Summary By Barbara Hoefener, FNP 10/2020
Go to DigitalClinicians.com for an appointment.
PreConception Counseling
The National Institute of health published preconception guidelines in 1989 to be part of woman's health care. the first prenatal visit should occur before conception include risk assessment have a woman planning to be pregnant
“Preconception health care is critical because several risk behaviors and exposures affect fetal development and subsequent outcomes. The greatest effect occurs early in pregnancy, often before women enter prenatal care or even know that they are pregnant. During the first weeks (before 52 days' gestation) of pregnancy, exposure to alcohol, tobacco, and other drugs; lack of essential vitamins (e.g., folic acid); and workplace hazards can adversely affect fetal development and results in pregnancy complications and poor outcomes for both the mother and infant.”
Components of preconception care by The American Academy of Pediatrics (AAP) and the
American College of Obstetricians and Gynecologists (ACOG)
1. Physical assessment
2. Risk screening- to help reduce risk of complications
a. Reproductive awareness
b. Environmental toxins and teratogens
c. Nutrition and folic acid
i. Start folic acid supplement, in the prenatal vitamins 3 months prior to pregnancy to
help reduce the risk for neural tube defects, this has been shown to help by 66%.
d. Genetics
e. Substance use, including tobacco and alcohol
i. Smoking- risk factor for low birthweight, preterm birth. Stop smoking before
pregnancy, as research shows when pregnant 20% of women are successful at
quitting.
ii. Alcohol and Drugs- risk of preterm birth, low birthweight, death, fetal alcohol
syndrome or Fetal withdrawals. Stop using prior to pregnancy.
f. Medical conditions and medications
i. (obesity, asthma, cardiac disease, hypertension, diabetes, thyroid disorder, anemia)
ii. Obesity. Adverse perinatal outcomes associated with maternal obesity include
neural tube defects, preterm delivery, diabetes, cesarean section, and hypertensive and thromboembolic disease. Weight loss before pregnancy reduces these risks
iii. Anti-epileptic drugs, teratogens (valproic acid) - Consider reduction of dose by
woman’s provider.
iv. Diabetes- there’s a 3x increase risk of birth defects if a woman with diabetes.
v. Isotretinoins. Use of isotretinoins (e.g., Accutane®) in pregnancy to treat acne can
result in miscarriage and birth defects.
vi. Hypothyroidism. Levothyroxine® dosage will likely need increased and
monitored during early pregnancy for mom and proper neurologic development of
the fetus
vii. Maternal phenylketonurea (PKU). Women diagnosed with PKU as infants have an
increased risk for delivering neonates/infants with mental retardation. Have a diet
low in phenylalanine
viii. Oral anticoagulant. Warfarin, has been demonstrated to be a teratogen, switch
to a different medication.
ix. Anemia has a risk of preterm labor, keep iron levels normal
g. Infectious diseases and Vaccinations
i. (High risk sexual behavior, exposes themselves and baby to STIs, including HIV.)
Treatment for HIV/AIDS prior to pregnancy would be best.
ii. STD. Chlamydia trachomatis and Neisseria gonorrhoeae have been strongly
associated with ectopic pregnancy, infertility, and chronic pelvic pain. STDs during
pregnancy might result in fetal death or substantial physical and developmental
disabilities, including mental retardation and blindness
iii. Prevent disease with vaccination: Influenza, Pertussis, Hepatitis B, Rubella
3. Counseling. Psychosocial concerns (e.g., depression or violence).
(https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm)
TAKE AWAY:
-See your provider for a preconception physical and lab work.
-Take prenatal vitamins for folic acid.
-Be as healthy as you can be, weight. Don’t smoke, drink, or use drugs.
-Take a prenatal vitamin with folic acid 3 months prior to being pregnant.
-If you have any of the conditions listed above, please bring this up during your visit with your provider.
Comments