Pre-pregnancy counselling and care

Question 1

Who can give pre-pregnancy counselling?

Answer 1

Any healthcare professional in contact with a women of child baring age
Most commonly – GPs, Nurses, family planning staff, specialists looking after existing medical problems

Question 2

When should you give pre-pregnancy counselling?

Answer 2

Whenever a women of child baring age - is diagnosed with a new condition or is started on medication which could have a harmful effect on the fetus
50% of pregnancies in the UK are unplanned so be opportunistic

Question 3

Who needs pre-pregnancy counselling?

Answer 3

Any women of child baring age

Particularly women undergoing a procedure or treatment which might effect their fertility

Question 4

How important is pre-pregnancy counselling to maternal outcomes?

Answer 4

> 50% of maternal deaths in the UK are due to pre-existing medicial problems
Particularly important in older mothers, obesity, chronic medical conditions, those who lack access to healthcare

Question 5

Aims of pre-pregnancy counselling?

Answer 5

Optimise maternal health before starting a pregnancy - recognise issues, amend lifestyles + address any social issues
Reduce maternal and perinatal mortality

Question 6

Lifestyle changes to consider pre-pregnancy (6)

Answer 6

Folic acid supplementation
Quit smoking, stop drinking and other drugs
Lose weight, improve diet and exercise, lower BP
Sexual health and cervical smears, check Vit D
Rubella vaccination
Check for domestic violence

Question 7

Other issues to consider before getting pregnant (6)

Answer 7

Control of chronic conditions + medications
Impact of disease on pregnancy and visa versa
any fertility issues, antenatal care, possible complications
Risks of miscarriage, preterm birth and stillbirth
Plan for delivery, breast feeding and post natal care
Subsequent pregnancies and contraception

Question 8

Challenges for the women when getting pregnant (4)

Answer 8

Lack of prep - 50% unplanned
Lack of access to care - young, migrants, non-english speakers
Socio-economic issues - poor health and nutrition
Ethnic issues

Question 9

Difficulties for the clinician when giving pre-pregnancy advice

Answer 9

Constraints of time and funding
Difficult to influence behaviour
May have to influence other people than the mother

Question 10

Ethnic differences in pregnancy outcomes and health

Answer 10

Consangunity & genetic issues (Ashkenazim)
different SGA rates and length of gestation
Higher rates of obstructed labour and GDM