Other candidates for genetic screening would those with a family history of Down's syndrome, Tay-Sach's disease, particularly in Jewish and French-Canadian families, sickle cell disease, which primarily affects African-American populations and thalassemia, a type of anemia common in people with Mediterranean and some Asian backgrounds. Hemophilia is also genetically predisposed, as is muscular dystrophy and cystic fibrosis.
People with any history of mental retardation and the thousands of other rare chromosomal and genetic disorders are also candidates.
I would encourage anybody who is in those categories to see a genetic counselor prior to pregnancy. This kind of specialist can talk to both future parents about all the risks and percentages of them carrying a genetic trait onto their baby.
What medical conditions might affect pregnancy? There are medical conditions that women have prior to conception that can worsen during pregnancy and that, if not monitored closely, especially in the first trimester, can lead to birth defects. For example, if diabetes is not controlled well in the first month of pregnancy (and again, most of us don't know until a couple weeks after we expect a period), it can lead to abnormalities with the fetus due to glucose levels that are out of control.
We also encourage women with pre-existing heart disease to have preconception visits. This includes women with hypertension and women who have had major cardiac anomalies when they were born that were surgically corrected. Women who have epilepsy, lupus, renal disease or genetic disorders should discuss their conditions with a health professional prior to pregnancy.
Women with asthma should talk about how asthma will affect their pregnancy. The good thing is that if these moms are given medication to control the asthma, the pregnancy is probably not going to cause any increased problems.
Are there medications that are known to be detrimental to the fetus? The medications for epilepsy that women take to prevent seizures are potentially harmful to the fetus. The preconception period is the best time to think about the best medications that a woman with epilepsy can use so that when she does become pregnant, seizure control is normalized with minimal effects to the fetus. These moms really need maternal fetal medicine specialists taking care of them.
In women taking mood stabilizers for a psychiatric condition, you weigh the risks and benefits. Is it healthier for the mom to be able to maintain a healthy state of well-being than the very vague potential risk to the fetus that we haven't identified as being harmful to the fetus, at least at this point?
It's important for women planning a pregnancy to stay away from tetracycline and Accutane, which some women take for acne control.
We also want to make sure women know that over-the-counter medications can be as powerful as prescriptive drugs. We really don't know what long-term risks might be associated with any drug because we can't do studies on pregnant women to find those answers. That is why we say, "Don't take anything, unless you seek medical advice," particularly in the preconception period.