For five years after marriage, Ms. Qin longed for a child. She conceived several times, but each pregnancy ended in miscarriage due to fetal abnormalities. Recently, she consulted specialists at Futian District Maternal and Child Health Hospital. After reviewing her case, experts recommended preconception testing, which revealed high blood sugar levels and diabetes. Specialists explained that diabetes increases risks of miscarriage, premature birth, and fetal malformations.
Therefore, experts recommend that women planning to conceive undergo pre-pregnancy checkups 4-6 months before pregnancy. This not only provides a healthier environment for the baby's development but also helps prevent birth defects.
Rising Birth Defect Rates
For most families, the arrival of a new life brings happiness and joy.However, for a small number of families, the moment a new life arrives also marks the beginning of family misfortune. Statistics show that approximately 900,000 newborns in China are born with birth defects each year. From 1996 to 2010, the incidence rate of birth defects in China increased by 70.9%, with 149.9 out of every 10,000 newborns suffering from congenital defects.
This figure is even more alarming in Shenzhen. According to statistics from the Shenzhen Municipal Health and Population and Family Planning Commission, in 2012, the birth defect rate in Shenzhen reached 18%, meaning that 180 out of every 10,000 newborns had congenital defects.In Futian District, the rate reached 22%. "This is primarily due to the high number of births in Futian, combined with many residents from other districts seeking medical care here, leading to a higher incidence of birth defects in Futian compared to other areas," explained Ma Jian, Director of the Women's Health Department at Shenzhen Futian Maternal and Child Health Hospital. Birth defects are a major cause of childhood disability and mortality.
Primary factors contributing to birth defects include genetics, gene mutations, and environmental influences. Environmental impacts encompass not only pollution and food safety concerns but also societal factors. "For instance, mounting work and life pressures have led to a rise in older mothers, increasing the incidence of premature births and Down syndrome."Ma Jian noted that objectively, the rising birth defect rate is also linked to recent economic development and advances in medical technology. Compared to the past, many severe disabilities can now be detected during prenatal examinations. "For instance, congenital heart disease is identified much earlier, rather than being discovered primarily during early childhood as was common before." Among the various birth defect conditions currently screened for in Shenzhen hospitals, congenital heart disease ranks first.
Prenatal screening serves as the first line of defense against birth defects. "It not only provides a healthier environment for the baby's development but also helps prevent the birth of children with abnormalities," Ma Jian emphasized. Many people assume that since their family has no history of genetic diseases, their children will be healthy and thus skip prenatal screening.In reality, over 95% of congenital defects in newborns are not solely genetic in origin. Pollution, radiation, and other factors can also contribute to birth defects. Comprehensive screening should be conducted 4 to 6 months before conception. Preconception screening determines whether one's physical condition is suitable for pregnancy. How can one assess their readiness? Through preconception testing."For example, among my clinic patients, there was a pregnant woman with severe heart disease who was unaware of her condition and had not undergone preconception screening. She was diagnosed with serious heart disease during pregnancy and ultimately had to terminate the pregnancy," said Ma Jian. For women planning to have a baby, physical health is paramount and must be prepared first. "Other preparations are useless if this foundation is missing.""Prenatal checkups provide a comprehensive assessment of your health," he continued. "If you have an illness, it requires treatment. Even if you don't have a disease but have abnormal test results—even if they don't warrant treatment yet—you must address these abnormalities and bring your body to its optimal state."
When is the best time to conceive? Ma Jian noted that due to increasing life pressures in Shenzhen, many people postpone childbearing until after establishing their careers. "They always wait until their jobs are stable and their income is higher before getting pregnant."In reality, age significantly impacts pregnancy. The older a woman is when conceiving, the higher the risk of birth defects in the child. "Unlike sperm, which is produced in batches every three months, a woman's egg supply is fixed from birth. No new eggs are generated during development. As a woman ages, her egg count diminishes, and egg quality declines compared to when she was younger."She recommends women have children earlier, with the optimal childbearing age around 25.
The best season for conception is autumn. Ma Jian explains that autumn is harvest season with abundant fruits, but more importantly, the climate is suitable and respiratory illnesses are less common. Additionally, beyond ruling out genetic factors, women should adjust their contraception methods: "It's best to wait six months after stopping birth control pills before trying to conceive."
So who needs preconception checkups? Ma Jian emphasized that everyone should undergo them, ideally starting 4 to 6 months before conception.Last year, Shenzhen launched the Eugenic Health Benefit Program, with the government investing 200 million yuan annually to provide ten free services for eligible residents, including premarital and prenatal checkups, and preconception thalassemia intervention. "Any Shenzhen resident with local household registration or a valid Shenzhen residence permit who complies with family planning policies, is married, and plans to conceive can obtain certification from their neighborhood office to access these free services," Ma Jian explained.
Oral Health Issues Should Not Be Overlooked
Among the numerous screening options, which should be prioritized? Ma Jian advised that physical examinations should come first, assessing heart, liver, and lung function to evaluate overall health and identify factors affecting optimal birth outcomes. "For instance, conditions like heart disease, enlarged liver, breast issues, or uterine abnormalities may necessitate additional tests."Additionally, gynecological examinations check for vaginal inflammation. "Some pregnant women who skipped preconception screening develop vaginal inflammation during pregnancy and hesitate to take medication. If gynecological issues exist before pregnancy, they must be treated first." Gonorrhea and Chlamydia trachomatis tests screen for infections, as these pathogens can cause intrauterine fetal infections and impair normal fetal development.If infection is present, conception should be postponed until treatment is completed."
Blood and urine routine tests screen for conditions like anemia and thrombocytopenia. Abnormal results may prompt investigation for thalassemia. Serum glucose testing is also essential, as lifestyle and dietary changes have increased diabetes prevalence. Diabetes heightens risks of miscarriage, preterm birth, and fetal abnormalities."After pregnancy, hormonal changes can affect pancreatic function, leading to abnormal blood sugar levels in the mother. The baby, exposed to high glucose levels, is at risk of developing abnormalities."Thyroid function testing is also crucial. Abnormal thyroid function can cause premature birth or miscarriage and affect fetal development. "If the mother has thyroid disease, it can affect the fetus's thyroid, leading to elevated fetal hyperthyroidism markers. These markers entering the fetal bloodstream can cause congenital thyroid dysfunction in the baby," said Ma Jian.
Additionally, both partners should undergo pre-pregnancy blood tests to screen for hepatitis B virus (HBV) carriage. HBV can cause intrauterine infection through the placenta, resulting in the baby becoming an HBV carrier after birth.Screening for rubella antibodies, cytomegalovirus antibodies, and toxoplasma antibodies (collectively known as "TORCH") is also essential. Venous blood tests measure TORCH-specific antibodies in serum to assess infection status. Women testing positive for TORCH antibodies before pregnancy should undergo treatment and regular monitoring under medical guidance until antibodies become negative before considering conception.It's important to note that consuming raw or cold foods increases the risk of Toxoplasma infection. Therefore, Dr. Ma Jian advises avoiding raw foods when planning pregnancy: "Avoid raw dishes like sashimi, especially before and during pregnancy. Also steer clear of pickled foods and leftovers."
Beyond free preconception screenings, Ma Jian recommends paid tests including liquid-based cytology, HPV screening, and breast ultrasound. Cytology and HPV tests primarily screen for cervical cancer, while breast ultrasound detects breast cancer. Oral examinations are also crucial, as untreated dental issues during pregnancy can spread bacteria to the placenta and harm the baby.
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