preconception counseling and care (1) Flashcards
folic acid or folate?
folate
how much does folate 400 mcg before preg to 6-12 wks post reduce neural tube defects?
75%
folate deficient women need how much
4-5 mg 3 months before to 12 wks postconception
folate vitamin #
b9
why folate?
MTHFR deficient
cannot process folic acid
things that may make folate deficient
5a, bcdu
antacids, anti inflam, antibiotic, anitconvulsants, antidiabetic, bc, cholestrol lowering, diuretics, ulcer meds
born w/ tube defects..
facial cleft, structural heart disease, limb dfe, urinary tract anomaly, hydrocephalus
why obese and infertility
insulin resistance and oligomenorrhea (infrequent periods)
how long after bariatric surgery should you wait for preg
12-18 mo
ADEKC, B1, b12, folic acid and iron
low BMI 18.5 associated w
preterm and low birth weight
how far in advance should you make healthy lifestyle changes
3 mo -1 yr
caffeine interferes w/
calcium, d, iron, b vitamins, manganese, zic, copper, magnesium, potassium, sodium, and phosphate
more than ___mg of caffeine may reduce fertility by…
300 mg
27%
MC serious disease to affect preg
diabetes
1%
pregestational diabetes increase risk of
miscarriage, congenital fetal anomalies, and perinatal death
glucose at high level is
teratogenic
which tri is most important in handling glucose
1
organogensis
a1c levels preconception
normal - 7% or lower
chronic hypertension in preg associate w/
preterm birth, placental abruption, intrauterine growth restriction, preeclampsia (25% w/ hyper will develop)
fetal death
can hypertension prepreg make mom at risk for end organ damage during preg?
yes
severe hypertension in preg?
180/110
thyroid preg impacts
hypo (1st tri) cognitive impairment in kids
preterm birth, low birth weight, placental abruption, fetal death
hypothyroid if treated early have no increased risk of perinatal morbidity
true
how much are thyroid dosages increased
30+ by 4-6 wks gestation
what disease almost always get worse w preg
asthma
abnormal flood coagulation that increases risk of thrombosis
thrombophilia
thrombophilia increased risk of
recurrent miscarriage, venous and art clots
preeclampsia
thrombophilia affects baby…
placental infarction, intrauterine growth restriction, placental abruption, fetal stroke, fetal death
what is usually given for thrombophilia?
warfarin…but its teratogenic
mc neuro disease to affect preg
seizer
more frequent seizures during preg?
1/3 of all women
associated w/ seizures?
low birth miscarriage congenital anom developmental disabilites microcephaly hemorrhagic disease
what do they do preconception for seizure disorders
folate increase!!
diabetes med preferred
metformin
what should be avoided for renal issues
ACE inhib, ARBs, and statins
