Pre Pregnancy Counciling

Question 0

Folate supplements

Answer 0

• 0.4mg daily > 1 month pre-conception till 13 weeks after
• 5mg/day if past NTD, antiepileptics, BMI > 30, diabetic, sickle cell, HIV
• Foods with folic acid: brussel sprouts, asparagus, spinach, black eyed beans, fortified cereals

Question 1

Advise pre-conception

Answer 1

• Check rubella immune
• Assess need for thromboprophylaxis (if hx/fhx screen for thrombophilia)
• Optimal control of chronic disease eg diabetes, hypothyroidism
• Stop teratogens
• Folate supplements
• Arrange genetic counselling if appropriate
• In relevant ethnicities check for thalassaemia and sickle cell
• Avoid infection eg sperm washing if HIV positive
• Diet - avoid liver, vit A, caffeine
• Smoking
• Alcohol

Question 2

Smoking in pregnancy

Answer 2

Smoking:

• Decreases ovulation
• Abnormal sperm production
• Increase miscarriage (x2)
• Pre-term labour
• Smaller babies
• Placenta praevia
• Placental abruption

Reduced reading ability in the smokers children up to 11yrs.

17% of smoking mother stop before or in pregnancy.

Question 3

Alcohol in pregnancy

Answer 3

High levels can cause fetal alcohol syndrome:

• microcephaly
• short palpebral fissure
• hypo-plastic upper lip
• absent philtrum
• small eyes
• lower IQ
• cardiac malformations

1-2u/wk has no adverse effects but can cross placenta and effect fetal brain.

Higher miscarriage rates.

Binge drinking (more than 5u) is especially harmful.

Question 4

Spontaneous miscarriage

Answer 4

8. 9% in 20-40yrs
9. 7% in 45+yrs

After 3 miscarriages risk of next pregnancy failure is 44% for nullips and 35% for multips.

Recurrent spontaneous miscarriage if loss of 3+ consecutive pregnancies < 24wks. Effects 1% of women.