You’ll have your basic bloodwork, the most evidence-based way to work. I like to test iron because it’s connected to pregnancy, postpartum, labour and delivery outcomes. 40% of pregnancies globally are iron deficient. It is important to test the iron storage form, ferritin. I like to order a transparent saturation to check iron deficiency, anaemia, or higher levels of ferritin associated with inflammation. Low iron increases the risk of pre-term delivery and higher risk of postpartum anxiety and depression.

There’s also the challenge of losing blood during labour and delivery, so making sure that we have enough stores to accommodate that. You’re also passing on your iron stores to the baby. Babies who have iron-deficient moms are going to be iron deficient as well. Iron deficiency is one of the most common nutritional deficiencies in paediatrics, and it can impact long-term cognitive health. A simple blood test can avoid many complications.

I like to look at health history before conception—things like PCOS or metabolic disorders. For inflammation, looking at CRP or hs-CRP is helpful if you’re getting a requisition from your doctor. That can be a marker for cardiovascular inflammation. ESR or Erythrocyte Sedimentation Rate can also be a very general marker of inflammation.

10:00
Vitamin B-12 is something that I like to look at, especially if a patient is vegan or vegetarian. Vitamin D is also a very big one. It’s an important marker that we don’t always look at. Suppose we are dosing vitamin D, which is one of the most common over-the-counter supplements. In that case, we want to make sure that we’re adequately doing so – taking enough to achieve the outcome but also not going overboard. Because it’s a fat-soluble vitamin, it can accumulate in the body, and it can lead to toxicity symptoms. This will help with preventing problems for gestational-age babies, pre-term birth, and placental complications. Placental complications are five times more likely after 32 weeks if you are vitamin D deficient.

12:30
Another thing to look at is thyroid health. Our pregnancy hormones are very similar to our thyroid hormones. It’s more likely that the thyroid will go away once you’re pregnant. You want to aim for specific values. Research indicates that TSH should be at less than 2.5 to maintain a healthy pregnancy. I also like to look at thyroid antibodies if there’s a strong history of autoimmune concerns. If there is any autoimmune disease, like Hashimoto’s thyroiditis, our thyroid antibodies will be elevated.

14:06
From a cardiovascular perspective, fasting insulin, insulin resistance and homocysteine can also be helpful because they’re related to how we build blood vessels and our blood vessels’ health.

14:33
And finally, blood pressure. With the switch to virtual care during the pandemic, people have not been having their blood pressure measured. If that’s higher, you also want to look at other values like liver enzymes and uric acid.