Preconception care Flashcards
In the preconception consult, what medical issues could be discussed or explored?
Take a medical, psych, reproductive and genetic history.
Optimise current medical conditions.
Avoid teratogenic medications.
General physical assessment
- BP
- BMI check
- CST (if due)
Vaccinations
- Hep B if not immune
- MMR if not immune
- Varicella (in those without clear history of chicken pox or non-immune on testing)
- dTpa - second trimester - protect newborn from pertussis
- influenza vaccine
Screening bloods / urine
- blood group and antibodies
- blood count / eLFTs
- iron studies
- HIV, Hep B/C, syphilis serology
- urine PCR for chlamydia +/- gonococcal
What should you do for a woman who is not immune to rubella prior to pregnancy?
Give MMR vaccine
This is a live vaccine so avoid becoming pregnant within 28 days of the vaccine.
What lifestyle issues can be discussed in preconception care?
Regular moderate intensity exercise
Avoid over / under weight
Diet history to assess risk of nutritional deficiencies
Avoidance drugs, EtOH and smoking
Iodine supplement of 150 μg each day
Folic acid 0.4 - 0.5mg per day, one month prior to pregnancy and during pregnancy
- women with increased risk of NTD - 5mg per day
Healthy environments - avoid exposure to potential toxins
Who is at high risk of NTDs?
On anticonvulsants Pre-pregnancy diabetes Personal or family history of NTD 5-methyltetrahydrofolate deficiency BMI >30 kg/m2 Risk of malabsorption
What are some strategies to avoid contracting toxoplasmosis during pregnancy?
Avoid cat litter, garden soil, raw/undercooked meat and unpasteurised milk products; wash all fruit and vegetables
What are some strategies to avoid contracting listeria during pregnancy?
Avoid paté, soft cheeses, prepackaged salads, deli meats and chilled/ smoked seafood. Wash all fruit and vegetables before eating
Any issues with fish during pregnancy?
Avoid high mercury fish
Eat fresh
Cook well
Strategies to avoid exposure to CMV during pregnancy?
Regular hand-washing
