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