Pregnancy Information and Testing
The outcomes of pregnancy for both mothers and babies have improved dramatically during the last century. Much of this progress is due to changes in social and living conditions as well as improved health care.
Despite this progress, during the last two decades of the 20th century, the rate of improvement has decreased significantly. This relates particularly to premature delivery and low birth weight in Australia.
Premature births are defined as those that occur before 37 weeks of pregnancy. In Australia:
- About 7 in every 100 pregnancies (7%), result in premature delivery. This figure may be higher or lower according to where in Australia the woman lives and her ethnic background
- Most of the premature deliveries occur in the last two months of pregnancy. The earlier the baby is born, the higher the chance of a serious problem.
- Problems that may affect women after a premature birth include mood disorders and anxiety.
The baby is most susceptible to developing certain problems in the first 10 to 12 weeks of pregnancy. Some of these may lead to a miscarriage or later complications. It needs to be recognised, however, that many women are not aware that they are pregnant until late in this critical period, and in most cases, the pregnancy outcome will be positive.
Dietary considerations both in the early pregnancy and prior to conception include supplementation with the B group vitamin, folic acid (folate). International and Australian studies have shown that when taken in sufficient doses, dietary folate reduces the chance that a woman will have a baby with a neural tube defect such as spina bifida. .
The continued improvement of pregnancy outcomes is vital and achievable. There is evidence that addressing some of the mother’s health issues, lifestyle and diet before she becomes pregnant can assist in improving pregnancy outcomes including reducing the rates of miscarriage and prematurity. 
Being informed and prepared therefore, before a pregnancy, may potentially reduce the likelihood for problems during a pregnancy. For this reason, a woman should try to consult with her health care provider at least six months before a pregnancy.
A woman’s health prior to pregnancy is vital. It is important that she be aware that her lifestyle and environment may affect the development of her baby.
Some of the risks associated with lifestyle and environment include:
These exposures may affect a baby’s growth and development, the chance for premature birth and a child’s ability to learn. For example, supplementation of diet with vitamins such as folic acid both before and during a pregnancy, can reduce the chance of spina bifida occurring in a baby.
Women may seek support to reduce their smoking or intake of alcohol.
Awareness of these issues may help a woman plan for a safer pregnancy. Importantly, some of these issues need to be addressed before a pregnancy
Some of the issues that a woman may wish to address prior to planning a pregnancy include:
Considering these issues prior to pregnancy is part of a critical path to achieve satisfactory pregnancy outcomes. Ideally, it may be useful to look into these issues six months or more before a pregnancy
When we think about improving a woman’s health in the time before a pregnancy, we do not always think about how having social support will affect her wellbeing both during and after pregnancy. Pregnancy is a time of increased physical and emotional stress, with effects on a woman's confidence and feelings of security. It is also a time when a woman and her partner are making important plans and lifestyle changes in anticipation of parenthood.
Support networks are therefore critical for a woman to adapt to a major change in her life. The psychological wellbeing of a woman may be influenced by her relationships. It is important for women to recognise that social support can have different meanings for different women. Support may include a partner, a family member, friends or a professional. Having support may in turn affect how a woman copes with pregnancy, childbirth and parenting. For example, this may be helpful in minimising the chances for postnatal depression in a woman if there has been a history of unmanaged depression before a pregnancy.
Financial management may also provide a raised sense of security, and there is some evidence that this improves pregnancy outcomes. A woman needs to be able to easily access reliable information to facilitate decision-making, and to understand the physical and emotional changes with pregnancy. These anxieties may be helped by accessing information through this website.
A prenatal test is usually done to determine if your baby is developing in the usual way or if it could be at risk of or affected by a specific condition. There are two types of tests in pregnancy, prenatal screening tests and prenatal diagnostic tests.
Prenatal screening tests can not definitely tell you if your baby has a certain condition, however they may indicate further testing may need to be considered. Prenatal screening tests include,
Prenatal diagnostic tests look for specific genetic conditions that your baby may be at risk of. These tests assess your baby for a chromosome condition or a condition involving a variation in a single gene. A diagnostic test does not test for every possible physical or intellectual condition that could affect your baby.
It is important that you understand these tests. The Centre for Genetics Education has developed a number of materials that can be viewed online or ordered from the Centre.
Preimplantation Genetic Diagnosis (PGD)
PGD involves testing for certain genetic conditions in an embryo created using assisted reproductive technologies (ART) such as in vitro fertilisation (IVF), prior to transferring it to the uterus and allowing it to develop normally. After hormonal stimulation of the woman’s ovaries, some eggs are removed and then fertilised in the laboratory with sperm. One to two cells are removed from the embryo at the eight cell stage (after 3 days) or at blastocyst stage (after 5 days), for testing. Only those embryos that do not have the specific genetic condition that was tested for, will be transplanted into the woman’s uterus. Usually, no more than one or two embryos will be transferred to the uterus at any one time to avoid the possibility of multiple births (more than one baby in a pregnancy). Success rates for having a child from an IVF cycle followed by PGD varies from IVF centre to centre, but tend to follow standard IVF success rates. Like any IVF procedure, stress and often disappointment can accompany PGD. Couples will need to balance the financial and emotional burden of the IVF procedure followed by PGD with that of termination of an affected child conceived naturally.
In Australia, PGD is currently only offered in the private setting.
More information on PGD
For most parents the diagnosis of an abnormality in their unborn baby is completely unexpected. The diagnosis generally comes as a shock and is often the start of a very difficult and at times devastating sequence of events.
When there is a diagnosis of an abnormality a parent may feel isolated, frightened, numb, alone or out of control. Decisions may be made amidst emotional confusion. The confusion and feelings can last for a long time.
The Centre for Genetics Education has produced materials below aimed to assist in this time.
 Bower C, de Klerk N, Hickling S, Ambrosini G, Flicker L, Geelhoed E, Milne E (2006). Assessment of the potential effect of incremental increases in folic acid intake on neural tube defects in Australian and New Zealand. Aust N Z J Public Health 30:369-74.