Pregnancy Flashcards
Discuss the effect of maternal pre-pregnancy weight
Its a modifiable risk factor (exercise will dec = preeclampsia, GDM, maternal weight gain, improve birth weight, inc chance of normal delivery
BMI-dependent relationship exists between pre-preg obesity and adverse preg outcome
What vitamins should women take preconception? Why?
Folic acid = prevent neural tube defects, prevent intrauterine growth retardation
Iodine = thyroid activity increases
Multiple micronutrients = possibly reduce congenital abnormalities, pre-eclampsia
Iron supplements = protective against low birth weight (low/middle income countries)
When would folic acid be used in pre-/pregnancy?
Around conception, >/= 2 months before conception, 1st 3 months of preg
Dose = >500 mcg/daily
Use later in preg = inc allergy risk
When is high dose (5mg/daily) folic acid recommended?
> 35yrs old
Hx neural tube defects (self or fam)
taking meds for epilepsy or seizures
type 1 diabetes
When and how much iodine should be taken during preg?
take 150mcg during preg, BF, pre-conception
What are considerations for iron supplementation in preg?
Indicated for those who are anaemic, intermittently
Prevent iron deficiency anaemia, foetal demand inc at 12 wks
Constipation is common ADR
Discuss the use of niacin (vit B3) in preconception care
Require for nicotinamide adenine dinucleotide (NAD) = reduce miscarriages and birth defects
Women tend to have lower levels in 1st trimester
What other supplements can be used in pre-conception?
Calcium = decrease pre-eclampsia risk, dont prevent pre-term or low infant birth weight
Magnesium = insufficient evidence to determine benefit/efficacy
Zinc = benefit in reduce perinatal mortality
Outline the stages of pregnancy
Pre-embryonic stage = 1st 17 days post conception
Embryonic stage = 18-56 days post conception (many things can go wrong)
Foetal stage = wks 8-38
What are the critical periods in pregnancy where drugs can effect the foetus?
First 2 weeks = rapid cell proliferation –> drugs exposure can be lethal
Weeks 3-12 = organogenesis (extremities, CNS, muscle, organs develop)
What are the limitations to classifying drugs in pregnancy?
Categories dont account for stage of pregnancy
Categories dont account for dose or route of administration
What are some practice points for drugs in pregnancy?
Balance risk and benefit of prescribing meds in preg = no treatment may be worse for mother and child compared to ADR
Take care when discussing risk w/ patient = don’t scare unnecessarily
Information sources down always provide context to guidelines
Follow guidelines when prescribing and consider non-pharm treatment where available
What CAMs should be avoided in pregnancy?
Internally applied essential oils, large quantities of herbs containing essential oil
Liquid extracts w/ high alcohol %
Those used to induce labour/menses = juniper, penny royal, goldenseal
Those that influence hormone levels or phytoestrogens = red clover, chaste tree
Those that effect muscle tone and/or circulation of uterus = blue cohosh, feverfew, hawthorn
Outline types of pre-natal testing
Human chorionic gonadatrophin HCG –> sec by placenta by corpus luteum = confirm preg marker to asses abnormalities in 1st tri
Foetal ultrasound = examine foetus feature/anatomy
Chorionic Villus sampling (11wks) = detect chromosomal abnormality
Amniocentesis (15wks) = definitive diagnosis of down syndrome
Urinary protein test = risk factors for pre-eclampsia (BP, oedema)
Per oral glucose tolerance test (POGTT) =24-29 wks
When do HCG levels peak?
Between weeks 4-16
