Pre-Pregnancy Counselling

Question 1

How can you maximise pregnancy changes and ovulation?

Answer 1

• ovulation approx 14 days (or 14d before the onset of menstruation if cycle isn’t 28 days)
  
  • ovulation urine stick
  • increased temperature
  • thin clear cervical mucus
• after ovulation approximately 48 hrs to fertilise the egg.
• ideal time of intercourse is 1-2days before ovulation.
  
  • every 1-2days from day 10-20 of the cycle.

Question 2

What are some things you can do to optimise health of women before pregnancy?

Answer 2

• folic acid (3 mths before)
  
  • DM
  • NT defects
  • epileptics on carbamazepine
  • multiple pregnancies
• Iodine, Fe, Vit D and calcium (consider it)
• aspirin (PE, IUGR)
• vaccines (immunity)
  
  • Flu
  • VZV
  • Rubella
  • Hep B
  • (DTPa)
• Genetics
  
  • thalassemia
  • CF/FX/SMA
  • Tay Sachs (in Ashkenazi Jews)
• Cease unsafe meds:
  
  • ACEI/ARB - renal defects (oligohydramnios)
  • NSAIDs
  • Anti-thyroid (PTU less teratogenic than carbimazole) - switch back at 20weeks
  • statins - malformations/limb defects
  • propranolol
  • ?metformin? - potentially - no LT data

Question 3

Counsel someone who is diabetic about getting pregnant?

Answer 3

• correct existing problems prior to pregnancy
  
  • diagnose autoimmune diseases
  • optimise diabetes control
    
    • HbA1c
    • detect other complications
    • review meds (insulin safe, metformin possibly safe, unsafe (sulphonylurea, glitazone, ACEI/AT2B, statins)
• folate supplementation
• smoking cessation
• weight loss

Question 4

What are some complications of diabetes during pregnany?

Answer 4

• pre-eclampsia
• polyhydramnios (PPROM)
• miscarriage
• increased operative delivery
• infection
• PPH

Pregnancy also worsens DM

• retinopathy
• nephropathy
• autonomic neuropathy (will exacerbate)
  
  • gastroparesis
  • orthostatic hypotension
  • hypoglycemic awareness