyle choices, and discuss emotional, genetic and reproductive health prior to pregnancy.

Early counselling may be able to minimize unnecessary pregnancy complications, the outcomes of the mother and her baby, and the likelihood of a healthy baby.

Couples are urged to consult a professional before they try for a baby, but at least 3 months beforehand. Taking the time to counsel both parents and their potential child before or in advance of marriage is an investment in long-term health and wellness for both parents and child.

More Information

  1. World Health Organization. Preconception care: Maximizing the gains for maternal and child health. Available from: https://www.who.int/publications/i/item/WHO-FWC-MCA-13.02
  2. Centers for Disease Control and Prevention. Preconception Health. Available from: https://www.cdc.gov/preconception/
  3. American College of Obstetricians and Gynaecologists. Prepregnancy Counseling. Committee Opinion No. 762. Available from: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/01/prepregnancy-counseling
  4. American Society for Reproductive Medicine. Optimizing natural fertility. Available from: https://www.asrm.org/
  5. National Institute for Health and Care Excellence. Antenatal care. Available from: https://www.nice.org.uk/guidance/ng201
  6. Office on Women’s Health. Preparing for Pregnancy. Available from: https://www.womenshealth.gov/pregnancy/you-get-pregnant/preparing-pregnancy
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