Never more important to ask patients about pregnancy plans

MANY Australians dream of becoming a parent. Before 2020, research showed most young Australians wanted children at some stage, with the majority wanting more than one. But the arrival of COVID-19 and its associated damage might be slowing down our fertility rate.

In July, the Australian Institute of Family Studies reported that a survey of more than 3700 Australians showed one in five women who had been trying for a baby before the COVID-19 pandemic had stopped trying because of it. Some of this was driven by job losses or reduced working hours.

The research also found that women in their 20s were more likely than those in their 30s to say they would delay having children and that they would likely have fewer children.

If people really are delaying plans for a baby, Australian GPs have a golden opportunity to help their patients use the wait to improve their pre-conception health, so they’re primed for pregnancy and parenthood when the time is right.

Here are five reasons why it’s never been more important to ask your patients about their pregnancy plans.

You can reduce the risk of pregnancy complications

It is now clear that pregnant women have a higher risk of severe illness from COVID-19 and that their babies are at higher risk of premature birth. So, if your patient is thinking about getting pregnant, help her maximise her protection against COVID-19 by getting vaccinated as soon as possible.

According to Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the federal department of health, women who are trying to become pregnant do not need to delay vaccination or avoid becoming pregnant after vaccination, and pregnant women can have the vaccine at any stage of pregnancy.

By asking your patients about their pregnancy plans, you can also help women and men assess their pre-conception health and improve it by getting to a healthy weight, for example. Being overweight or underweight can reduce fertility, and obesity can increase the risk of pregnancy complications such as gestational diabetes (here, here and here). Try to avoid stigmatising language though. You can read some helpful pointers here.

You can improve the health of babies

Parenting starts before conception. People who plan a pregnancy and are in good health before they try to conceive have healthier babies. Asking people of reproductive age about their pregnancy plans allows you to offer information about pre-conception health to those who want a baby now or in the future.

The quality of eggs and sperm at the time of conception will affect the health of the baby at birth and into adulthood. Pregnancy planners can use the months leading up to pregnancy to improve the quality of eggs and sperm by eating a well balanced diet, avoiding harmful chemicals, not smoking, and limiting alcohol intake. For women, taking folic acid and being up-to-date with vaccinations, including COVID-19 vaccination, reduces the baby’s risk of birth defects and harmful infections.

You can help prevent infertility

Every year, thousands of Australians find themselves suffering age-related infertility. It can be a heartbreaking experience, and costly in vitro fertilisation (IVF) treatment is often fruitless. While IVF has helped countless women and men have much wanted babies, most people over the age of 40 years finish IVF without a baby. Asking your patients about their pregnancy plans allows you to talk about the impact of age on fertility and chance of IVF success. These data show why IVF should not be considered a back-up plan.

You can prevent unplanned pregnancies

For the one in four pregnancies in Australia that are unplanned, the opportunity for parents to improve their pre-conception health was missed. By asking about pregnancy plans you can offer advice about reliable contraception to those who don’t want or are ambivalent about pregnancy.

Patients are okay with it

Research shows GPs want to be involved in shaping the health of the next generation, and most patients don’t mind being asked about their pregnancy plans. In fact, many say they would appreciate it.

If you want more information about how to broach the topic with your patients, Your Fertility, a government-funded program, has practical resources for GPs here.

Dr Karin Hammarberg is a Senior Research Fellow in the School of Public Health and Preventive Medicine at Monash University.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.