Pre-pregnancy preparation is the first step to ensure children's health, and it is even more important in the era of three children

This is the 3445th article of Da Yi Xiao Hu

In order to slow down the process of population aging and promote the prosperity of the country and the nation, the Central Committee of the Communist Party of China and the State Council issued the "Decision on Optimizing Fertility Policies and Promoting Long-term Balanced Population Development" on July 20, 2021, proposing "implementing a policy that allows a couple to have three children, canceling restrictive measures such as social maintenance fees, cleaning up and abolishing relevant penalty regulations, and implementing supporting active fertility support measures."

Entering the era of three children is a great thing, but we must also fully realize the current situation that women of childbearing age are relatively old and have more high-risk factors. We need to pay more attention to eugenics measures to improve the quality of life of the population. The first step to ensuring children's health is to make good preparations before pregnancy.

1. The significance, content and importance of pre-pregnancy preparation

What is life? How is life inherited and replicated? Can we make new life better? These are the questions that prenatal preparation should answer.

In the compulsory education courses "Children's Physiology and Health" and "Biology" in primary and secondary schools, we know that the law of inheritance is Mendel's law, and the material basis of inheritance is the DNA molecules located on genes and chromosomes. In 1953, at the Cavendish Laboratory of Cambridge University in London, England, when Rosalind Franklin, James D. Watson, Francis Crick and others discovered the double helix structure of DNA and successfully made a model that could reveal the law of genetic replication, people were surprised to think that the mystery of life had been unveiled, and in 1963, the great Nobel Prize was awarded to the discoverers. This great discovery, as a basic education, has now become scientific common sense possessed by the general public, and has also laid a certain mass foundation for good preparation before pregnancy.

Pre-pregnancy preparation is to use the existing scientific evidence to comprehensively analyze the clinical data of both husband and wife to provide better pregnancy advice and necessary intervention measures. Pre-pregnancy preparation includes three aspects: knowledge preparation, physical preparation and psychological preparation of both men and women. With the development of social economy, culture and science, people who are getting married, preparing to raise children in their love nest, and upgrading to become parents, pay more and more attention to pre-pregnancy preparation.

Children are the future and hope of mankind. Children's health is the foundation of national prosperity, family happiness, and national prosperity. Pre-pregnancy preparation is the first step to ensure children's health. For most healthy couples, pre-pregnancy preparation is completed at the obstetrics and gynecology clinic of the hospital 3-6 months before pregnancy. Obstetricians and gynecologists investigate and analyze the genetic background, living environment, and physical and mental health of the couple by asking about medical history, physical examination, and necessary auxiliary examinations, assess their risks of conceiving a healthy baby, decide on the intervention measures that need to be implemented, promote favorable factors, prevent unfavorable factors, and take the first step to ensure children's health.

2. Pre-pregnancy research and risk assessment

1. Medical history

It includes the current medical history of the couple's living conditions after marriage, family history of genetic diseases, personal growth and development history, past medical history, and history of contact with infectious diseases.

2. Physical examination

Routine physical and reproductive examinations of both spouses, and mental health assessments when necessary.

3. Auxiliary examination

① Examinations to assess the health status of both spouses: three routine tests of blood, urine and stool, examination of heart, liver and kidney function, and examination of hormones related to the endocrine and reproductive systems.

② Pathological examination related to intrauterine infection, also known as eugenics test, the TORCH series of examinations are currently widely used. TORCH is a combined abbreviation for several common pathogens that can cause fetal malformations after intrauterine infection, such as Toxoplasma, Rubella, Cytomegalovirus, Herpes Simplex Virus, etc. After the test is found that the patient is currently infected, he or she should consider preparing for pregnancy only after treatment and confirmation of cure.

③ Gynecological specialist examination: including gynecological color ultrasound, cervical cytology and vaginal secretion examination, etc.

④ For those with a family history of genetic diseases, it is recommended to conduct a genetic risk assessment for related diseases and, if necessary, use assisted reproductive technologies such as in vitro fertilization to select healthy genetic material and prevent the transmission of adverse genes.

⑤ For older women over 35 years old, or couples with a history of adverse fertility, it is recommended to conduct a pregnancy risk assessment for related diseases and use assisted reproductive technologies such as in vitro fertilization when necessary.

III. Measures to Promote Healthy Pregnancy

1. Preparation for daily life

Choose a good living environment, including plenty of sunshine, fresh air, clean water, no noise, spacious housing, no pollution, etc. Both husband and wife need to maintain a good mood, combine work and rest, properly improve nutrition, quit bad habits such as smoking, drinking and drugs, and avoid abusing drugs and health products. Maintaining good hygiene habits will help strengthen their own immunity and prevent the occurrence of infectious diseases such as bacteria and viruses.

2. Supplement folic acid

Folic acid is a nutrient in the vitamin B group, also known as vitamin B9, named because it was found in spinach leaves. It is water-soluble and cannot be accumulated and stored in the body. Folic acid is an essential substance for fetal growth. Timely supplementation of an appropriate amount of folic acid during the preparation and pregnancy period can effectively improve the quality of fertilized eggs and fetuses, and is beneficial for preventing infant neural tube malformations, Down syndrome, congenital heart disease, cleft lip and other diseases. It can also prevent premature birth and megaloblastic anemia during pregnancy. Folic acid needs to be taken daily starting 1-3 months before pregnancy, supplementing 400 micrograms per day until the pregnancy is 3 months.

3. Educate on the adverse factors that lead to birth defects. It is recommended to avoid the following adverse factors as much as possible.

① When close relatives marry, the incidence of genetic diseases increases significantly.

② In advanced pregnancy, the risk of Down syndrome increases when the mother is over 35 years old.

③ Lack of nutrients such as folic acid during pregnancy can cause neural tube defects, so supplementation needs to be started before pregnancy.

④ TORCH infection such as rubella virus infection in pregnant women may lead to birth defects.

⑤ Blood sugar monitoring is very important. Pregnant women suffering from diabetes and other diseases will increase the incidence of fetal malformations.

⑥ Many drugs may cause fetal malformations, so pregnant women should use them as little as possible.

⑦ Drug abuse, smoking, alcoholism, drug addiction, drinking large amounts of coffee, etc. can lead to abnormal fetal development. Pregnant women should give up all these bad habits.

⑧ Mercury, lead, benzene, pesticides, radiation, etc. have teratogenic effects. Pregnant women should avoid contact with these toxic and harmful substances.

Excerpted from the author's original popular science book "Anti-Confusion of Common Pediatric Diseases" (written by Xu Lingmin)

Author: Department of Pediatrics, Qingpu Branch, Zhongshan Hospital Affiliated to Fudan University

Xu LingminChief Physician