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%
