Professor Dommergues, you specialize in planning the pregnancy for women with various chronic medical diseases. Dr. Anton Titov, MD. So if somebody has a medical condition that can complicate the pregnancy, what can a woman do to make sure that pregnancy planning is done properly and correctly, and that pregnancy and successful? Dr. Anton Titov, MD. There are steps that are not specific at all. As usual, she should quit smoking and drinking. She should take folic acid tablets, do the usual blood tests such as HIV, etc. But then, when it comes to someone who has a chronic disease, the first point is that the lady should discuss the pregnancy with the doctor who is usually in charge of her disease. Dr. Marc Dommergues. Medical second opinion. And it is also very important that she should see an obstetrician who is familiar with the type of disease she has. This is what we call a 'preconception clinic'. In this preconception clinic the first part is to learn about the history of the person, get all information and medical data, and then give information to patient, first verbally and then as a written record [fr. compte rendu] that gives details that patient can think about, discuss with her doctors, discuss with her family. This enables her to have an adequate health information. Dr. Anton Titov, MD. So the information is the first step. Dr. Marc Dommergues. Medical second opinion. And there's a simple way of providing it: First, it's important to consider the effect the disease may have on pregnancy. Then we need to consider the effects that pregnancy may have on the disease. Regarding the effect of the disease on pregnancy, probably the first question is the question of the medicines that a person is taking. It is a major fear for future pregnant women that they might take drugs that could harm babies. It is, of course, very dangerous to discontinue medications that you need to take, stopping them just out of fear. This is one of the reasons why preconception meeting is extremely important. To illustrate, drugs may have different types of effects on a fetus. The first type of effect is that medications may induce fetal malformations. Then it's important to know what is the rate of fetal malformations, what type of malformations, how malformations can be identified. In some cases, we just do not know precise risks for a given drug to induce malformations. It's important to exchange data on medications during pregnancy with specialists who concentrate on the effect of drugs on fetuses. Those experts exist in different countries. They can provide us with published data, but also with unpublished data that belongs to the laboratories or information from clinical cases that were reported to their centers. Dr. Anton Titov, MD. So the first point to assess any medication used in pregnancy would be to establish whether those drugs have a risk of inducing fetal malformations or if medication has a long-term effect on the baby without inducing malformation. Another type of effect a medication may have is that a drug interacts transiently with the baby's health. For instance, if you're taking psychotropic drugs or some antiepileptic drugs, the baby may be lazy and sleepy for a few days, and then may have withdrawal syndrome. Usually, this resolves spontaneously with baby care by pediatricians who are used to those babies being under the influence of medicines taken by their moms. But this is something that has to be considered. Sometimes the question of breastfeeding must be taken into account. For example, it may be a reasonable choice to choose not to breastfeed if there's a significant concentration of drugs in the milk, which may then pass from the milk to the baby. This is often controversial. In different countries, physicians may have different opinions on what should be done. Of course, the more time future mother and family have time to think about this - the better. Because it helps in making decisions. This was point #1 - the medicines.