Preconception Care Flashcards
When is the best time to engage in preventive health discussions for pregnancy?
A. During the first trimester
B. During the “fourth trimester”
C. Before pregnancy is planned
D. After a missed period
C. Before pregnancy is planned
Correct: Preventive discussions before conception allow time for interventions like folic acid supplementation.
Incorrect Options:
A: Preventive discussions are most effective before pregnancy.
B: The “fourth trimester” is for postnatal care, not initial prevention.
D: After a missed period may be too late for critical interventions.
What is pica, and why is it a concern during pregnancy?
A. Craving for high-sugar foods; it increases gestational diabetes risk
B. Consumption of nutritionally void substances; it may replace healthful foods
C. Preference for bland diets; it can lead to iron deficiency
D. A rare genetic condition; it poses no significant risks
B. Consumption of nutritionally void substances; it may replace healthful foods
Correct Answer Explanation:
Pica is the craving and consumption of non-nutritive substances such as dirt, clay, chalk, ice, or even paint chips. These behaviors can lead to nutritional deficiencies, such as iron or zinc deficiency, because the substances consumed may replace healthy foods in the diet. Pica during pregnancy often signals an underlying nutritional imbalance, particularly iron deficiency anemia, which needs to be addressed with appropriate supplementation and dietary adjustments.
Incorrect Options Clarified:
A: Sugar cravings, while common in pregnancy, do not fall under the definition of pica. They are typically related to hormonal changes and energy demands.
C: Pica does not refer to eating bland foods. It involves non-food items with no nutritional value.
D: Pica does pose risks, such as toxic exposure (e.g., lead in paint chips) or digestive blockages, making it a significant health concern during pregnancy.
Which of the following statements is correct regarding exercise during pregnancy?
A. Pregnant women should avoid all forms of exercise.
B. Balance issues and joint relaxation may increase the risk of orthopedic injury.
C. Exercise during pregnancy has been shown to harm fetal development.
D. Exhaustion and overheating during exercise are not concerns for pregnant women.
B. Balance issues and joint relaxation may increase the risk of orthopedic injury.
Correct Answer Explanation:
These issues arise as pregnancy progresses, increasing injury risk. Pregnancy introduces balance issues due to a shifting center of gravity and joint relaxation caused by increased levels of the hormone relaxin. These factors can heighten the risk of falls and orthopedic injuries, especially during high-impact or unstructured exercise. Safe exercises during pregnancy are those that promote strength, flexibility, and endurance without overexertion or excessive joint stress. Examples include:
Low-impact aerobic exercises: Walking, swimming, and stationary cycling.
Prenatal yoga or pilates: Focuses on flexibility and strength while improving balance and reducing stress.
Strength training: Using light weights or resistance bands with controlled movements to avoid strain.
Kegel exercises: Strengthen pelvic floor muscles to support pregnancy and aid postpartum recovery.
Incorrect Options Clarified:
A: Exercise is not inherently dangerous during pregnancy. In fact, it provides numerous benefits, such as improved circulation, reduced back pain, and better mental health. However, activities involving high impact, heavy lifting, or the risk of falls (e.g., skiing, horseback riding) should be avoided.
C: Exercise does not harm fetal development when done safely and with guidance. It improves overall pregnancy outcomes, including reduced risk of gestational diabetes and preeclampsia.
D: Exhaustion and overheating are concerns, but they can be mitigated by avoiding strenuous activities, staying hydrated, and exercising in a cool environment.
What are the risks associated with tobacco and nicotine use during pregnancy?
A. High birth weight and delayed labor
B. Placental abruption, low birth weight, and orofacial clefts
C. Reduced susceptibility to respiratory infections
D. Faster postnatal growth in newborns
B. Placental abruption, low birth weight, and orofacial clefts
Correct: Tobacco and nicotine use increase these risks.
Incorrect Options:
A, C, D: These do not accurately reflect tobacco risks.
Effects of Nicotine Use in Pregnancy
Correct Answer Explanation:
Tobacco and nicotine exposure during pregnancy significantly increase the risks of placental abruption, low birth weight, and orofacial clefts:
Placental abruption: Smoking reduces blood flow to the placenta due to nicotine-induced vasoconstriction, which can result in the placenta detaching prematurely from the uterine wall. This is a life-threatening condition for both the mother and fetus.
Low birth weight: Nicotine and carbon monoxide from cigarettes reduce oxygen availability to the fetus by competing with oxygen for binding sites on hemoglobin. This restricts fetal growth.
Orofacial clefts (e.g., cleft lip and palate): Smoking during pregnancy interferes with embryonic development by exposing the fetus to teratogens, increasing the likelihood of these birth defects.
Incorrect Options Clarified:
A, C, D: Tobacco use during pregnancy is not primarily associated with neural tube defects, congenital heart defects, or gastrointestinal abnormalities. While smoking impacts overall fetal health, these risks are not directly tied to nicotine use.
Why is cannabis use during pregnancy discouraged?
A. It may increase protein levels in the fetus.
B. It has been proven to enhance neurodevelopment.
C. It is associated with low birth weight and impaired fetal neurodevelopment.
D. It has no significant risks if used medicinally for nausea.
C. It is associated with low birth weight and impaired fetal neurodevelopment
Correct: Cannabis poses risks to fetal growth and development.
Effects of Marijuana Use in Pregnancy
Correct Answer Explanation:
Cannabis use during pregnancy is associated with low birth weight and impaired fetal neurodevelopment:
Low birth weight: THC, the active psychoactive compound in cannabis, crosses the placenta, reducing oxygen and nutrient supply to the fetus. This can inhibit normal fetal growth.
Impaired fetal neurodevelopment: THC interacts with the endocannabinoid system, which plays a critical role in brain development. Prenatal exposure to cannabis is linked to cognitive delays, attention deficits, and behavioral problems in childhood.
Additional risks include preterm labor and stillbirth, particularly when cannabis is used in conjunction with tobacco or other substances.
Incorrect Options Clarified:
A, B, D: These do not reflect cannabis-specific risks. For example, cannabis is not strongly linked to structural anomalies or placental issues like abruption but instead affects fetal growth and neurodevelopment.
What is the primary management goal for asthma during pregnancy?
A. Minimizing the use of medications to avoid teratogenic effects
B. Preventing maternal hypoxia to ensure adequate fetal oxygenation
C. Avoiding all asthma triggers without lifestyle modifications
D. Reducing the frequency of prenatal monitoring visits
B. Preventing maternal hypoxia to ensure adequate fetal oxygenation
Correct: This is the primary goal of asthma management in pregnancy.
Asthma Management in Pregnancy
Correct Answer Explanation:
The primary goal of asthma management during pregnancy is preventing maternal hypoxia to ensure adequate fetal oxygenation:
During pregnancy, the fetus is entirely dependent on the mother’s oxygen supply. Poorly managed asthma increases the risk of hypoxia, which can lead to intrauterine growth restriction (IUGR), preterm delivery, and even fetal demise.
Exacerbations of asthma during pregnancy can also increase maternal morbidity, including preeclampsia and the need for emergency care. Proper use of inhalers, medications like bronchodilators, and corticosteroids is critical.
Asthma’s Unique Challenges During Pregnancy:
Physiological changes: Pregnancy causes diaphragmatic elevation, increased oxygen demand, and nasal congestion, which can exacerbate asthma symptoms.
Medication considerations: While some patients may hesitate to use asthma medications during pregnancy, uncontrolled asthma poses far greater risks to both the mother and fetus than the use of appropriately managed inhaled or systemic therapies.
Incorrect Options Clarified:
A: Asthma management does not focus on preventing premature rupture of membranes.
C: Controlling allergic rhinitis is secondary to managing maternal oxygenation.
D: Maternal corticosteroid use is not the primary focus but rather a treatment tool when indicated.
What condition is indicated by an increased craving for and consumption of non-food items like clay or dirt during pregnancy?
A. Protein deficiency
B. Pica
C. Gastrointestinal pathology
D. Acid reflux
B. Pica
Correct: Pica involves cravings for non-food substances.
Incorrect Options:
A, C, D: These are unrelated to the symptoms of pica.
Which of the following strategies is recommended for smoking cessation during pregnancy?
A. Behavioral counseling using the five As framework
B. Using unregulated nicotine replacement products
C. Waiting until after pregnancy to quit
D. Limiting cigarette use to one per day
A. Behavioral counseling using The Five As Framework for Smoking Cessation
The Five As framework is a structured approach recommended for smoking cessation in healthcare settings:
Ask: Identify tobacco use by directly inquiring about smoking habits at every visit.
Example: “Do you currently smoke or use any form of tobacco?”
Advise: Provide clear, personalized advice to quit, emphasizing the benefits of cessation for both mother and fetus.
Example: “Quitting smoking now will improve your baby’s growth and development.”
Assess: Determine the patient’s willingness to quit.
Example: “On a scale from 1 to 10, how ready do you feel to quit smoking?”
Assist: Help the patient develop a quit plan, offer resources (e.g., counseling, nicotine replacement therapy when appropriate), and address barriers.
Example: Offer referral to a smoking cessation program or suggest coping strategies for cravings.
Arrange: Schedule follow-ups to provide ongoing support and monitor progress.
Example: “Let’s check in at your next visit to see how things are going.”
Incorrect Options Clarified:
B, C, D: Strategies like punitive measures, non-personalized advice, or generic educational materials are not as effective as the personalized, evidence-based Five As approach.
What are the potential effects of alcohol use during pregnancy?
A. Fetal growth acceleration and fewer birth complications
B. Reduced risk of neurodevelopmental disorders
C. Increased risk of Fetal Alcohol Spectrum Disorders and miscarriage
D. Improved maternal mental health and pregnancy outcomes
C. Increased risk of Fetal Alcohol Spectrum Disorders and miscarriage
Correct Answer Explanation:
Alcohol consumption during pregnancy is associated with the following major risks:
Fetal Alcohol Spectrum Disorders (FASDs):
FASDs include a range of physical, behavioral, and neurodevelopmental impairments caused by prenatal alcohol exposure.
Characteristic features: growth restriction, facial anomalies (e.g., smooth philtrum, thin upper lip), and cognitive or behavioral deficits (e.g., ADHD, learning disabilities).
Alcohol disrupts fetal brain development, particularly during the first trimester when critical structures form.
Miscarriage and stillbirth:
Alcohol increases the risk of miscarriage, particularly with heavy or binge drinking.
It disrupts placental function and may cause fetal hypoxia or abnormal cellular development, leading to pregnancy loss.
Preterm birth and low birth weight: Alcohol can impair placental function, leading to restricted fetal growth.
Incorrect Options Clarified:
A, B, D: While alcohol use can affect overall fetal health, these options do not specifically address the risks of FASDs, miscarriage, or stillbirth.
What is the role of preconception counseling for women with diabetes?
A. To delay conception until after the age of 35
B. To reduce maternal and fetal risks by maintaining preconceptional hemoglobin A1c levels below 7%
C. To encourage the use of angiotensin-converting enzyme inhibitors during pregnancy
D. To avoid addressing end-organ damage during pregnancy
To reduce maternal and fetal risks by maintaining preconceptional hemoglobin A1c levels below 7%
Correct Answer Explanation:
Maintaining preconceptional hemoglobin A1c levels below 7% is critical for reducing maternal and fetal risks associated with diabetes:
Congenital anomalies: Elevated HbA1c (>7%) during the first trimester increases the risk of neural tube defects, congenital heart defects, and other malformations. These risks are directly related to poor glycemic control in early pregnancy.
Preterm birth and macrosomia: High HbA1c levels increase the likelihood of fetal overgrowth (macrosomia), which complicates delivery and may lead to birth injuries or necessitate a cesarean section.
Preeclampsia: Poor glycemic control contributes to hypertension and increases the risk of preeclampsia.
Stillbirth: Persistent hyperglycemia can impair placental function, leading to fetal hypoxia and stillbirth.
Additional Goals of Preconception Counseling in Diabetes:
Optimize blood glucose control with lifestyle interventions and medications.
Identify and address complications like retinopathy, nephropathy, and cardiovascular issues that may worsen during pregnancy.
Incorrect Options Clarified:
A, C, D: The primary focus of preconception counseling is glycemic control to minimize maternal and fetal complications. These options do not adequately reflect this goal.
Which of the following infections is an asthmatic pregnant individual at higher risk for, requiring preventive measures during pregnancy?
a) Influenza
b) Respiratory syncytial virus (RSV)
c) COVID-19
d) All of the above
D) All of the above
1. Influenza
Increased Risk:
Pregnancy and asthma both independently increase the likelihood of complications from the flu, including pneumonia, bronchitis, and exacerbations of asthma symptoms.
Influenza can lead to hospitalization, preterm labor, and fetal complications such as restricted growth or stillbirth if untreated.
Preventive Measures:
Annual influenza vaccination (inactivated form) is strongly recommended for all pregnant individuals, especially those with asthma.
Hand hygiene, avoiding sick contacts, and prompt treatment with antivirals if infected (e.g., oseltamivir) are essential.
2. Respiratory Syncytial Virus (RSV)
Increased Risk:
RSV, a common cause of respiratory illness, can result in bronchiolitis and pneumonia in high-risk populations, including asthmatic pregnant individuals.
Asthma exacerbations triggered by RSV can cause decreased oxygen delivery to both the mother and fetus, increasing the risk of hypoxia and fetal distress.
Preventive Measures:
In 2023, the FDA approved an RSV vaccine for use in late pregnancy to protect both the mother and newborn during the vulnerable postpartum period.
General precautions include avoiding exposure to crowded or high-risk areas during RSV season.
3. COVID-19
Increased Risk:
Asthma increases susceptibility to severe respiratory complications from COVID-19, such as pneumonia and acute respiratory distress syndrome (ARDS).
Pregnancy further amplifies risks, including preterm delivery, severe illness, and potential effects on fetal growth and neurodevelopment.
Preventive Measures:
The COVID-19 vaccine and boosters are recommended for pregnant individuals to reduce the risk of severe illness.
Wearing masks in crowded places, practicing hand hygiene, and ensuring good asthma control minimize infection risk.
Why Preventive Care is Vital
Respiratory infections worsen asthma by increasing airway inflammation, bronchospasm, and mucus production, leading to acute exacerbations.
Poorly controlled asthma increases the risk of maternal hypoxia, which can result in fetal hypoxia, growth restriction, and preterm birth.
Conclusion
Correct Answer: d) All of the above
Pregnant individuals with asthma should be vaccinated against influenza and COVID-19 and may benefit from the new RSV vaccine. In addition to vaccination, good asthma management, infection prevention, and early treatment of symptoms are essential to mitigate risks.
More info on why:
- Changes in the Immune System
Shift to a T-helper 2 (Th2)-dominant immune response:
During pregnancy, the immune system adjusts to protect the fetus, which is considered semi-allogenic (partially foreign). This results in a reduced Th1-cell-mediated immune response, which is essential for fighting off viruses like influenza.
Weakened antiviral response: Pregnant individuals may have a less robust ability to clear viral infections, making them more susceptible to complications.
Increased susceptibility to secondary infections: A weakened immune response can lead to bacterial superinfections, such as pneumonia. - Cardiopulmonary Changes
Increased oxygen demand:
The growing fetus requires more oxygen, leading to elevated maternal respiratory rates and changes in lung mechanics. This increased demand makes the respiratory system more vulnerable to stress caused by influenza.
Reduced lung capacity:
As the uterus enlarges, it compresses the diaphragm, reducing lung expansion. This can exacerbate respiratory symptoms and make conditions like pneumonia more dangerous. - Increased Inflammatory Response
Heightened inflammatory state:
While the immune system shifts to protect the fetus, there is an increase in systemic inflammation during pregnancy. When infected with the flu, this exaggerated inflammatory response can lead to more severe symptoms and complications like acute respiratory distress syndrome (ARDS). - Risk of Complications
Severe respiratory symptoms:
Influenza can lead to worsening of asthma or other underlying respiratory conditions, causing severe breathing difficulties.
Maternal hypoxia:
Reduced oxygen levels in the mother can compromise oxygen delivery to the fetus, increasing the risk of fetal hypoxia, growth restriction, and preterm labor.
Increased hospitalizations:
Pregnant individuals with the flu are more likely to require hospitalization and intensive care than non-pregnant individuals of the same age. - Impact on the Fetus
Influenza infection in pregnancy has been associated with:
Fetal growth restriction
Preterm birth
Stillbirth
Neurodevelopmental issues later in childhood, potentially linked to maternal fever during critical periods of development.
Preventive Measures
Annual Influenza Vaccination:
Safe and recommended during any trimester of pregnancy, it protects both the mother and baby (by passive antibody transfer).
Early Antiviral Treatment:
Medications like oseltamivir (Tamiflu) can reduce the severity and duration of illness if started promptly.
Which of the following medications is recommended for managing gastroesophageal reflux (GERD), a common asthma trigger during pregnancy?
a) Proton pump inhibitors (PPIs)
b) Beta-blockers
c) Opioids
d) Nonsteroidal anti-inflammatory drugs (NSAIDs
Correct Answer: a) Proton pump inhibitors (PPIs)
Explanation: GERD is a common issue in pregnancy that can exacerbate asthma. PPIs, such as omeprazole, are considered safe and effective during pregnancy.
What is the primary goal of stepwise asthma treatment during pregnancy?
a) Minimizing medication use
b) Maximizing fetal exposure to oxygen
c) Reducing maternal weight gain
d) Avoiding all inhaled corticosteroids
Correct Answer: b) Maximizing fetal exposure to oxygen
Explanation: Asthma management during pregnancy prioritizes optimal oxygenation for both the mother and fetus. Inhaled corticosteroids are commonly used when needed to achieve this.
