Pre-Conception Care

Question 1

What is PREPARE?

Answer 1

Programme of Research and Education in Pre-Conception Care

Question 2

What can bad nutrition before/ during pregnancy cause?

Answer 2

Stunted growth and increased risk of miscarriage and premature birth

Question 3

What is the life course approach?

Answer 3

Investigates long-term effects of biological, behavioural and social exposures during gestation, childhood, adolescence and young adulthood on health and chronic disease in later life and across generations

Question 4

How can we decrease the risk of getting diseases in the future?

Answer 4

• Pregnancy acts as an early ‘stress test’ for future disease risk
• Highlights the potential for early intervention
• Physical and social exposures in utero, childhood and adult life affect health and the onset of disease

Question 5

What are epigenetics?

Answer 5

Reversible, heritable changes in gene expression that occur without a change in DNA sequences - a change in phenotype without a change in genotype

Question 6

What can affect epigenetics?

Answer 6

Nutrition, environment and stress

Question 7

What is an example of a small change that may occur as a result of epigenetics?

Answer 7

• Terminal differentiation of cells into skin cells, brain cells etc
• Can develop into bigger problems such as disorders and fatal diseases (e.g. cancer)

Question 8

List some healthy lifestyle choices in pre-conception

Answer 8

• Eat healthily
• Healthy weight
• Stop smoking
• No recreational drug use
• Reduce caffeine
• Moderate alcohol
• Regular dental checks
• Exercise
• Relax to reduce stress

Question 9

How is BMI calculated?

Answer 9

weight / height squared

Question 10

What is considered a healthy BMI?

Answer 10

18.5 - 25

Question 11

Describe the effects of having a BMI below 18.5

Answer 11

• Called anorexia
• Weight loss affects cyclical ovarian function
• Anorexia disrupts hypothalamic-pituitary-ovarian axis
• Can lead to reduced bone density
• Fluctuations in body fat can disturb transport and metabolism of steroid hormones

Question 12

Describe the effects of having a BMI above 25

Answer 12

• Called overweight/ obesity
• Affects conception rates
• PCOS associated with anovulation (not ovulating)
• MBRRACE shows that BMI >30 is a significant risk factor for direct and indirect maternal deaths

Question 13

What is PCOS?

Answer 13

Polycystic Ovary Syndrome

Question 14

What is the woman at higher risk of getting if she is obese?

Answer 14

• Gestational diabetes
• Gestational hypertension
• CS delivery
• Macrosomia (high birth weight)
• NTD (neural tube defects)
• Congenital heart disease
• Intestinal malformations

Question 15

Who is pre-conception nutrition advice important for?

Answer 15

• BMI <20
• BMI >30
• Medical conditions affecting diet
• Poor obstetric histories or past foetal abnormality
• Low income women (especially adolescents)

Question 16

What vitamins are beneficial in pregnancy?

Answer 16

• Vitamin B9 (folic acid), A, D, calcium and caffeine = prevent NTDs
• Vitamin A = immune function and reproductive and foetal health
• Vitamin E + C = antioxidants
• Vitamin D = regulates calcium and phosphorous
• Vitamin B = DNA synthesis

Question 17

What is the recommended dosage for folic acid?

Answer 17

• 44mcg/day (low risk)

- 5mg/day (high risk)

Question 18

Name some of the screening programmes available in pregnancy

Answer 18

• Immunisations (rubella, chicken pox, flu and whooping cough)
• STI screening
• Occupational hazard review (workplace)
• Genetic traits

Question 19

Name some chronic conditions that cause women to need closer monitoring

Answer 19

1. Diabetes
2. Epilepsy
3. Mental health disorders
4. Hypertension
5. Sickle cell and thalassaemia

Question 20

What is the woman at higher risk of if she has diabetes?

Answer 20

• Stillbirth = 4.7x risk
• Death of baby in first 4 weeks = 2.6x risk
• Major congenital anomaly = 2x risk