Preparation for Pregnancy

Question 1

Folic Acid

Answer 1

Prior to conception, up to 12/40 for women otherwise on healthy diet
o 400mcg per day shown to reduce occurrence of NTDs
o For women at higher risk (E.g. previously affected child, Epileptic mothers, Diabetes or Obesity) – 5mg/day recommended

Question 2

Iron

Answer 2

Not routine; Only if medically indicated or areas with high incidence IDA
o 3mg/day during pregnancy; 2mg/day during reproductive age

Question 3

Calcium

Answer 3

Supplementation if low intake; Ideally through dietary

Question 4

Iodine

Answer 4

Deficiency endemic in some parts of the world; Deficiency can lead to Neonatal
Hypothyroidism and Cretinism
o Supplementation with Iodinised salt or oil

Question 5

Zinc

Answer 5

Deficiency associated with increased risk of Preterm Labour and IUGR; Increased
dietary intake is sufficient to rectify

Question 6

Vitamin A

Answer 6

Food products high in Vitamin A (E.g. Liver, Pate) are Teratogenic

Question 7

Alcohol

Answer 7

Excessive ETOH conclusively linked to Foetal Alcohol Syndrome; Threshold yet to be established; Advice abstinence or limit to one standard unit per day

Question 8

Smoking

Answer 8

Associated with Preterm Labour and Low Birthweight; Women should be encouraged to stop/reduce

Question 9

Recreational Drugs

Answer 9

associated with Miscarriage, Preterm Birth, Poor Foetal Development and
Intrauterine Death; Management of Drug Addiction

Question 10

Weight

Answer 10

Reduced fertility if Obese (BMI>30) or Underweight (<18.5); Obesity associated with GDM, Hypertension; Monitoring and Assessment more challenging in Labour

Question 11

Poor Nutrition

Answer 11

Poor Nutrition in Pregnant women associated with Low Birthweight (<2500g)

Question 12

Weight gain during pregnancy

Answer 12

Weight Gain should be around 11 – 16kg during pregnancy; Should consume additional 350kcal per day; Risk in Protein, Dairy Foods, Starch Foods and Fruits and Vegetables

Question 13

Foods to avoid during Pregnancy

Answer 13

Undercooked Meat and Egg, Pate, Soft Cheeses, Shellfish and Raw Fish, Unpasteurised Milk should be avoided as potential risk of Listeria and Salmonella; Adverse Perinatal outcome

Question 14

Pre Pregnancy General Health: No health problems

Answer 14

• General Examination, Family History, Urine Dipstick
• Blood Tests for Thalassaemia and Sickle Cell Disease if at risk
• Rubella and Hepatitis Status – Immunisations given if not immune; Avoid pregnancy for 3months following immunisation
• HIV screening if at risk
Assured that women safe to work before and during pregnancy; Specific advice for high risk
jobs via Occupational Health

Question 15

Pre Pregnancy General Health: Medical Issues

Answer 15

Optimisation of Pre-existing Medical Conditions (Diabetes Mellitus), Change in Medications (E.g. Anti-Epileptics); Use of as little Prescription drugs and OTC medications where possible

Question 16

Diagnosis of Pregnancy

Answer 16

Most obvious symptom is cessation of periods
Other common symptoms are Nausea and Vomiting (Morning Sickness, common in first trimester), Increased Micturition (Important to rule out Dysuria which might be underlying Infection), Fatigue, Breast Tenderness, Foetal Movements

Question 17

Beta HCG

Answer 17

Secreted by Trophoblastic Tissue of the Placenta; Doubles every second day in
ongoing pregnancy; Blood or Urine
o Home Pregnancy kits can confirm pregnancy within 1 week of missed period

Question 18

Dating of Pregnancy

Answer 18

• First day of LMP to calculate Gestation Age and EDD; Inaccurate when women not certain about LMP; Ovulation might also not occur on day 14, and may vary considerably
• 40% delivery within 5 days of EDD; 2/3rds within 10 days
• Dating Ultrasound – Between 8 – 13/52 (Earlier scan unreliable due to small size of Gestation sac and Foetal pole; After 13 weeks other factors affect growth)