Preconceptual counseling is especially important for women who have known medical problems. Getting a medical tuneup before pregnancy offers the best opportunity for optimal maternal and fetal well being.
If you are overweight or obese, weight reduction, diet and exercise are critical to start a pregnancy at a more optimal weight (obese women in pregnancy are more at risk for hypertension, toxemia of pregnancy, gestational diabetes, cesarean section, and untoward maternal and fetal outcomes).
Women with preexisting diabetes who are not in good control of their blood glucose have a very high chance of birth defects. Most of these defects can be prevented by optimizing blood glucose control preconceptually.
In women with hypertension, optimizing blood pressure preconceptually and making sure the medications you are on are safe in pregnancy is critical.
Other disease processes such as seizure disorder, bowel diseases, asthma and kidney disease are conditions which are chronic and often require medication on a chronic basis, in the nonpregnant as well as the pregnant state. Some medications are safe to use in pregnancy, while others are clearly not. If we know beforehand that you are thinking of getting pregnant, we can consult with your medical doctor/specialist so that we can find a medication alternative that appropriately and effectively treats your disease process, but that is safe for a developing baby. If there is any area of medication controversy we can also enlist a geneticist in the decision making process.
Rarely, there are disease processes such as certain maternal cardiac or pulmonary conditions (Eisenmenger's syndrome and severe pulmonary hypertension to name two) where the risk of maternal death in pregnancy is very high and pregnancy is not recommened and may be contraindicated.