Preconceptional Care Flashcards
when should preconceptional phase be considered?
at 26 weeks or 5-6 months before conception
when does the most active phase of of ovarian follicular development commence?
around 14 weeks preconception
this is called the preconceptional period
“a set of
interventions that aim to identify and modify biomedical,
behavioral, and social risks to a woman’s health or
pregnancy outcome through prevention and
management.
preconceptional care
ultimate aim of preconceptional care?
improve maternal and child health in both long term and short term
best time for pre pregnancy counseling
the time a reproductive aged patient is currently using contraception or planning pregnancy
Accdg to ACOG when should women be counseled to seek medical care for preconception?
before attempting to become pregnanct or as soon as they believe they are pregnant
purpose is to establish correct gestational age and to monitor medical conditions
What age group when pregnant is most prone to iron deficiency?
adolescents
Maternal undernutrition is prevalent among what age group?
Vey young and advanced age
Most common type of maternal undernutrition in the philippines
iron deficiency anemia
Preconceptional care only involves the women related to preconceptional health? t or f
False
men and women
fundamental aspect of pre pregnancy counselling
Family planning
Using this drug is recommended to prevent pre eclampsia, recurrent pregnancy loss and unexplained fetal death from recurring
Low Dose Aspirin
Medications used during pregnancy should be?
of the lowest effective dose of the safest medication
most thorough method for obtaining family history as part of genetic screening?
Pedigree method with symbols
those with genetic disease should be referred to a?
geneticist
for counseling
this is available to determine a
patient’s carrier status for some autosomal
recessive conditions
genetic testing
most common fetal structural fetal malformation
cardiac anomalies (TOF etc)
second most common fetal structural malformation?
Neural tube defects
seen in diabetic patients
Neural tube defect is associate with what gene mutation?
667T substitution in the gene that encodes methylene tetrahydrofolate reductase
What can be done to prevent neural tube defects?
Preconceptional folic acid therapy
is an example of a disease in which
the fetus is not at risk to inherit the disorder, but
may be damaged by maternal disease
Phenylketonuria
recommendation for patients with phenyketonuria?
Phenylalanine levels to be normalized 3 months before pregnancy and maintained throughout the pregnancy
complications of PKU?
Spontaneous abortion mental retardation microcephaly congenital heart disease fetal growth restriction
most common single gene disorder worldwide
Thalassemia
globin chain synthesis disorder
can cause bleeding and anemia to the mother
Ashkenazi Jewish communities are at risk of?
autosomal recessive diseases (tay sachs, canavan, cystic fibrosis, fanconi anemia, NPD type A, mucolipidosis, Bloom syndrome, gaucher type 1)
what kind of vaccine are not recommended during pregnancy?
Live vaccines
which vaccine should be offered to all women at high risk?
Hepatitis B
women with unknown Tdap vaccination should receive how many doses?
single dose
Tdap vaccine should be given to all women during when regardless of prepregnancy immunization history?
27-36 weeks
which vaccine can give protective cocooning to the infant
Tdap
gives atleast 1-2 months of passive immunity
We can give HPV vaccine during pregnancy? t or f?
false
when should we give rubella and varicella vaccination pre pregnancy?
at least 28 days before pregnancy or after delivery if not previously given
if a women receive a live attenuated vaccine, how many months should she delay pregnancy?
1 months
when should a women planning to get pregnant start getting vaccinated?
before getting pregnant
for vaccines that need 2 doses, how many months should we advice to delay the pregnancy?
2 months
Screening for gonorrhea, chlamydial infection,
syphilis, and HIV should be done based on
patient’s risk factor
What virus can cause microencephaly?
Zika Virus
what should be the goal of a woman with HIV before getting pregnant?
goal of a suppressed plasma viral load
to an undetectable level before achieving
getting pregnant.
What is the safest way to get pregnant without transmission of the virus to the partner who is HIV-negative
artificial insemination
This may be beneficial in reducing risk of transmission to HIV uninfected partners?
Pre-pregnancy PrEP with anti retrovirals
what complications can smoking cause in a pregnant women and her child?
mother- miscarriage
child - bronchial asthma, child obesity, infantile colic
What is the safe level of alcohol use during pregnancy?
there is no safe level of alcohol use during pregnancy
What is the most sever result of of drinking during pregnancy and are
associated with central nervous system (CNS)
abnormalities, growth defects, and facial
dysmorphism
Fetal alcohol spectrum disorder
What ages of gestation can be affected by alcohol drinking?
All ages of gestation
alcohol related birth defects include?
growth deformities, facial abnormalities CNS
impairment, behavioral disorders impaired
intellectual development.
includes a range of behavior that
a partner may use related to sexual decisionmaking to pressure another person to
have sexual intercourse without using physical
force such as sabotage of contraceptive methods,
pregnancy coercion, and pregnancy pressure
Sexual coercion
during pregnancy, RDA for vitamins are met except?
folic acid an iron
during pregnancy RDA for minerals are met except?
iodine and iron
those with malabsorptive GI diseases, bariatric surgery and those on vegan diet benefit from?
Multivitamin supplementation
For women of low- risk, supplementation with __ of folic acid is adequate
400mcg/ day
Patients at increased risk for NTDs, including
women with a prior pregnancy with an NTD or
women with seizure disorders, should be advised
to take
4mg folic acid per day
Women of reproductive age are at risk for iron
deficiency with or without anemia because of the
menstrual losses
Apart from weakness, easy fatigability, difficulty of
breathing with severe cases of iron deficiency
anemia, patients in the reproductive age who are
iron-deficient may suffer from
poor cognition and
concentration
WHO recommends receiving iron ____ for menstruating
adult women and adolescents esp those who are
living in settings where anemia is prevalent
30-60 mg of elemental iron per day, 5 days a
week
Poor folate status during pregnancy is associated with?
- abruptio placentae
- pre-eclampsia
- spontaneous abortion
- congenital heart defects
- preterm delivery, stillbirth
- low birth weight
Effects of Maternal Anemia During Pregnancy:
- Preeclampsia
- Postpartum hemorrhage
- Low birth weight
- Preterm birth1
During pregnancy, supplementation of at least _____ is recommended to achieve
the RDA
27 mg of elemental iron
What is recommended by WHO for post partum women for reducing the risk of
anemia in settings anemia is of public health
concern applicable to all postpartum women,
regardless if they are breastfeeding or not.
oral iron supplementation,
either alone or in combination with folic acid for 6-12 weeks after delivery
abnormal, high or low BMI is associated with
infertility and maternal
and fetal pregnancy complications
Weights should be optimized
before a
woman attempts to becoming pregnant
ACOG recommends that patients should perform
moderate exercises, at least
30 minutes a day, 5
days a week, for a minimum of 150 minutes
examples of ubiquitous endocrine disrupting chemicals
Parabens, phthalates, BPA’s
Man-made chemicals that can alter hormonal
responses to physiologic processes such as
reproduction and immune system. They have the capability to mimic, block or interfere
with our own hormones, hence, altering the normal
physiological processes.
ENDOCRINE DISRUPTING CHEMICALS (EDC’s
Everyday endocrine disruptors
Cookware (tefal)
- Scented candles/fragrances
- Cosmetics
- Cleaning supplies
- Plastic water bottles
- Hair spray/shampoo
this may y directly damage spermatozoa,
alter Sertoli cell or Leydig cell function or disrupt
the endocrine function in any stage of hormonal
regulation.
pesticides
exposure to this has been shown to
affect sperm motility
Heavy metals
it affects the
ovary by reducing ovarian weight, follicle growth
and oocyte viability and /or increasing atresia
Organophosphates
also show reduced
fertility and increased fetal loss in women
pesticides
associated with decreased
mature oocytes and oocyte yield following
ovarian stimulation
heavy metals
causes women to have lower antral
follicle counts, shortened menstrual cycles,
decreased estradiol
parabens
tissues most affected by high phenylalanine levels
cardiac and neural tissues
