Pre-Conception Care Flashcards
What is the NICE recommended inter-pregnancy interval (where there are no concerns regarding age-related decline in fertility)?
18-59 months
In what circumstance should high-dose folic acid be taken THROUGHOUT pregnancy?
Sickle cell or thalassaemia (including trait)
In what circumstances should high-dose folic acid be used until 12 week gestation?
- History or family history of NTD in either partner
- A previous pregnancy with a NTD
- AED use
- Diabetes mellitus
- Obesity (BMI>30)
What is the recurrence rate of PET with delivery prior to 34 weeks?
25%
What are the reproductive health risks associated with being obese?
- Reduced fertility
- Increased risk of miscarriage
- GDM
- Gestational HTN/PET
- Macrosomia and shoulder dystocia
- PTL
- Birth trauma.
- Caesarean delivery
- Postpartum complications (e.g. haemorrhage, VTE and infection)
- Stillbirth
- Congenital anomalies
What are the reproductive health risks associated with being underweight?
- Reduced fertility
- First-trimester miscarriage
- PTL
- LBW
- Gastroschisis
How long should a patient delay conception when they travelled WITHOUT their partner to a Zika affected country?
Avoid conception and consider the use of barrier precautions for 2 months from symptom onset or departing the Zika-affected country
How long should a patient delay conception when their partner has travelled to a Zika affected country?
Avoid conception and consider the use of barrier precautions for 3 months from symptom onset or departing the Zika-affected country
How can pregnancy affect a patient’s diabetes?
Pregnancy is associated with increased rates of hypoglycaemia (and decreased hypoglycaemic awareness), increased rates of diabetic ketoacidosis, and worsening of diabetic retinopathy and nephropathy.
How can diabetes affect a pregnancy?
Diabetes during pregnancy is associated with an increased risk of a number of adverse outcomes, including miscarriage, macrosomia and obstetric complications, developmental and growth abnormalities, and stillbirth.
At what HbA1c should conception be avoided?
86 mmol/mol (10%)
Prior to conception, what HbA1c should be aimed for if it is safe to do so?
Less than 48 mmol/mol (less than 6.5%)
What pre-conception measures should be offered/arranged for pt’s with diabetes?
- Diet advice/weight loss recommendation if BMI >27
- Folic acid 5mg until 12/40
- Retinal assessment (unless completed in last 6/12)
- U&Es
- TSH, free thyroxine, and thyroid peroxidase Abs (in T1DM)
When should a referral to nephrology be made for a diabetic patient, pre-conception?
- If serum creatinine is >/= 120 micromol/L
- Urinary albumin:creatinine ratio > than 30 mg/mmol
- eGFR < 45 mL/minute/1.73m2
What is the most common congenital infection?
CMV
What proportion of babies are born with congenital CMV infection?
1 in 200
What proportion of babies born with congenital CMV have long-term health problems?
1 in 5
What is the most common long-term health problem in babies born with congenital CMV?
Hearing loss
What are the long-term health problems that can result from CMV?
- Hearing loss
- Developmental and motor delay
- Vision loss
- Microcephaly
- Seizures
What signs of CMV may be present in babies at birth?
- Rash
- Jaundice
- Microcephaly
- LBW
- Hepatosplenomegaly
- Seizures
- Retinitis
When is the risk of complications in the fetus greatest in the context of CMV infection?
When primary infection occurs in the 1st trimester
What is the risk of CMV transmission in primary infection when acquired in the 1st and 2nd trimester?
30-40%
What is the risk of CMV transmission in primary infection when acquired in the 3rd trimester?
40-70%
What is the risk of CMV transmission in NON-primary infection?
3%
When does Rubella do the most harm when acquired in pregnancy?
When acquired in the first trimester
What are the most common birth defects associated with congenital rubella syndrome?
- Deafness
- Cataracts
- Heart defects
- Intellectual disabilities
- Liver and spleen damage
- LBW
- Skin rash at birth
What cardiac defect is most associated with CRS?
Patent ductus arteriosus
What proportion of women will miscarry/have a stillbirth when Rubella acquired in the first trimester?
80–90%
What is the skin manifestation associated with CRS?
Blueberry muffin lesions
What are the characteristics of the Rubella virus?
Family = Matonaviridae
Enveloped - icosahedral capsid
Single-stranded RNA
How is Rubella transmitted?
Respiratory route
What are the possible symptoms of Rubella in adults?
- Rash begins on the face which spreads
- Low fever of <38.3 °C
- Posterior cervical lymphadenopathy
- Swollen glands
- Coryza
- Aching/painful joints (especially in young females)
How long after a toxoplasmosis diagnosis should a patient wait before conceiving?
6 months
How long after the toxoplasma parasite become infectious after being shed in cat faeces?
Between 1 and 5 days (hence early clearing, along with glove use/hand washing, if no one else able to clear litter trays, likely to still be safe in pregnancy)
What type of organisms is toxoplasma gondii?
Protozoan parasite
When is the affect of toxoplasmosis greatest on an unborn child?
When acquired in he first trimester?
What are the possible adverse outcomes of toxoplasmosis in pregnancy?
- Miscarriage
- Stillbirth
- Congenital toxoplasmosis
What are the possible affects of congenital toxoplasmosis?
- Hydrocephalus
- Cerebral calcifications
- Chorioretinitis, leading possibly to blindness
What proportion of babies born to women infected with Zika virus during pregnancy, will have Zika-associated birth defects?
5%
Additionally, some babies affected by Zika during pregnancy might look healthy at birth but can develop long-term health problems
What features are suggestive of congenital Zika infection?
- Severe microcephaly in which the skull has partially collapsed
- Decreased brain tissue with a specific pattern of brain damage, including subcortical calcifications
- Damage to the back of the eye, including macular scarring and focal retinal pigmentary mottling
- Congenital contractures, such as clubfoot or arthrogryposis
- Hypertonia restricting body movement soon after birth
