KCP: Pre-Conception Counselling, Pregnancy and Prescribing

Question 1

What is a teratogen?

Answer 1

Anything a person is exposed to or ingests during pregnancy that’s known to cause fetal abnormalities

Question 2

What is folic acid converted into by the body?

Answer 2

It is coverted by the body into folate. Also known as folacin or vitamin B9

Question 3

What is folic acid required for?

Answer 3

Synthesis of purine and pyrimidine

Question 4

Why are purines and pyrimidines required by an embryo?

Answer 4

They are involved in many things but particularly the conversion of amino acids required to make neuroepithelial cells in order to close the neural tube and prevent brain and CNS defects

Question 5

What is the neural tube?

Answer 5

This is the proto brain and spine

Question 6

Advised folic acid intake for women trying to conceive?

Answer 6

400μg daily when trying to conceive until 12 weeks pregnant

Question 7

Safe levels of alcohol during pregnacy?

Answer 7

No safe levels of alcohol

More significant exposure causes foetal alcohol syndrome

Question 8

What does foetal alcohol spectrum disorder effect?

Answer 8

• CNS
• Facial dysmorphism

Question 9

What are the common features of facial dysmorphism caused by foetal alcohol spectrum disorder

Answer 9

• Low nasal bridge
• Smooth philtrum
• Thin upper lip
• Small palpebral fissures

Question 10

Drugs that can effect foetal development and what they are used to treat

Answer 10

• Methotrexate (RA)
• Sodium valproate (Epilepsy)
• Angiotensin converting enzyme inhibitors ACEi (hypertension, heart failure & renal disease)
• NSAIDs

Question 11

What is the action of methotrexate in causing foetal defects?

Answer 11

• DHF (dihydrofolate) is part of the process of purine and pyrimidine sythesis
• Methotrexate is a competative inhibitor of DHF
• Reduces cell devision
• Reduces amino acid sythesis
• Anatagonises action of folic acid

Question 12

What is the advice regarding methotrexate?

Answer 12

• Should be off methotrexate for 3 months before conception
• Hydroxychloroquine and sulfasalazine and safe DMARDs

Question 13

What are alternative DMARDs that a safe during pregnancy?

Answer 13

• Hydroxychloroquine
• Sulfasalazine

Question 14

Effect of sodium valproate on foetuses

Answer 14

• Neural tube defects are associated with 1-2% of pregnancies
• Also associated with cadiac, oral and urogenital defects

Question 15

Advice for sodium valproate prescription

Answer 15

Should not be prescribed to womean or child bearing age unless in a pregnancy prevention programme

Question 16

Effects of ACEi/ARB in pregnancy

Answer 16

Question 17

When should ACEi/ARB exposure be avoided?

Answer 17

2nd and 3rd trimester

Question 18

When should NSAIDs be avoided?

Answer 18

Third trimester

Question 19

Why do NSAIDs need to be avoided?

Answer 19

• Foetuses have a blood vessel called ductus areteriosus which allowing blood to pass form the pulmonary artery to the aorta therefore bypassing the lung
• This closes after birth and is kept open by protaglandin E (PGE) produced by the placenta
• NSAIDs inhibit PGE therefore causes early closing of the ductus areteriosus
• This leads to pulmonary hypertension and fetal hydrops

Question 20

What is foetal hydrops?

Answer 20

Basically odema in a foetus