Optimising preconception health: Medical tests, gynaecologists' role, and appointment guidelines

Written by: Dr Panicos Shangaris
Edited by: Kate Forristal

In his second article of a two-part series on preconception care, Dr Panicos Shangaris gives us his insights. He talks about the medical tests and screenings that are recommended to assess a woman’s overall health and identify potential risks, the role of a gynaecologist during preconception care and how often women should schedule appointments with them.



What medical tests and screenings are typically recommended during preconception care to assess a woman's overall health and identify potential risks?

Preconception care includes several medical tests and screenings to assess a woman's overall health and identify potential risks. These assessments vary based on the individual's medical and family history, lifestyle, and age, but generally may include:


1. Full blood count (FBC): This is a basic test to check for anaemia and other blood conditions.


2. Blood type and Rh factor: Knowledge of blood type is crucial in case a blood transfusion is needed during pregnancy. Rh factor is important as well since an Rh-negative woman carrying an Rh-positive fetus may require special care to prevent complications, especially if they carry a Rh+ fetus.


3. Blood glucose test: This test checks for pre-existing diabetes or prediabetes, which, if left uncontrolled, can lead to complications during pregnancy.


4. Thyroid function test: Undiagnosed thyroid conditions can affect fertility and pregnancy outcomes. A simple blood test can check thyroid function.


5. Sexually transmitted infection (STI) screening: Tests for STIs, including HIV, syphilis, gonorrhoea, chlamydia, and hepatitis B and C, are important since they can impact pregnancy and the health of the baby.


6. Pap smear and HPV test: These tests check for cervical cancer and human papillomavirus (HPV), which can cause cervical cancer. The tests are routinely done as part of the NHS cervical screening program, so ensure you are current.


7. Genetic carrier screenings: If the woman or her partner has a family history of genetic disorders or if they belong to certain ethnic groups at higher risk for specific genetic diseases, carrier screenings can be done for conditions like cystic fibrosis, Tay-Sachs disease, sickle cell disease, or thalassemia.


8. Immunisation status: A check on the woman's immunisation status for diseases like measles, mumps, rubella, chickenpox, hepatitis B, and others. Some diseases can harm the fetus, and some vaccines are unsafe to get during pregnancy, so it's better to ensure immunity before conception.


9. Tuberculosis (TB) test: If a woman is at risk for TB (due to travel, work, or exposure history), a TB test may be recommended, as it can cause complications during pregnancy.


10. Urine analysis: A urine test can reveal kidney problems or urinary tract infections, which need to be treated prior to pregnancy.


11. Mental health screening: This is used to identify untreated depression, anxiety, or other mental health conditions.


12. Substance use assessment: Screening for alcohol, tobacco, and drug use is crucial as these substances can harm the developing baby.


13. Review of current medications: Some medications are unsafe during pregnancy, and a review can help decide if any changes need to be made.


The results of these tests can provide valuable information about potential risks and can guide the management of health conditions prior to pregnancy, increasing the chances of a healthy pregnancy and baby. These tests and screenings should be conducted in addition to routine medical care. It's also important to remember that preconception care involves both partners. Men's health and lifestyle also affect pregnancy outcomes, so preconception care for men is equally important.


What role does a gynaecologist play in providing preconception care, and how often should women schedule appointments for preconception consultations?

A gynaecologist plays a crucial role in preconception care as they are typically the primary provider for women's healthcare needs and can address a wide range of health issues that affect women.


1. Health assessment: The gynaecologist can perform an overall health assessment to identify existing medical conditions that may affect pregnancy. This includes checking the woman's weight, blood pressure, and overall physical health.


2. Laboratory tests and screenings: The gynaecologist orders necessary tests and screenings, such as blood tests and STI screenings, to evaluate the woman's health status and detect potential issues that could affect pregnancy.


3. Medical history review: The gynaecologist reviews the woman's personal and family medical history to identify potential genetic or hereditary conditions that could affect the pregnancy.


4. Lifestyle counselling: The gynaecologist provides counselling about healthy lifestyle changes, including diet, exercise, substance use, and mental health.


5. Vaccination review: The gynaecologist checks the woman's immunisation status and recommends necessary vaccinations to protect the mother and baby.


6. Medication review: If the woman takes any medications, the gynaecologist reviews these and recommends changes if necessary to ensure that the medications are safe during pregnancy.


7. Fertility counselling: The gynaecologist can provide fertility counselling and recommend treatments or interventions if necessary for women who have difficulty getting pregnant.


8. Education: The gynaecologist provides education about what to expect during pregnancy and childbirth, potential risks and complications, breastfeeding, newborn care, and more.


The frequency of preconception care visits varies based on the individual's health status, age, lifestyle factors, and reproductive plans. Generally, women planning to become pregnant should schedule a preconception care visit with their gynaecologist at least three months to a year before they start trying to conceive. This allows enough time to address any health issues, start making healthy lifestyle changes, take prenatal vitamins, and adjust any necessary medications.


For women with existing health conditions, such as diabetes or hypertension, or those who have had complications in previous pregnancies, more frequent visits may be necessary. It's also recommended that all women of reproductive age have regular check-ups, regardless of their plans for pregnancy, to monitor their health and address any issues early.


Dr Panicos Shangaris is an esteemed consultant obstetrician with over 15 years of experience. You can schedule an appointment with Mr Shangaris on his Top Doctors profile.

By Dr Panicos Shangaris
Obstetrics & gynaecology

Dr Panicos Shangaris is a highly skilled consultant in obstetrics and maternal and foetal medicine in London. With over 15 years of experience, Dr Shangaris' dedicated clinical expertise specialises in all aspects of fetal medicine, pregnancy, high-risk pregnancy, prenatal diagnosis, preconception counselling, birthing control, and medicolegal cases.

In addition to his roles within the NHS and academic sectors at King's College, Dr Shangaris provides an extensive range of private maternity care services. These services include in-person consultations as well as video e-consultations. His private offerings span comprehensive antenatal care, featuring additional tests such as non-invasive prenatal testing (NIPT), as well as a range of birthing options that include both private caesarean sections and normal vaginal deliveries.

Dr Shangaris graduated from the Royal College of Surgeons in Ireland in 2005 and completed his foundation training in East Lancashire. He then pursued higher specialist training in London at renowned institutions such as University College London, the Royal Free London, Barnet, and North Middlesex Hospitals.

He obtained a Master's degree in foetal medicine and prenatal genetics at University College London (UCL) with distinction. Notably, he was awarded the prestigious Wellcome Trust SPARKS research training fellowship in 2011, which allowed him to undertake his PhD research at UCL. His research focuses on treating genetic blood disorders through foetal stem cell transplantation or gene therapy.

Dr Shangaris has received additional funding from esteemed organisations like the Academy of Medical Sciences, the National Institute for Health and Care Research, and the Fetal Medicine Foundation to further his clinical research endeavours. During his subspecialty training in maternal and fetal Medicine at St Thomas' and King's College Hospitals, he worked under the guidance of prominent experts in the field. He gained expertise in specialised clinics such as complex fetal medicine, fetal urology, gestational diabetes, hypertension in pregnancy, multiple pregnancy, fetal cardiology, genetics, and perinatal pathology.

Dr Shangaris holds the position of maternal and fetal medicine consultant at King's College Hospital NHS Foundation Trust and a Senior Clinical Lecturer at King's College London. He is also an academic co-lead for the BRC DTP PhD programme and supervises research projects for BSc, MSc, and PhD students.

With a commitment to collaborative research, Dr Shangaris actively contributes to maternal and fetal medicine clinical research, leading to numerous publications in peer-reviewed journals. He is part of the editorial team at the Reproductive Science Journal and holds the position of president of the Royal Society of Medicine, Maternity and Newborn Forum, further showcasing his leadership role in the field.

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