Preconception Health Care Flashcards
(44 cards)
Most 1st prenatal visits at 8 weeks or later
period of time before this visit carries the most risk to fetal development
8wk or later fetus development
Fetal heart has been formed & functioning. Spinal canal is closed. Eyes are formed. Limbs are actively moving. Recognizable genitalia.
by 8 weeks gestation
, any genetic risks or teratogenic effects of medications or environmental hazards have been expressed in the fetus.
Preconception Counseling Visit”
offered for couples by many healthEvery contact with a woman of
childbearing age is an opportunity for preconception care.
care providers.
Goals of Preconception Counseling:
Identify risk factors for maternal or fetal outcome.
Stabilize medical conditions before conception in order to optimize maternal & fetal outcomes.
Provide education & counseling targeted to patient’s needs.
Create a healthy environment for fetus.
Benefits of Preconception Counseling
Helps prevent exposure to potentially harmful substances during early pregnancy.
Risk assessment helps prevent potential complications which would have adversely affect the mother & baby.
Prepares woman/couple physically & emotionally for pregnancy.
Opportunity to plan & arrange early prenatal care.
Preconception Care Visit
Thorough history of woman & couple.
Physical exam.
Laboratory tests to identify medical & genetic conditions that increase risk for poor outcome.
Referral to appropriate health care provider for evaluation of medical/genetic problems
Counseling/screening to include:
Psychological readiness to bear & raise children:
Room in relationship for a child? Expectations?
Emotional & financial stability or woman/couple.
Can be used as opportunity to screen for domestic violence.
Incidence of domestic violence shown to increase during pregnancy.
Discontinuation of contraceptive method.
When & how to stop method.
Expected timeframe of return to fertility for method being used.
Recording menstrual cycles
– crucial for dating a pregnancy.
Nutrition:
Achieving ideal body weight, controlling eating disorders & pica, developing nutritionally balanced dietary habits → important preparation for growing a healthy baby & prevention of low birth weight.
Educate on minor dietary changes.
Nutrition:
Refer to nutritionist → women with major nutrition deficits or obesity.
Refer for psychological evaluation → women with eating disorders.
CDC Nutrition Guidelines:
Folic acid supplementation → reduce risk of spina bifida or other neural tube defects.
Women of childbearing age – 0.4 mg daily.
Most otc multivitamins have 0.4 mg folic acid.
Women with diabetes or epilepsy – 1 gm daily
Women who have previously had infant with neural tube defect:
4.0 mgs daily for at least 1 month prior to conception & through 1st 12 weeks of pregnancy
CDC cautions
against total folate consumption of more than 1mg daily for women who do not have a specific increased requirement
CDC recommends
Ingesting a consistently adequate quantity of folate from food sources is difficult, supplementation is required.
Exercise:
Regular moderate exercise – beneficial.
1st trimester – hyperthermia related to hot tub use has been associated with ↑ congenital anomalies.
Pregnant women should limit vigorous exercise to avoid an ↑ in body core temperature above 38ºC (100.4ºF).
Dental care:
Advise to take care of any needed dental work prior to pregnancy.
Women with significant periodontal disease → ↑ risk of preterm labor & birth.
↑ blood volume during pregnancy & resulting hyperemia in the gums – cause excessive bleeding if gum surgery has to be done during pregnancy.
Genetic Screening
Women over 35:
Higher risk for medical problems during pregnancy & chromosomal abnormalities in the fetus.
Counsel about genetic risks & availability of antenatal testing.
Amniocentesis.
Chorionic villus sampling.
Nuchal translucency ultrasound.
Testing is time sensitive – may not be an option if 1st prenatal visit is delayed.
Ethnic background for prenatal screening
of either partner determines need for prenatal screening for:
Sickle cell trait.
Thalassemias.
Tay-Sachs disease carrier state.
Family history of certain diseases
cystic fibrosis, congenital hearing loss) – indicates need for additional screening:
Carrier for CF – recommended with family history of disease in a cousin or closer relative.
Recent recommendation – CF screening offered to all patients.
50% congenital hearing loss are linked to a single genetic defect in the protein connexin-26.
Family with affected person – that person is usually tested.
If test +, preconception counseling should be offered.
Refer to genetic counselor:
Specific risk factor identified.
Future parents with serious concerns.
Medical Risk Factors
Medications
Rx & OTC medications taken by woman need to be evaluated for possible teratogenic effects.
Evaluate any herbal preparations being used.
Medications that may not be safe during pregnancy – risk/benefit ratio of medication use & pregnancy should be evaluated prior to pregnancy.
Medical risk factors
Women with epilepsy, chronic hypertension, malaria, & other diseases – may be treated with drugs that are known teratogens.
MD consult – Risk to fetus? Can another nonteratogenic medication be used to treat disease effectively?
Important that woman does not just stop taking medication – may negatively effect their medical or mental health
