pre-conceptual counselling Flashcards
for women that are obese >30kg/m2 what would the advice be re weight loss
aim for a 5-10% weight loss as this is realistically
however ideally before conceiving would be good to be a healthy BMI 18.5-24.9kgm/2
can you name some of the increased risks that an obese patient who is pregnant is at risk of
1st trimester risks = increase risk miscarriage and infertility
maternal risks = pre-eclampsia, hypertension, gestational diabetes
obstetric risks = birth trauma, c-section, PPH, macrosomia leading to shoulder dystocia, stillbirth, pre-term delivery
neonatal - increased risk congenital defects, NTD
which women are considered high risk and in need of 5mg folic acid
- BMI>= 30kg/m2
- women who have had a previous pregnancy with NTD, mother or father with NTD or family history of NTD
- women with diabetes, sickle cell anaemia or thalassaemia
-women taking anti-epileptic drugs
-coeliac disease
how long should patients take folic acid for
pre-conception (1 month prior) up until 12 weeks
unless they suffer from sickle cell anaemia or thalassaemia then they should continue throughout pregnancy
what is the dose of folic acid for high risk women
5mg od folic acid
what is the usual dose of folic acid for women considered low risk for NTD
400mcg OD folic acid
what is the advice for men and women who are considering pregnancy and have travelled to a country where Zika virus is known to be prevalent
males - wait 3 months before conceiving
females - wait 2 months
zika is a single stranded RNA virus
what vaccines should you consider prior to pregnancy
check women have had rubella (if unknown check serum IgG if negative give rubella pre pregnancy - can’t give during pregnancy as is a live vaccine)
check immunity history to chickenpox, if they are unsure then check VZV immunity IgG antibodies if negative can consider varicella vaccine
Patients at risk of acquiring hepatitis B during pregnancy then offer hep B (IVDU, patients with multiple partners, chronic renal or liver disease or close contact with someone who is hep B positive)
how long after having a live attenuated vaccine should you wait to start trying for a baby
4 weeks
what is the name of questionnaire that should be used to measure women suffering from depression in pregnancy/pre-conceputally
Edinburgh postnatal depression scale (EDDS)
what should the general advice be to women on SSRIs during pregnancy
if symptoms are mild to moderate try and wean but mum is probably fine to continue, evidence very conflicting and increased risks a/s with mums mental health
if medication required, use lowest effective dose and aim for mono therapy
which SSRI is considered the ‘best’ option in pregnancy
sertraline
what are the main risks associated with SSRIS in pregnancy
small increase risk of PPH at delivery
increased risk of neonatal withdrawal syndrome
very small increased risk of pulmonary hypertension
what are women >35 at increased risks if counselling pre-conceptually
- increased risk of miscarriage
- increased risk chromosomal abnormalities
- increased risk of obstetric complications
what is the recommended inter-pregnancy interval guided by NICE
18-59 months
when is the right time for women to start trying again for a baby following a miscarriage?
no right time, when they feel ready
if a woman is diabetic at what HbA1C level should pregnancy be avoided?
HbA1C level > 10% (86mmol/L)
what should women with diabetes planning a pregnancy aim for their HbA1c to be pre conception
< 48mmol/L (<6.5%)
what should the aims for serum blood glucose monitoring be in those wanting to conceive if diagnosed with diabetes
Fasting blood glucose
RBG (pre-meals)
FBG: 5-7mmol/L
RBG (pre meals): 4-7mmol/L
what are the general principles when advising a woman who has epilepsy and taking AEDs
check if AED is safe in pregnancy
all AED associated with risks - sodium valproate most significant risk
discuss pregnancy with their neurologist
aim for monotherapy of lowest dose
do NOT stop their treatment abruptly
what is the risk of teratogenicity for women taking AED during pregnancy
8%
how long should a woman wait to conceive if they have had had recent treatment with radio-active iodine
6 months
how often should you check TFTs in women who developed post party thyroiditis
annually
what affect can hCG have on TSH levels
hCG can stimulate TSH receptors and cause a decrease in TSH production/secretion
