Preconception Care Flashcards
“New” Focus
Primary care - preparation of the best pregnancy outcome
Risk assessment
Health Promotion
Optimize management of any preexisting medical conditions
- BP control in HTN
- BG control in DM
- Remission or control in eating disorders
- Compliance to gluten free diet in celiac
- Compliance to low phenylalanine in PKU
DGA (2010)
- <5000 IUD’s Vit A - excess can cause birth defects
- Consume Heme iron - ideally with Vit C rich foods
- Consume synthetic folic acid
- > 400 mcg/day
- Supplements or fortified foods
- All women of childbearing potential should consume synthetic folic acid to minimize risk of neural tube defects
Fe Status
Indonesia
- 50% incidence of Fe deficiency anemia during pregnancy
- Couples planning marriage are counceled on Fe supplementation
- 30-60 mg/day, incidence of Fe deficiency as dropped by almost half
Multivitamin
decreases risk of preterm delivery from 12-5%
Decreases risk of preeclampsia (high BP) during pregnancy
Interventions
High risk pregnancy groups
Immunization
Nutrition counseling
Supplementation
Oral contraceptives
Increased risk for thromboembolism
Increased risk of cervical cancer
Nutrition related side effects
- Increase TG 30% and chol 6%
- Decrease B12 levels 33%
- Increase Cu
- <1/2 oz licorice/day to avoid BP and fluid retention
Contraceptive Injections
- Irregular Periods
- Fatigue
- Abdominal pain
- Nutrition Side effects
- weight gain (12 lbs in first year)
- Lower bone density
- low HDL, high LDL
- Increase insulin
Contraceptive Implants
- Erratic vaginal bleeding
- weight gain - 9 lbs in first year
- headaches
- Acne
- Ovarian cysts
Contraceptive Patches
- Chol and TG
- Thromboembolism risk
- Less effective when >198 lbs
- Breast soreness
- Headaches
- Abdominal Pain
PMS
Life-disrupting physiologic and psych changes prior to menses
Cause unknown
Nutrition
- Ca - 1200 mg/day
- B6 - 50-100 mg/day (UL = 100mg)
- Chaseberry Extract - 20 mg/day
- Decrease caffeine
- Increase Mg and Vit D
Infertility
Lack of conception after one year of unprotected intercourse
40% conceive within 3 years (without technology)
~15% of all couples in western world are involuntarily childless
~18% of all couples are sub-fertile (multiple miscarriages, sperm abnormalities, ovulation abnormalities) - but can **conceive with intervention **
Fertility BMI
lower in women with BMI <20 or >30
Lower in men with BMI >35
Body Fat
impaired fertility if waist >35 inches
Obese Men
- Decreases
- Testosterone
- Sex hormone binding globulin
- Sperm count and motility
- Increases
- Estrogen
- Leptin
- FSH oxidative stress, inflammation
- Malformed sperm
Obese Women
- Increase
- Estrogen
- Testosterone
- Leptin
- Decrease
- Sex hormone binding globulin
- Oxidative Stress
- Inflammation
