A LEADING health expert has called for men and women to be asked if they plan to get pregnant and told to think again if they take drugs, smoke or are obese. 
Dr Jonathan Sher, author of a report for NHS Greater Glasgow and Clyde on “preconception” healthcare, said the move would help prevent babies being born into bad circumstances. 
While warning against a tendency to “name, blame and shame”, he said many Scots put more planning into their work, homes, holidays or education than they do to having a baby. 

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He wants health services and charities to intervene before conception and offer support such as supplements, dietary and exercise advice or help dealing with depression or domestic abuse. 
In a report commissioned by Glasgow’s director of public health, Linda De Caestecker, Dr Sher said: “Unnecessarily risky pregnancies are common across Scotland. Fundamentally, we need to help people get what they deeply desire – a safe pregnancy, a healthy baby and rewarding parenthood. 
“Virtually everyone wants those three things, but we don’t do a very good job as a society of helping them achieve it.”
Dr Sher is calling for a Scottish version of the One Key Question, an initiative by the Oregon Foundation For Reproductive Health in the US, which encourages all primary care providers to ask every woman patient every year if there is a chance they will become pregnant. He wants men to be asked if their partner is likely to do so.

A stop-start checklist should also be used, with those considering a family asked to think again if they are taking drugs, smoke or likely to drink alcohol while pregnant. It would also include those in abusive relationships or in a poor state of physical or mental health.
The report says the checklist should become as familiar in Scotland as the football league tables or Irn-Bru adverts.

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Those who are not ready for a healthy pregnancy should be offered supports such as vitamin and folic acid supplements, advice on diet or exercise, or help dealing with their other problems.
Dr Sher said issues such as drug use, domestic violence, stress, obesity and depression would be far better dealt with before someone gets pregnant. 
He highlighted the “greatly increased pregnancy risks for the mother and a genuine risk that the baby’s life will be compromised before his/her first breath” when pregnant women are dealing with those issues.

“Even when conception is intentional and wanted, most prospective parents are stunningly unprepared to increase their chances of a healthy pregnancy,” he said.

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Dr Sher, a former policy director of Children in Scotland, suggests everyone should have a Reproductive Life Plan, with a particular focus on the vulnerable groups such as care leavers, people with mental health issues, homeless people and those living in persistent poverty, as well as those with drug or alcohol dependency, obese women, those affected by domestic abuse.
He believes it is not just traditional health services such as midwifery and general practice that can play their part but also youth groups, schools, community groups and faith organisations. Schools and youth groups should promote understanding of sexual health but also other life opportunities besides parenthood and how to have healthy relationships that are not characterised by violence.
He said his recommendations are not expensive nor impractical. 
“The preventable human financial or societal costs of adverse pregnancy and birth outcomes are much too high to allow a continuation of Scotland’s ‘blind spot’ in relation to every prospective mother and father preparing well for each pregnancy,” he said.
 

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The report is backed by Catherine Calderwood, Scotland’s chief medical officer, herself an obstetrician. 
Dr Calderwood said: “Since we know at least 50 per cent of all pregnancies are unplanned, accessing parents-to-be immediately before conception is challenging. 
“But the messages contained in Dr Sher’s report are areas the Scottish Government are actively looking at.”
Professor John Frank, chairman in public health research and policy at Edinburgh University, said the report should be “required reading” for politicians with a responsibility for health matters. 
 

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Dr De Caestecker, who is currently on secondment to the International Federation Of Gynaecology And Obstetrics, said: “Many pregnancies are unplanned, although not ultimately unwanted, and many babies are affected by tobacco, drugs, alcohol, stress or poor nutrition in the womb. 
“Supporting parents, especially mothers, to be as healthy as possible before conceiving has real potential for a positive impact on health.”

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However, a spokeswoman for NHS Greater Glasgow and Clyde said simply asking people to change their behaviour tended to increase health inequalities, as the most affluent are more likely to hear and heed the advice. 
She added: “The report highlights the importance of this issue. At present there is no inter- national evidence of effective interventions that improve pre-conception health of both future parents, the pregnancy outcomes and the health of the child. There is clearly a need to work to create an evidence base for effective interventions.”