Part 3 of 6 in the "Can I see a TCM practitioner while preparing for pregnancy" series. Part 2 has the full table of pre-pregnancy checks; this part takes three of them apart.

The table in part 2 lists the items. This part takes three of them apart: what each is looking for, and why it is arranged the way it is.

The three share one feature — each has to be dealt with before the pregnancy.

The short version

• Thalassaemia checks whether each partner is a carrier. The Ministry of Health's Family Health Development Division explains that a carrier shows none of the features of a person with the disease, and that status is known only through screening.
• So one person's result decides whether the other needs the test — which is what "the untested partner" in the table means.
• Rubella checks immunity. The order is fixed: test, vaccinate if not immune, then wait three months — that is the manual's arrangement.
• Folic acid starts ahead of time. The manual's requirement is at least 3 months before a pregnancy. The dose is your doctor's decision for your situation; this article states none.
• Severe abdominal pain, heavy bleeding, or fever with lower abdominal pain: call 999 now, or go to the nearest hospital emergency department.

I. Thalassaemia: why both of you are tested

A thalassaemia carrier is someone who inherited the gene from one of their parents. A carrier shows none of the features of a person with the disease and can live like anyone else, but can pass the gene on to their children — that is the explanation from the Ministry of Health's Family Health Development Division.

In other words, a carrier cannot tell from the outside. Status is known only through screening: the same page says a suspected carrier has an Hb analysis, and a DNA analysis if the Hb analysis cannot confirm it.

The key is "both of you". If both parents are carriers of the gene, each pregnancy carries a 25% risk of a baby born with the disease — that is how the Perlis State Health Department puts it. One carrier and one non-carrier is a different situation.

So the manual's pre-pregnancy sequence runs: once either partner is confirmed a carrier, referral to a family medicine specialist or O&G for counselling (including information on prenatal diagnosis), and screening of the untested partner.

One person's result decides whether the other needs the test — which is what "the untested partner" in the table means.

The same logic continues after the birth: the manual has the baby referred to paediatrics at delivery if both parents are carriers, and seen at six months in the health clinic if only the mother is.

One more thing worth digging out of old paperwork: since 2016 the Ministry has offered thalassaemia screening to Form 4 students, which the Family Health Development Division also states. If you were screened at school, that result is useful now; if not, the table in part 2 says where to go.

II. Rubella: why immunity is checked first, and why the wait after the vaccine

First, what it guards against. The NHS explains it this way: if you catch rubella while pregnant, it could harm the baby — it can cause miscarriage, or serious problems after the birth such as problems with the child's sight, hearing, heart or brain; the risk is highest early in pregnancy. That is why immunity is confirmed before a pregnancy.

How it is confirmed: if you are unsure of your status, a Rubella IgG test settles it — that is what the manual says.

Why the wait: the rubella vaccine (MMR) is not suitable if you are pregnant, which is the NHS. So the manual's arrangement is that someone who is not immune is vaccinated first, with contraception at the same time, because pregnancy is contraindicated for three months after vaccination.

The order is therefore fixed: test first; if not immune, vaccinate; after vaccinating, wait three months. The earlier this item sits in your plan, the less waiting it costs later.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

III. Folic acid: why it starts before the pregnancy

First, what it guards against. The manual lists folic acid supplementation as essential to prevent neural tube defects; the NHS explains a neural tube defect as a problem with the brain or spine, or both, such as spina bifida.

Then, why early. The manual's requirement is at least 3 months before a pregnancy; the NHS's advice is "ideally 3 months before". The two agree: this is not an item that starts once you know you are pregnant.

As for how much: the manual sets different doses for specific medical histories, so the dose is your doctor's decision for your situation. It is available at the pharmacy counter, and worth asking the doctor or pharmacist about before you buy. This article states no dose.

IV. Put the three side by side and the logic shows

One tests both of you, one goes test–vaccinate–wait, one starts ahead of time.

So the pre-pregnancy checks belong on the calendar from the moment you decide to have a child, not from the moment you find out you are pregnant. Which is also why part 1 calls this stage a stretch of preparation.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

First, the things that cannot wait

Severe abdominal pain, heavy bleeding, or fever with lower abdominal pain — call 999 now, or go to the nearest hospital emergency department. The NHS's pelvic inflammatory disease page puts pelvic pain that is severe or getting worse, pelvic pain with heavy bleeding from the vagina, and a very high temperature at the call-999 tier; the same page describes pelvic inflammatory disease as an infection that affects the womb, fallopian tubes and ovaries.

Periods absent for a long stretch or a marked change in the cycle, bleeding between periods or after sex — get this checked. Vaginal bleeding that is unusual for you, including bleeding between periods and during or after sex, is listed among the symptoms of cervical cancer by the NHS.

The full list, and the reason for four of them, are in part 6. TCM and Western medicine complement each other; it is not a choice between them.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

The words in this part

• Carrier (携带者) — someone who inherited a gene from one parent but shows none of the features of a person with the disease. The Ministry of Health's Family Health Development Division states that a carrier can live like anyone else, but can pass the gene on to their children.
• Hb analysis and DNA analysis — the two steps for establishing thalassaemia carrier status. The Family Health Development Division states that a suspected carrier has an Hb analysis first, and a DNA analysis if that cannot confirm it.
• Rubella IgG — a blood test for rubella immunity. The manual states that if you are unsure of your status, this is the test that confirms it.
• MMR — the combined measles, mumps and rubella vaccine. The NHS states that it is not suitable if you are pregnant.
• Neural tube defect (神经管缺陷) — a problem with the brain or spine, or both, such as spina bifida, as the NHS explains it. The manual lists folic acid supplementation as essential to prevent it.

The other five parts

• Part 1: Can I see a TCM practitioner while preparing for pregnancy — what this stage is, and how long before you see a doctor
• Part 2: What the pre-pregnancy checks usually include, and where each belongs
• Part 4: The advice that applies to both partners, and the options a consultation raises
• Part 5: How TCM theory reads this stage — 天癸 and 冲任
• Part 6: When to see a doctor first

👉 All three of these are checks a doctor arranges, so they belong with a family doctor or an O&G. For the routine-and-general-state side, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• Kementerian Kesihatan Malaysia, Bahagian Pembangunan Kesihatan Keluarga (Family Health Development Division), Soalan Lazim — Topik Thalassaemia (BM; site footer © 2023) — https://hq.moh.gov.my/bpkk/index.php/soalan-lazim.html
• Jabatan Kesihatan Negeri Perlis (Perlis State Health Department, MOH), Talasemia — Masa Depan Anak Anda Ditangan Anda (BM; site footer © 2007–2026) — https://jknperlis.moh.gov.my/v3/index.php/kenali-jabatan/talasemia
• Ministry of Health Malaysia, Perinatal Care Manual 4th Edition (released May 2023), Appendix 1-8 Pre Pregnancy Health Education; Appendix 3 Nutritional status; Section 5.1.2 Thalassaemia in Pregnancy — https://hq.moh.gov.my/bpkk/images/PERINATAL_CARE_MANUAL_4th_Edition_2020_11Mei2023.pdf
• NHS (UK), Rubella (german measles), page last reviewed 13 March 2026 — https://www.nhs.uk/conditions/rubella/
• NHS (UK), Pregnancy vitamins and supplements, page last reviewed 3 June 2026 — https://www.nhs.uk/pregnancy/keeping-well/pregnancy-vitamins-and-supplements/
• NHS (UK), Pelvic inflammatory disease, page last reviewed 17 December 2025 — https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/
• NHS (UK), Cervical cancer — Symptoms, page last reviewed 4 September 2024 — https://www.nhs.uk/conditions/cervical-cancer/symptoms/

本文是「备孕期间可以看中医吗」系列的第 3 篇，共 6 篇。第 2 篇有整张孕前检查表，这一篇把其中三项拆开来说。

第 2 篇那张表列了项目。这一篇把其中三项拆开来说：各自在查什么、为什么这样安排。

三项有一个共同点——都要在怀孕之前处理。

一分钟看完

• 地中海贫血查的是双方是否携带者。卫生部家庭健康发展局说明，携带者不会表现出病人的特征，状态只能靠筛查得知。
• 所以一个人的结果，决定另一个人要不要验——这就是表格里「未检查的另一方」那句话的意思。
• 风疹查的是有没有免疫力。顺序是固定的：先验，没免疫就先打，打了先等三个月——这是手册的安排。
• 叶酸要提前开始。手册的要求是怀孕前至少 3 个月。剂量由医生按您的情况决定，这篇不写剂量。
• 剧烈腹痛、大量出血、发烧伴随下腹痛：请立刻拨打 999，或前往最近的医院急诊部。

一、地中海贫血：为什么两个人都要验

地中海贫血携带者，是从父母其中一方遗传到这个基因的人。携带者不会表现出病人的特征，可以像其他人一样生活，但可以把基因传给下一代——这是卫生部家庭健康发展局的说明。

也就是说，携带者自己看不出来。状态只能靠筛查得知：同一份说明写着，疑似携带者做 Hb 分析，Hb 分析无法确认的再做 DNA 分析。

关键在「两个人」。若父母双方都是携带者，每一次怀孕都有 25% 的风险生下患病的孩子——玻璃市州卫生局是这样写的。一方是、另一方不是，就是另一种情况。

所以手册的孕前流程这样排：任何一方确认是携带者，就转介家庭医学专科或妇产科咨询（包括产前诊断的资讯），并为未检查的另一方安排检查。

一个人的结果，决定另一个人要不要验——这就是表格里「未检查的另一方」那句话的意思。

同一个逻辑延续到产后：手册写明，双方都是携带者的，宝宝出生时就转介儿科；只有母亲是携带者的，宝宝六个月时在诊所看一次。

还有一件事值得先翻一翻旧资料：卫生部从 2016 年起为中四学生提供地中海贫血筛查，这也是家庭健康发展局写的。在中学做过的，那份结果现在用得上；没做过的，第 2 篇的表写了该往哪里。

二、风疹：为什么先验免疫，打了疫苗为什么要等

先说在防什么。NHS 的说明是：怀孕期间感染风疹可能伤害胎儿——可能造成流产，或孩子出生后在视力、听力、心脏或脑部出现严重问题；怀孕早期感染，风险最高。这是要在怀孕前确认免疫力的原因。

怎么确认：不确定自己有没有免疫的，验一次 Rubella IgG——手册就是这样写的。

为什么要等：风疹疫苗（MMR）不适合在怀孕期间接种，这是 NHS 写的。所以手册的安排是，没有免疫的先接种，同时避孕，因为接种后三个月内不宜怀孕。

顺序因此是固定的：先验，没免疫就先打，打了先等三个月。 这一项排得越前面，后面越不用等。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

三、叶酸：为什么要在怀孕之前就开始

先说它在防什么。手册把叶酸补充列为预防神经管缺陷的必要措施；NHS 的解释是，神经管缺陷指脑部或脊柱（或两者）的问题，如脊柱裂。

再说为什么提前。手册的要求是怀孕前至少 3 个月开始；NHS 的建议是「最好提前 3 个月」。两边一致：这一项不是知道怀孕之后才开始的。

至于吃多少：手册对特定病史另有剂量，所以剂量由医生按您的情况决定。药剂行买得到，买之前问医生或药剂师。这篇不写剂量。

四、三项摆在一起，逻辑就出来了

一项要查两个人，一项要先验、再打、再等，一项要提前开始。

所以孕前检查从「决定要孩子」那一刻就该排进日程，而不是等到「怀上了」。这也是为什么第 1 篇说，这段时间是一段准备。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

先说不能等的几件事

剧烈腹痛、大量出血、发烧伴随下腹痛——请立刻拨打 999，或前往最近的医院急诊部。NHS 的骨盆腔发炎页把剧烈或持续加剧的骨盆疼痛、骨盆疼痛伴随大量阴道出血，以及很高的体温，都列在立刻拨打 999 那一级；该页说明骨盆腔发炎是一种影响子宫、输卵管与卵巢的感染。

月经长时间没有来或周期出现明显改变，非经期出血或性行为后出血——请就医检查。对您来说不寻常的阴道出血，包括非经期与性行为期间或之后的出血，NHS 把它列在子宫颈癌的症状里。

完整清单，以及其中四项的理由，见第 6 篇。中医与西医是互相补位的关系，不是二选一。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

这篇出现的几个词

• 携带者（carrier）——从父母其中一方遗传到某个基因、但不会表现出病人特征的人。卫生部家庭健康发展局写明，携带者可以像其他人一样生活，但可以把基因传给下一代。
• Hb 分析与 DNA 分析——查地中海贫血携带状态的两步。家庭健康发展局写明，疑似携带者先做 Hb 分析；Hb 分析无法确认的，再做 DNA 分析。
• Rubella IgG——一项验风疹免疫力的血液检查。手册写明，不确定自己有没有免疫的，验这一项来确认。
• MMR——麻疹、腮腺炎与风疹的三合一疫苗。NHS 写明它不适合在怀孕期间接种。
• 神经管缺陷（neural tube defect）——NHS 的解释是脑部或脊柱（或两者）的问题，如脊柱裂。手册把叶酸补充列为预防它的必要措施。

这个系列的另外五篇

• 第 1 篇：备孕期间可以看中医吗——这段时间是什么，多久没怀上该看医生
• 第 2 篇：孕前检查通常包括什么、该往哪里
• 第 4 篇：对双方都适用的建议，以及看诊会提出哪些选项
• 第 5 篇：中医理论怎么看这个阶段——天癸与冲任
• 第 6 篇：什么时候要先看医生

👉 这三项都属于医生安排的检查，请由家庭医生或妇产科医生处理。作息与整体状态这一面，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• 马来西亚卫生部家庭健康发展局，Soalan Lazim — Topik Thalassaemia（马来文；网站页脚 © 2023） — https://hq.moh.gov.my/bpkk/index.php/soalan-lazim.html
• 玻璃市州卫生局（马来西亚卫生部），Talasemia — Masa Depan Anak Anda Ditangan Anda（马来文；网站页脚 © 2007–2026） — https://jknperlis.moh.gov.my/v3/index.php/kenali-jabatan/talasemia
• 马来西亚卫生部，《围产期护理手册》第 4 版（2023 年 5 月发布），附录 1-8 Pre Pregnancy Health Education；附录 3 Nutritional status；第 5.1.2 节 Thalassaemia in Pregnancy — https://hq.moh.gov.my/bpkk/images/PERINATAL_CARE_MANUAL_4th_Edition_2020_11Mei2023.pdf
• NHS（英国），Rubella (german measles)，页面最后审阅 2026 年 3 月 13 日 — https://www.nhs.uk/conditions/rubella/
• NHS（英国），Pregnancy vitamins and supplements，页面最后审阅 2026 年 6 月 3 日 — https://www.nhs.uk/pregnancy/keeping-well/pregnancy-vitamins-and-supplements/
• NHS（英国），Pelvic inflammatory disease，页面最后审阅 2025 年 12 月 17 日 — https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/
• NHS（英国），Cervical cancer — Symptoms，页面最后审阅 2024 年 9 月 4 日 — https://www.nhs.uk/conditions/cervical-cancer/symptoms/