Pre-pregnancy Counselling Flashcards
Main points of pre-pregnancy councelling
Rubella immune Stop smoking Weight loss Exercise Folic acid supplementation Vitamin D supplementation Reduced alcohol consumption Pre-Existing medical disorders Medication review Genetic counselling Spontaneous miscarriage risk
Stop smoking
Smoking reduces ovulation and Fallopian tube function
Causes abnormal sperm production (less penetrating capacity)
Increased rates of miscarriage
Associated with preterm labour and fetal growth restriction, placenta praaevia and abruption
Encourage stopping/reduction
Weight loss
For both partners increases conception rate and reduces risk
BMI18.5-30
Exercise
Improves fitness and self-esteem
Avoid contact sports
Folic acid supplementation? Dose? Diet?
To prevent neural tube defects and cleft lip
Daily >1month pre-conception til 13 weeks
Avoid liver and vitamin A (teratogenic) and limit caffiene
Cook meat and eggs thoroughly
Avoid soft cheese, shellfish and raw fish
All women should take 0.4mg pre-conception to 12th week
Women at higher risk should take 5mg :
- Obesity (BMI>30)
- Partner has NTD, previous pregnancy NTD, FHx NTD
Woman is taking AED or has Coeliac’s, DM, thalassaemia
Vitamin D supplementation
In at-risk ethnic groups, obese and those with chronic medical disease and reduced mobility
Alcohol
High level of consumption causes fetal alcohol syndrome
Minimal drinking
Miscarriage rates are higher
<1u/day
Recreational drug use
Associated with miscarriage, preterm birth, poor development, intrauterine death
Pre-existing medical disorders
May worsen during pregnancy or be worsened by pregnancy
If sever disease, conception may be discouraged
Medication review
AEDs, ACEi, immune modulators
Seek expert help and use lowers effective dose
OTC/homeopathic/herbal
Genetic counselling
If relevant or FHx
Spontaneous miscarriage
Risk 15-20% of all pregnancies
Rising at extremes of age
