Module 2 lecture Part 1

Question 1

What are some of the specific clinical situations in which we might provide preconception care?

Answer 1

Gynecologic care visit
Contraception visits
Visits schedule for the specific purpose of preconception care
Primary care visits
Any patient who wants to get pregnant or might become pregnant in the next year or so.

Question 2

Preconception History

Answer 2

Reproductive/Menstrual history
Infection History
Vaccination history
Social history
Family/genetic history

Question 3

A helpful place to start with a preconception menstrual history is determining cycle regularity:
What is that piece of information so important?

Answer 3

Because regular cycles are often ovulatory cycles

Question 4

We know that ovulatory cycles are often regular
What other history elements tend to be associated with regular cycles?

Answer 4

Premenstrual syndrome symptoms and uterine cramping

Question 5

Patient was treated for chlamydia when she was 18. She has had no STIs diagnosed since that time.
what connection does this history have to preconception health?

Answer 5

Chlamydial infections can result in scarring of the uterine tubes and difficulty getting pregnant or ectopic pregnancy,.

Undiagnosed and untreated!!

Question 6

Vaccination history

Answer 6

MMR
Varicella
COVid-19
Tetanus, diptheria, pertussis (TDAP)
Influenza
HPV
Hepatitis B

Question 7

what is ideal for MMR vaccination

Answer 7

Get MMR then wait at least one month before getting pregnant
OR
Could draw rubella titre

Question 8

What individual are considered to be in the HIGH Risk Category

Answer 8

People with a personal history of NTD or previous child with NTD

Question 9

Folic recommendation for low risk category for NTD

Answer 9

0.4 mg/day or 400 mcg

Question 10

Folate is naturally present in

Answer 10

Beel liver
Vegetables (especially)
asparagus
brussels sprouts
dark green leafy vegetables
spinach
mustard greens
Fruits and fruit juices (especially)
oranges
oranges juice
Nuts, beans, peas
peanuts
Blacke-eyed peas
kidney beans

Question 11

Folic acid is added to:

Answer 11

Enriched bread, flour, cornmeal, pasta and rist
Fortified breakfast cereal
Fortified corn masa flour (used to make)
corn tortillas
tamales

Question 12

One of the person to be concerned about for potentially risk of inadequate dietary folate equivalent (DFE)

Answer 12

A person who follow a keto diet

Question 13

Folate is what is naturally present in foods:
Folic acid is what is used in fortification and supplements
dietary folate equivalent (DFE) is the bioavailable folate

Do you think that folate or folic acid is better absorbed

Answer 13

Folic acid is better absorbed than folate

Question 14

Notes about folic acid vs folate vs DFE

Answer 14

We absorb more folic acid from fortified foods and supplements than folate found naturally in foods

Folic acid is more heat-stable than natural food folate

Natural food folate is broken down easily by heat and light

Compared to folate found naturally in foods, we need less folic acid to get recommended amounts

Question 15

Do clinicians always recommend that patient take vitamins specifically labeled as prenatal vitamins

Answer 15

Som clinicians prefer to individually assess whether patient would be best served by regular multivitamins or prenatal vitamins

Question 16

Patient tells us that her cycles are reliably every 29-30 days long. On which cycle day does she most likely ovulate?

Answer 16

Day 15 or 16

When does ovulation normally happen?

Occurs 14 days before the END of the cycle
so : cycle length -14 days = ovulation day

29 day cycle - 14 days = 15
30 day cycle - 14 day = 16 days

Question 18

Patient question about intercourse timing as she tries to get pregnant. l
What is the most likely to be reliable estimate FERTILE window for patient with her cycle 29-30 days

Answer 18

Days 12-19

So we do about 3 days before first part of cycle and about 3 days after……which would be 15 - 16 days…..etc etc…..

Not an absolute scientific exam!!!

Question 19

How often should a patient and her partner have intercourse during their fertile period to become pregnant

Answer 19

To maximize the chance of pregnancy, having intercourse every 1–2 days is ideal but you should base it on your comfort level.