The first week of pregnancy is the most fascinating process in biology. Even though a woman is not aware that she is 1 week pregnant, the most important event in the science of life is happening within her.
When the ovary releases the egg cell, there are only two days for a sperm to fertilize it. When a woman has sex with a man a day or two before or during her ovulation, pregnancy is very likely if no contraception is used.
The sperms released by the male partner travels up the cervix to the uterus and swims up the fallopian tube. The egg cell also travels from the ovary to the fallopian tube towards the uterus. The sperm cells and egg cell meet near the exit end of the fallopian tube where the smaller sperm cells try to get inside the bigger egg cell. Only one sperm cell can get inside the egg however. And once this happens, the process of fertilization begins.
After fertilization the cell divides into two individual cells and is called the zygote. The zygote becomes a blastomere when the each two cells divide into two more cells. These cells continue to divide during the next three days in the fallopian tube while travelling towards the uterus. They eventually form into a clump of cells that looks like a mulberry called morulla. By this time it has already reached the end of the fallopian tube and enters the uterus.
Fluid starts to accumulate between the cells until there is a little lake enclosed by one layer of cells on one side and the clump of cells on the other side. This is now called the blastocyst. By the fourth to fifth day, there have already been 58 cells and these cells transform into 5 different parent cells that will form the baby and the placenta.
All this time a layer called zona pellucida surrounds this structure until the cell count reaches 107. After that the zona pellucida releases the blastocyst into the cavity of the uterus. The blastocyst then releases substances called cytokines and hormones that would make the uterus accept the blastocyst as it burrows within its wall by the sixth to the seventh day.
The movie “Look Who’s Talking” has an entertaining and nearly accurate depiction of how these processes takes place. By the time the woman is 1 week pregnant the blastocyst has already anchored itself to the uterus and is ready to form the placenta, the amniotic sac and fluids, and the baby.
Although all this wonder is not felt by the 1 week pregnant mother, she has probably started feeling the changes in her body, such as breast tenderness and mood swings, as a response of the hormonal changes being made to accommodate the growing life inside her.
Most sexually active women not using contraception are aware of the possibility of pregnancy. It is important to have a preconception visit to the OB-GYNE so that the determination for risk of environmental hazards and risks of genetic diseases can be made.
Preparation for pregnancy should be planned carefully and thoroughly. Preconception visit is a good way to start. Preconception care aims to identify and modify biomedical, social, and behavioral risks to a woman’s health or pregnancy outcome through prevention and management.
For sexually active women who do not want to get pregnant, preconception care helps in educating them how to prevent unwanted pregnancy.
Preconception counselling educates women with risks, possible pregnancy complications and congenital abnormalities, and chronic diseases. Behaviour modification may also be needed especially for women with unhealthy lifestyle and habits like smoking, alcoholism, and illicit drug use.
A very good example where preconception care is of great benefit is in the care of women with diabetes. Diabetes is a chronic disease that needs ongoing care. The goal for a diabetic woman wanting to get pregnant is to reach the possible lowest haemoglobin A1c levels without causing dangerously low blood sugar. With this achieved at least six weeks before pregnancy there is a decrease in the risk of congenital anomalies in the baby as well as less complications during pregnancy.
Epilepsy is another disease that makes pregnancy complicated. Taking two or more drugs to control epilepsy are known to cause congenital defects in the baby, but not taking them also poses a risk. Preconception care helps in planning treatment based on a single antiepileptic drug that will reduce congenital defects in the baby as well as effectively control the mother’s epilepsy.
Other diseases that can be helped by preconception counselling include hypertension, asthma, kidney diseases, and heart diseases.
What happens during a preconception counselling visit? After giving the necessary information regarding identity, a thorough personal and family history is taken. It is better to disclose all pertinent information regarding social, personal, and family medical history of both the woman and her male partner. Race and ethnic backgrounds are usually inquired as this will determine specific genetic risks that need to be looked into. Other aspects that the preconception counsellors would look into are the history of previous pregnancies, age of the couple, smoking and recreational drug use, environmental exposures, lifestyle and work habits, such as diet and exercise. Domestic behaviour such as abuse is a sensitive issue but important in order to provide proper care. Pregnancy may increase the risk from an abusive partner causing complications like hypertension, bleeding and having smaller than normal babies.
Family history is important in determining which diseases run in the family. Some of these hereditary diseases can only be found in males or in females and some skip generations. Usually a pedigree is constructed in order to determine possible risks of genetic diseases.
Immunization history is also taken as well as travel plans since some vaccines are required while others are contraindicated during pregnancy. Travel plans, especially to places with endemic disease may require the couple to be vaccinated.
After taking a thorough history of the couple, screening tests are done so that proper vaccinations are carried out before pregnancy. It also checks for diseases that may cause risk in pregnancy such as heart, kidney, and immune disorders.