We all (hopefully) see our GP for a check up before falling pregnant. Your GP will likely screen you for STI's, full blood count, fasting glucose, maybe cholesterol and check that you have immunity to rubella and pertussis (whooping cough). If you've got a thorough GP, they will also do a thyroid function test, maybe iron studies and possibly a vitamin D. This is about all that they are allowed to screen for as apart of a normal preconception testing. It's a great start.
I like to dig a little deeper. Not because I think I know more that doctors, please don't take it that way. I most certainly don't. But I look at it from a nutritional perspective and having baselines. The preconception period and early pregnancy is a great time to optimise nutrition and correct any deficiencies.
Here's what I typically test for in addition to the standard screening and why:
Red Cell Folate
It's recommended that women of reproductive age take a folic acid supplement because it help reduce the risk of neural tube defects. But I always like to check a woman's level to see if she is deficient and infect might need more folate.
Approximately 40% of the population have the MTHFR mutation. MTHFR is the enzyme that metabolises folic acid to 5-MTHF that combines with homocysteine in the body to assist in methylation. Methylation is needed to synthesis DNA and protein in the body.
AKA Methylmalonic Acid, is a far more sensitive test for detecting early or mild B12 deficiency. I clinically see a lot of B12 deficiency, mostly because it can be a trick vitamin to get in the diet and it realise heavily on intrinsic factor in the stomach for absorption. Any stomach inflammation, SIBO or compromised stomach lining will all reduce absorption. It can usually be picked up on it in standard RBC count but this is when it's chronic and overt. Preconception, we want to make sure your levels are optimal because b12 is also an important part of the methylation cycle.
Occasionally I'll test this if the woman has a history of miscarriage or symptoms of low progesterone.
Plasma Zinc and Serum Copper
Zinc is essential for the health of reproductive hormones and thyroid. Copper is also needed in the body, but in much smaller amounts. I like to compare the ratio of the two and optimise need be. Typically zinc is low and copper is high, depending on where you live, how much seafood you eat and if you drink tap water.
1, 25 Vitamin D (active vitamin D)
Very important for healthy cellular Division and Differentiation.
An essential building block of all your steroid (sex hormones) so yes I test for it and I hope you have some! It's not always the bad guy.
Blood Heavy Metal Screen-Mercury, Lead, Arsenic and Cadmium
I don't believe in hair mineral analysis. They show what is outside of your body. I'm interested in whats inside your body. Blood is the most accurate method to test for heavy metals. Mercury tends to be high in people that eat a lot of fish. Lead, Arsenic and Cadmium test to be higher in construction workers (pressure treated wood and lead paint) or people with industrial or farm exposures and sometime people who play a lot of lawn sports (like golf or foot ball). These heavy metals displace our essential minerals like zinc, calcium and iron. They are neurotoxic and can pass the placental barrier so wouldn't you like to know what you've been exposed to long before you fall pregnant?!
Full Thyroid Panel- TSH, T3, T4 and rT3
TSH (thyroid stimuaing hormone) is release by the pituitary gland and stimulated the production of thyroid hormones. T4 (thyroxine) is the the major product of the thyroid gland and the "storage" form of the hormone. T3 (triiodothyronine) is produced by the peripheral cells from the conversion of T4 and is heavily dependant on zinc and selenium. rT3 is produced in much smaller amounts and is also produced by peripheral cells from T4. It's an inactive form for thyroid homrone. By seeing a full thyroid panel, I can see whether your thyroid hormones are being converted properly. This process relies heavily on nutrients like cholesterol, iodine, zinc and selenium. Optimal thyroid function is essential for the health of a developing foetus.
Thyroid antibodies-TPO Abs, Tg Abs, TRAb
General screening of thyroid dysfunction in preconception and early pregnancy has been proposed but is not widely accepted. I screen any woman with a family history of thyroid disease, over 30 years, symptoms of thyroid dysfunction, a goiter, obese, lives in a low iodine area, history of miscarriage or has type 1 diabetes, celiac disease or any other autoimmune condition. Does this sound like every preconception patient, it sure does! Any one of these thyroid antibodies can cause sub fertility, miscarriage, and preterm birth. The windows for risk are in early pregnancy (up to 20 weeks) and 3-4 days post partum (for the mother) as antibody levels can increase. It can be thyroid "shit storm" and can look a lot like post natal depression. I always check thyroid and thyroid antibodies 4-6 week postpartum.
Corrected Urinary Iodine
Guess what, Australian soils are very iodine deficient. Most of us aren't consuming iodised salt and we have halogen exposure (fluoride in our water and dental products) that displaces iodine. This test is a simple urine test. It's slightly different to just a spot iodine because it also accounts for hydration. A simple formula iodine / creatinine x 8.85 will give us an accurate iodine level. Women who are pregnant or planning to become pregnant should have levels > 150mmol/L.
Iron is important blood building and an oxygen carrying nutrient. A lot of women are iron deficient due to monthly blood loss, diets high in phytates and low meat consumption.
Up to 50% of adults are infected with it. Read more here.
Fasting blood glucose, fasting insulin and HbA1c (if confirmed diabetes an insulin resistance).
You will have a GTT mid way through pregnancy but I believe it’s important to determine if you are insulin resistant from the beginning of pregnancy.
It’s important to have blood glucose managed 3-4 month prior to conception.
Relevant GUT and stool testing
If you have digestive or gut issues, sort them out before falling pregnancy. Same goes for oral health. I usually recommend regular dental check ups for oral hygiene reason because guess what, the placental microbiome has been found to mimic the oral microbiome!
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