 Hi, Dr. Sheshkaila Shirasagay here, Concertant Obstetian Gynecologist, Manipal Hospital, Miller's Road, Banyur. Importance of preconception counseling. Aim of preconception care is to improve maternal and child health, both in the short and long term. A British epidemiologist by the name, David Parker, in 1990 proposed a theory. He said that, whenever there is intrauterine growth restriction or low birth weight babies, these babies when brought, they are more likely to get hypertension, diabetes malitis or coronary heart disease in their middle age. So an international society for the developmental origins of health and disease was set up and it is doing a lot of research in this field. Whenever a mother is stressed in her preconception periods as regards to her nutrition or any infections, immunological conditions, metabolic conditions or psychosocial or pharmacological factors, then these things can have implications on the development of the baby. These factors can affect the baby's growth, development and also the adult life of the baby. So it becomes very important for us to find out if a lady is having any such stresses before she gets pregnant. In the visit, what we do is we take a detailed health history, we ask her if she is having any problem at home, any domestic violence, any abusive relationship, not only that we look into her nutrition and then we look for any signs of anemia, hypothyroidism, we take a detailed health history, we check for if she is having any diabetes, hypertension or is she on treatment for any neurological conditions like epilepsy or any immunological conditions. Once we have gone through and we have seen her medical history, we then see that her health is optimized before she starts a pregnancy. Then the vaccination is enquired into, is she vaccinated for probella, for varicella that is chicken pox. So why it is important is if a girl is pregnant in her first trimester and acquires these infections then it is going to affect the fetus. Also few medicines which are teratogenic can affect the development of the fetus. So we make sure that she is off these medicines, for example if they are on treatment for acne with isotretinoic acid that is vitamin A, she needs to stop it at least 3 months prior to become pregnant. We also look at her body weight, an ideal body weight is important before getting into pregnancy. What is an ideal body weight? An ideal body weight is nothing but a BMI that is body mass illness somewhere between 22-24. Why it is important is because those girls who are very underweight or overweight may have difficulty getting pregnant. Not only that, women who start their pregnancy with a high body mass illness are going to have many complications in the pregnancy in terms of gestational diabetes, malitis, hypertension, pregnancy induced hypertension or preeclampsia, then there will be problems she can have miscarriages, baby can have subcontinatal cardiac defects, not only that even her delivery and the post delivery period may become complicated due to things like blood clot in the vessels and so on and so forth. So it is ideal that the patient, the girl who is planning a pregnancy is in her optimal health before she starts or she thinks of pregnancy. Also it is well known that folic acid of 400 micrograms per day is the requirement for any woman who is planning a pregnancy and she needs to take this for at least 3 months before pregnancy in order to avoid neural tube defects in the fetus. Those men who have conditions like hyperhomocystinemia or who are on medicine for fits that is anti-epileptic medicines, all of them are started on 5 milligrams of folic acid so that there is no folic acid deficiency and subsequently there is no neural tube defects in the fetus. The importance of nutritious diet in terms of eating lots of fruits and vegetables, preferably organic, avoiding packaged foods which are full of preservatives, completely giving up on smoking, alcohol, regular exercises, have a body weight between that is a BMI of between 22 to 24 and optimizing any pre-existing health conditions, all these go a long way in having a healthy baby. Thank you.