Preconception & Pregnancy Counseling

Question 1

What are the core interventions of a preconception visit

Answer 1

• folic acid
• glycemic control/DM screening
• abstinence from alc & drugs
• nicotine & THC cessation
• vaccines up to date/plan to complete
• healthy BMI
• avoidance of teratogens
• behavioral changes (nutrition, exposures)

Question 2

What exams & labs should be completed on a preconception visit

Answer 2

Exam
- BP & BMI
- Thyroid, mouth, heart, lungs, breasts, abdomen, pelvic

Labs
- HIV & STIs
- Rubella & Varicella immunity

Question 3

When should folic acid be started & what is it helpful for in fetal development

Answer 3

Should be started immediately (at least prior to 8 weeks)
- reduces risk of neural tube defects & promotes neural tube closure at 25 days gestation

Question 4

What is the acceptable threshold for alcohol consumption in pregnancy

Answer 4

NONE - any consumption can result in harmful effects & fetal alcohol syndrome/spectrum disorders

Question 5

What are some harmful effects of smoking & secondhand smoke on pregnancies and babies

Answer 5

Pregnancy: difficulty conceiving, tissue damage (lung, brain, cleft lip), miscarriage

Baby: early, low birth weight, SIDS, weaker lungs

Question 6

How long does it take for toxins to clear from a male who was previously taking cytotoxic/mutagenic substances

Answer 6

6 months (two sperm cycles)

Question 7

Describe the medication risk classifications

Answer 7

A: no risk in human studies
B: no risk in animal studies
C: risk can’t be ruled out
D: evidence of risk
X: contraindicated

Question 8

List the W/TERATO-genic mnemonic

Answer 8

W: warfarin
T: Thalidomide
E: epileptic drugs (valproic acid, phenytoin, carbamazepine)
R: retinoids
A: ACEi (lisinopril)
T: third element Li
O: OCPs & other hormones

Question 9

What are some of the risks of late pregnancy (age)

Answer 9

• amniotic fluid embolism, obstetric shock, renal failure, ICU admit, hemorrhage, thrombosis, preeclampsia, gestational DM
• fetal aneuploidy, miscarriage, stillbirth

Question 10

List the 3 goals of preconception care

Answer 10

• ID potential risks to mom/baby
• educate & mitigate risks
• initiate interventions

Question 11

Approximately how many pregnancies in the US are unintended & at what milestone do people typically begin prenatal care

Answer 11

• 50% unintended
• prenatal care starting in 2nd trimester