Antenatal_Care_Lifestyle_Advice_Flashcards

Question 1

What dose of folic acid should be given to pregnant women and for how long?

Answer 1

Folic acid 400mcg should be given from before conception until 12 weeks to reduce the risk of neural tube defects. Certain women may require higher doses, such as those who take antiepileptics.

Question 2

Should iron supplementation be offered routinely to pregnant women?

Answer 2

No, iron supplementation should not be offered routinely.

Question 3

Why should vitamin A supplementation be avoided during pregnancy?

Answer 3

Vitamin A supplementation (intake above 700 micrograms) might be teratogenic. Liver is high in vitamin A, so consumption should be avoided.

Question 4

What is the recommended vitamin D supplementation for pregnant women?

Answer 4

Women should take a vitamin D supplement (10 micrograms per day), as found in the Healthy Start multivitamin supplement. Women who are not eligible for Healthy Start should be advised where to buy the supplement. Particular care should be taken with higher risk women, such as those with darker skin or who cover their skin for cultural reasons.

Question 5

What are the current government guidelines on alcohol consumption during pregnancy?

Answer 5

Pregnant women should not drink alcohol at all to minimize risks to the baby. Drinking in pregnancy can lead to long-term harm to the baby, with more drinking increasing the risk.

Question 6

What are the risks of smoking during pregnancy?

Answer 6

Smoking increases the risk of low birthweight and preterm birth.

Question 7

Can nicotine replacement therapy (NRT) be used during pregnancy?

Answer 7

NRT may be used, but women must have stopped smoking and the risks/benefits need to be discussed. Neither varenicline nor bupropion should be offered to pregnant or breastfeeding women.

Question 8

What foods should be avoided to prevent listeriosis during pregnancy?

Answer 8

Avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate, or undercooked meat.

Question 9

What foods should be avoided to prevent salmonella during pregnancy?

Answer 9

Avoid raw or partially cooked eggs and meat, especially poultry.

Question 10

Is it safe for pregnant women to continue working?

Answer 10

For the majority of women, it is safe to continue working. Women should be informed of their maternity rights and benefits, and the Health and Safety Executive should be consulted if there are concerns about possible occupational hazards during pregnancy.

Question 11

What are the guidelines for air travel during pregnancy?

Answer 11

Women >37 weeks with singleton pregnancy and no additional risk factors should avoid air travel. Women with uncomplicated, multiple pregnancies should avoid travel by air once >32 weeks. Air travel is associated with an increased risk of venous thromboembolism, and wearing correctly fitted compression stockings can reduce this risk.

Question 12

Should prescribed medicines be avoided during pregnancy?

Answer 12

Yes, unless the benefits outweigh the risks.

Question 13

How should over-the-counter medicines be used during pregnancy?

Answer 13

They should be used as little as possible.

Question 14

What does NICE state about complementary therapies during pregnancy?

Answer 14

Few complementary therapies have been established as safe and effective during pregnancy. Women should not assume that such therapies are safe and they should be used as little as possible during pregnancy.

Question 15

Is exercise safe during pregnancy?

Answer 15

Yes, beginning or continuing moderate exercise is not associated with adverse outcomes. However, certain activities such as high-impact sports with a risk of abdominal trauma and scuba diving should be avoided.

Question 16

Is sexual intercourse safe during pregnancy?

Answer 16

Yes, it is not known to be associated with any adverse outcomes.

Question 17

summarise

Answer 17

Antenatal care: lifestyle advice

NICE has made a series of recommendations regarding the advice that pregnant women should receive:

Nutritional supplements
folic acid 400mcg should be given from before conception until 12 weeks to reduce the risk of neural tube defects. Certain women may require higher doses (women who take antiepileptics)
iron supplementation should not be offered routinely
vitamin A supplementation (intake above 700 micrograms) might be teratogenic. Liver is high in vitamin A so consumption should be avoided
vitamin D: ‘women should be advised to take a vitamin D supplement (10 micrograms of vitamin D per day), as found in the Healthy Start multivitamin supplement. Women who are not eligible for the Healthy Start benefit should be advised where they can buy the supplement’. Particular care should be taken with higher risk women (i.e. those with darker skin or who cover their skin for cultural reasons)

Alcohol
in 2016 the Chief Medical Officer proposed new guidelines in relation to the safe consumption of alcohol following an expert group report.
the government now recommend pregnant women should not drink. The wording of the official advice is ‘If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.’

Smoking
risks of smoking including low birthweight and preterm birth should be discussed
NRT may be used but women must have stopped smoking and risks/benefits need to be discussed
neither varenicline nor bupropion should be offered to pregnant or breastfeeding women

Food-acquired infections
listeriosis: avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate or undercooked meat
salmonella: avoid raw or partially cooked eggs and meat, especially poultry

Work
inform women of their maternity rights and benefits
for the majority of women it is safe to continue working. Women should be asked whether they work. The Health and Safety Executive should be consulted if there are any concerns about possible occupational hazards during pregnancy

Air travel during pregnancy
women > 37 weeks with singleton pregnancy and no additional risk factors should avoid air travel
women with uncomplicated, multiple pregnancies should avoid travel by air once >32 weeks
associated with increased risk of venous thromboembolism
wearing correctly fitted compression stockings is effective at reducing the risk

Prescribed medicines
avoid unless the benefits outweigh the risks

Over-the-counter medicines
should be used as little as possible during pregnancy

Complimentary therapies
NICE state ‘Pregnant women should be informed that few complementary therapies have been established as being safe and effective during pregnancy. Women should not assume that such therapies are safe and they should be used as little as possible during pregnancy’

Exercise in pregnancy
women should be informed that beginning or continuing moderate exercise is not associated with adverse outcomes
certain activities should be avoided e,g, high-impact sports where there is a risk of abdominal trauma and scuba diving

Sexual intercourse
not known to be associated with any adverse outcomes

Question 18

A young married couple are trying to conceive and seek advice from their GP about when to commence folic acid as a close friend recently gave birth to a baby with ‘spinal problems.’ They are both fit and well, non-smokers and tee-total. What would be the recommended advice?

• Both of them should commence folic acid 400mcg as soon as possible until they conceive
• The woman should ideally take folic acid 400mcg OD 3 months before conception up to 12 weeks gestation
• The woman should ideally take folic acid 5mg OD 3 months before conception up to 12 weeks gestation
• The woman should take folic acid 400mcg OD as soon as possible until birth
• The woman should take folic acid 5mg OD as soon as possible until birth

Answer 18

The woman should ideally take folic acid 400mcg OD 3 months before conception up to 12 weeks gestation

Women should be encouraged to take folic acid 400mcg OD 3 months before conception up to 12 weeks gestation

It is recommended that women take folic acid 400mcg OD 3 months before conception up to 12 weeks gestation to reduce the risk of their baby developing Spina Bifida. Women with certain comorbidities (e.g. diabetes) may need to use a higher dose of 5mg OD.

Question 19

A 32-year-old woman with an uncomplicated twin pregnancy at 33 weeks gestation books an appointment to see her midwife at her General Practice. She inquires about the safety of taking a three-hour flight to Barcelona for a holiday with her husband.

Reading her notes, this is her second pregnancy. Her previous pregnancy was complicated with hyperemesis gravidarum, but not her current pregnancy.

What is the most appropriate advice to provide?

Advise her to mobilise throughout the flight
She can not travel as the flight is >2 hours
She can travel as she is <37 weeks pregnant
She can travel as the flight is <5 hours
She should avoid air travel

Answer 19

She should avoid air travel

RCOG advice: women with uncomplicated, multiple pregnancies should avoid travel by air once >32 weeks

She should avoid travelling as she is > 32 weeks pregnant with twins is the correct answer. The Royal College of Obstetrics and Gynaecology (RCOG) recommends that women with uncomplicated twin pregnancies refrain from air travel beyond 32 weeks gestation. This guidance is based on the increased risk of spontaneous labour occurring during the latter stages of pregnancy, which could potentially happen mid-flight.

Advising her to mobilise throughout the flight is incorrect. Merely providing advice on mobility during the flight is inadequate for this case. Given that she is more than 32 weeks pregnant with twins, she should be counselled against air travel entirely.

She can not travel as the flight is > 2 hours - this is not appropriate advice. RCOG guidelines clearly state that air travel should be avoided for women over 32 weeks pregnant with twins without making distinctions based on the flight length.

She can travel as she is < 37 weeks pregnant with twins - is incorrect. Although this may be appropriate advice for a singleton pregnancy, it does not apply to our patient’s circumstances, as she has a twin pregnancy and therefore should not fly after reaching 32 weeks gestation.

She can travel as the flight is < 5 hours - is also incorrect advice. According to RCOG recommendations, women over 32 weeks pregnant with twins are advised against air travel regardless of the flight’s duration.

Question 20

A 23-year-old woman who is 10 weeks pregnant is seen in the booking appointment. She is a current smoker and has tried to quit with willpower alone but has had no success. Which one of the following should be used to help her quit?

Bupropion
Varenicline
Nicotine replacement therapy
E-cigarette
Citalopram

Answer 20

Nicotine replacement therapy

The correct answer is Nicotine replacement therapy. Nicotine replacement therapy (NRT) is the preferred method of smoking cessation in pregnant women, according to UK guidelines. It involves replacing nicotine that would normally be obtained from cigarettes in a way that does not expose the woman or her baby to harmful tobacco smoke. The safety of NRT is not completely established in pregnancy, but it’s considered less harmful than smoking.

Bupropion and Varenicline are both non-nicotine medications used to aid smoking cessation. However, they are not recommended for use in pregnancy due to lack of safety data. Bupropion is an antidepressant which has been found to help with nicotine withdrawal symptoms, while Varenicline works by blocking nicotine receptors in the brain, reducing the pleasurable effects of smoking and alleviating withdrawal symptoms.

The use of an E-cigarette may seem like a safer alternative to traditional cigarettes, however, its safety during pregnancy is not well studied. E-cigarettes still deliver nicotine and can contain other potentially harmful chemicals. Therefore, they’re not recommended as a first-line treatment for smoking cessation in pregnant women.

Citalopram is a selective serotonin reuptake inhibitor (SSRI) used primarily to treat depression. There’s no evidence that it aids in smoking cessation and should therefore not be used for this purpose. Additionally, SSRIs are generally avoided during pregnancy unless absolutely necessary due to potential risks to the fetus.