Traditionally, pregnancy is viewed as a nine-month process divided into three trimesters, but experts now suggest this timeline overlooks crucial periods impacting both maternal and fetal health. A growing understanding of the complete gestational journey is prompting a reevaluation of prenatal and postnatal care. The gynecologist Santiago Novoa, of Policlínica Gipuzkoa, emphasizes that gestation actually begins before conception and extends well beyond delivery. He proposes recognizing a “true first trimester” – the preconception period focused on preparing a woman’s health for pregnancy – and a “fourth trimester,” which spans the postpartum period and can significantly influence a woman’s long-term well-being.
“Pregnancy begins before a positive test and ends long after giving birth,” says Santiago Novoa, gynecologist at Policlínica Gipuzkoa, highlighting that “these overlooked phases directly influence maternal well-being, fetal development, and perinatal outcomes.”
The Preconception Period: Setting the Stage for a Healthy Pregnancy
“Although most pregnancies proceed without complications, a woman’s health status when she begins gestation decisively conditions the prognosis,” Novoa states. “Preconception follow-up allows for the identification and modification of risk factors, control of chronic diseases, and promotion of healthy habits that prepare the body for a safe gestation.”
“Preconception follow-up allows for the identification and modification of risk factors, control of chronic diseases, and promotion of healthy habits that prepare the body for a safe gestation”
The specialist explains that for women with conditions like type 1 or type 2 diabetes, high blood pressure, or epilepsy, optimizing treatment *before* conception is crucial to avoid risks during organogenesis and reduce complications and birth defects. Genetic counseling is likewise becoming increasingly important, helping to identify couples who carry recessive gene mutations and potentially prevent the transmission of certain diseases.
Novoa also emphasizes other essential recommendations during this phase, including updating vaccinations, supplementing with folic acid, preventing infections like toxoplasmosis or cytomegalovirus – a leading cause of congenital deafness – and complete abstinence from alcohol.
Maintaining a healthy weight is also vital. “Following a balanced diet and engaging in regular physical exercise promotes fertility, reduces the risk of miscarriage, and decreases the likelihood of thrombosis or metabolic complications during pregnancy,” he explains.
The Fourth Trimester: Long-Term Health for Women
After delivery, healthcare often focuses on the immediate postpartum period, but Santiago Novoa believes the “fourth trimester” extends much further and requires ongoing monitoring. This phase includes watching for warning signs like fever or excessive bleeding, evaluating reproductive plans, supporting breastfeeding, assessing emotional well-being, and adjusting medications for women with chronic conditions.
“Pregnancy acts as a genuine natural stress test for the body, capable of revealing metabolic or vascular alterations that remained hidden,” Novoa notes. Hypertensive complications affect approximately 2% to 10% of pregnancies and are associated with a higher long-term risk of metabolic syndrome and cardiovascular disease. Similarly, gestational diabetes, present in 4% to 10% of pregnancies, increases the future probability of developing type 2 diabetes and cardiovascular disease.
medical reevaluation after childbirth is essential. Scientific evidence suggests that adequate follow-up allows for the early identification of cardiovascular risks, the implementation of lifestyle changes, and the prevention of more serious complications in adulthood.
“The goal,” explains the gynecologist at Policlínica Gipuzkoa, “is to promote heart-healthy habits including a balanced diet, regular physical exercise, smoking cessation, and control of weight, blood pressure, glucose, and cholesterol.”
Policlínica Gipuzkoa: Comprehensive Care Throughout the Journey
“At Policlínica Gipuzkoa, we promote preconception visits to ensure women enter pregnancy in optimal condition, and we provide support during gestation, the postpartum period, and throughout their lives,” emphasizes Santiago Novoa, adding, “The service has expert professionals in obstetrics, maternal and fetal medicine who facilitate navigate pregnancy healthily, minimize risks, and protect a woman’s future health.”
