pre-conceptual counselling

Question 1

for women that are obese >30kg/m2 what would the advice be re weight loss

Answer 1

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

Question 2

can you name some of the increased risks that an obese patient who is pregnant is at risk of

Answer 2

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

Question 3

which women are considered high risk and in need of 5mg folic acid

Answer 3

• 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

Question 4

how long should patients take folic acid for

Answer 4

pre-conception (1 month prior) up until 12 weeks
unless they suffer from sickle cell anaemia or thalassaemia then they should continue throughout pregnancy

Question 5

what is the dose of folic acid for high risk women

Answer 5

5mg od folic acid

Question 6

what is the usual dose of folic acid for women considered low risk for NTD

Answer 6

400mcg OD folic acid

Question 7

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

Answer 7

males - wait 3 months before conceiving
females - wait 2 months

zika is a single stranded RNA virus

Question 8

what vaccines should you consider prior to pregnancy

Answer 8

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)

Question 9

how long after having a live attenuated vaccine should you wait to start trying for a baby

Answer 9

4 weeks

Question 10

what is the name of questionnaire that should be used to measure women suffering from depression in pregnancy/pre-conceputally

Answer 10

Edinburgh postnatal depression scale (EDDS)

Question 11

what should the general advice be to women on SSRIs during pregnancy

Answer 11

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

Question 12

which SSRI is considered the ‘best’ option in pregnancy

Answer 12

sertraline

Question 13

what are the main risks associated with SSRIS in pregnancy

Answer 13

small increase risk of PPH at delivery
increased risk of neonatal withdrawal syndrome
very small increased risk of pulmonary hypertension

Question 14

what are women >35 at increased risks if counselling pre-conceptually

Answer 14

1. increased risk of miscarriage
2. increased risk chromosomal abnormalities
3. increased risk of obstetric complications

Question 15

what is the recommended inter-pregnancy interval guided by NICE

Answer 15

18-59 months

Question 16

when is the right time for women to start trying again for a baby following a miscarriage?

Answer 16

no right time, when they feel ready

Question 17

if a woman is diabetic at what HbA1C level should pregnancy be avoided?

Answer 17

HbA1C level > 10% (86mmol/L)

Question 18

what should women with diabetes planning a pregnancy aim for their HbA1c to be pre conception

Answer 18

< 48mmol/L (<6.5%)

Question 19

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)

Answer 19

FBG: 5-7mmol/L
RBG (pre meals): 4-7mmol/L

Question 20

what are the general principles when advising a woman who has epilepsy and taking AEDs

Answer 20

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

Question 21

what is the risk of teratogenicity for women taking AED during pregnancy

Answer 21

8%

Question 22

how long should a woman wait to conceive if they have had had recent treatment with radio-active iodine

Answer 22

6 months

Question 23

how often should you check TFTs in women who developed post party thyroiditis

Answer 23

annually

Question 24

what affect can hCG have on TSH levels

Answer 24

hCG can stimulate TSH receptors and cause a decrease in TSH production/secretion

Question 25

what condition are women with chronic hypertension (pre pregnancy) at increased risks of developing?

how can they reduce this risk

Answer 25

increased risk of developing PET

should take aspirin 75-150mg OD from 12/40