Recommendations for Preconception Counseling and Care

Question 1

How many pregnancies are unintended?

Answer 1

Nearly 50%

Question 2

When should folic acid supplementation be advised during pregnancy?

Answer 2

400 mcg daily started before pregnancy and continued until 6-12 weeks postconception reduces the rate of neural tube defects by nearly 75%

Question 3

What are the potential effects of not taking folic acid supplements during early pregnancy?

Answer 3

oral facial clefts, structural heart defects, limb defects

urinary tract anomalies

hydrocephalus

Question 4

How much folic acid should be advised in women with increased risk of folic acid related deformities in offspring (i.e. previous birth with neural tube defects, insulin dependent maternal DM, obesity with BMI over 35, epilepsy)?

Answer 4

4-5 mg of folic acid daily starting 3 months before conception and continuing until 12 weeks postconception

Question 5

What pregnancy defects are related to maternal obesity?

Answer 5

macrosoma, shoulder dystocia, operative delivery, congenital abnormalities, SAB, stillbirth, preeclampsia

Question 6

What are some effective interventions for women who are overweight (BMI 25-29.9) or obese (30+)?

Answer 6

Weight Watchers is the least costly and is associated with a 3.2% decreased in weight 2 yrs after starting, while medically supervised programs are more expensive but are associated with greater weight loss (15-25%)

Question 7

Why are overweight women more likely to have difficulty with conception?

Answer 7

insulin resistance and oligomenorrhea

Question 8

How are women advised on fertility after undergoing bariatic surgery?

Answer 8

dont get pregnant for 12-18 months to stabilize weight loss and optimize nutritional statue, but the time from surgery to conception does not increased obstetric and neonatal complications

Question 9

T or F. Oral contraceptives may be less effective after malabsorptive bariatric surgery

Answer 9

T.

Question 10

How would preconception care in women who have had bariatric surgery be altered?

Answer 10

these pts are at risk of nutrient deficiencies, including vitamins A, D, E, K, B1, B6, B12, folic acid, and iron. It is recommended these pts. take at least two multivitamins per day in addition to an extra 65mg iron, 400 mcg of folic acid, vitD, and VitB12

Question 11

What is low prepregnancy weight associated with?

Answer 11

preterm birth and low birth weight

It is also asociated with nutrient deficiencies, osteoporosis, amenorrhea, infertility, and arrhythmias

Question 12

Infants whose mothers had low prepregnancy body weight are at higher risk of _________

Answer 12

gastroschisis