4. +
Maternal
Assessment: family
history, behaviors, obstetric history, general physical
exam, etc.
Vaccinations:
Screening:
Rubella, varicella, influenza, etc.
HIV, STD, genetic disorders, etc.
Counseling:
folic acid consumption, smoking and
alcohol cessation, weight management, etc.
Source: Atrash HK, Johnson K, Adams M, Cordero JF, Howse J (2006) Preconception care for improving perinatal outcomes: the time to act. Matern Child Health J 10: S3–11.
5. +
Preterm
deliveries are increasing:
Source: Martin, J., Kirmeyer, S., Osterman, M., & Shepard, R. (n.d.). Retrieved from website: http://www.cdc.gov/nchs/data/databriefs/db24.pdf
6. +
Low
birthweight births are increasing.
Low birthweight: United States, 2000-2010
Source: Martin, J., Kirmeyer, S., Osterman, M., & Shepard, R. (n.d.). Retrieved from website: http://www.cdc.gov/nchs/data/databriefs/db24.pdf
7. +
Leading causes of infant death have changed – Maternal
complications are now third leading cause of infant death.
Percent of Infant Deaths
Source: Atrash, H. K., Johnson, K., Adams, M., Cordero, J., & Howse, J. (2006). Preconception Care for Improving Perinatal Outcomes: The Time to Act. Maternal & Child Health Journal, 103-11.
doi:10.1007/s10995-006-0100-4
8. + Critical Periods of Fetal Development
4
5
6
7
8
9
10
Central Nervous System
Central Nervous System
Heart
Heart
Arms
Arms
Eyes
Eyes
Legs
Legs
Teeth
Teeth
Palate
Palate
External genitalia
External genitalia
Ear
Ear
Missed Period
Mean Entry into Prenatal Care
11
9. +
Folate metabolism impacts Embryogenesis
Neural tube closes around 28 days post conception
Neural tube, heart & orofacial tissue are folate sensitive
regions
Folate requirements much higher for rapidly dividing cells
associated with early embryonic development.
Folic Acid Supplements Reduce the occurrence of neural tube
defects by two thirds
Source: Wilson, S., Bivins, B., Russell, K., & Bailey, L. (2011). Oral contraceptive use: impact on folate, vitamin B6, and vitamin B12 status. Nutrition Reviews, 69(10), 572-583. doi:10.1111/j.17534887.2011.00419.x
10. +
Source: March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved May 08, 2013, from website: www.marchofdimes.com/peristats.
11. +
Source: March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved May 08, 2013, from website: www.marchofdimes.com/peristats.
12. +
Rubella
(German measles): can cause fetal
anomalies and spontaneous abortion if contracted
during the first half of pregnancy.
Varicella
(chicken pox): can cause fetal
harm, particularly if symptoms appear just before or
during delivery.
Source: Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314.
13. +
Diabetes Mellitus: Improving glycemic control prior to conception is
linked to a 3-fold decrease In the prevalence of birth defects.
Hypothyroidism: Poorly controlled hypothyroidism may cause
developmental growth, and neurologic abnormalities.
Hypertensive disorders: may lead to pregnancy-induced
hypertension, growth restriction, and renal disease.
Medications: can have various effects on the health of the fetus
early in pregnancy.
Source: Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314.
14. +
Patients from certain ethnic groups are
more susceptible to specific genetic
mutations.
Maternal PKU: Low phenylalanine
diet before conception and
throughout pregnancy prevents
mental retardation in infants born
to mothers with PKU
Source: Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314.
Source : Maternal phenylketonuria. ACOG Committee Opinion No. 230 American College of Obstetricians and Gynecologists. Jan. 2000
15. +
Obesity: Increased risks of maternal and fetal
complications
Underweight: increases risk of low birth weight
baby, maternal and fetal complications
Goal: Proper weight gain or reduction prior to
conception that leads to a normal
pregnancy, uncomplicated labor and delivery and a
healthy baby.
Preconception care aims to help
women reach and maintain
healthy weight
Source: Good health before pregnancy: Preconception care.2012. American College of Obstetrics and Gynocology. Retrieved from http://www.acog.org/~/media/For
Patients/faq056.pdf?dmc=1&ts=20130508T2238494476
Source: Obesity in Pregnancy. (2005). Obstetrics & Gynecology, 106(3), 671-675.
16. +
Assess
the risk factors to attempt to predict
complications
Insure
the health of the mother
Assess
the growth of the fetus
To
educate the patient
To
establish an EDD
To
treat conditions that could affect the outcome
of the pregnancy
17. +
Source: Child Trends Data Bank. (n.d.). Retrieved from http://www.childtrendsdatabank.org/sites/default/files/25_Prenatal_Care.pdf
18. +
Preconception care is amiss:
Most providers don’t provide it
Most Insurances don’t pay for it
Most consumers don’t ask for it
Prenatal Care is available:
Yet many women don’t receive
it in the first trimester.
19. +
Screen
for risks.
Recommend
interventions to address identified
risks.
Promote
health and provide education.
21. +
References:
Atrash, H. K., Johnson, K., Adams, M., Cordero, J., & Howse, J. (2006).
Preconception Care for Improving Perinatal Outcomes: The Time to Act.
Maternal & Child Health Journal, 103-11. doi:10.1007/s10995-006-0100-4
Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the
annual exam. Journal Of Family Practice, 58(6), 307-314.
Child Trends Data Bank. (n.d.). Retrieved from
http://www.childtrendsdatabank.org/sites/default/files/25_Prenatal_Care.p
df
Good health before pregnancy: Preconception care.2012. American
College of Obstetrics and Gynocology. Retrieved from
http://www.acog.org/~/media/For
Patients/faq056.pdf?dmc=1&ts=20130508T2238494476
Escott-Stump, S. (2012). Nutrition and diagnosis-related care. Lippincott
Williams & Wilkins.
Mahan, L. K., Escott-Stump, S., & Raymond, J. L. (2011). Krause's food
and the nutrition care process. (13th ed.). W.B. Saunders Company.
22. +
References:
March of Dimes Folic Acid Surveys, conducted by Gallup.
Retrieved May 08, 2013, from website:
www.marchofdimes.com/peristats.
Martin, J., Kirmeyer, S., Osterman, M., & Shepard, R. (n.d.).
Retrieved from website:
http://www.cdc.gov/nchs/data/databriefs/db24.pdf
Maternal phenylketonuria. ACOG Committee Opinion No. 230
American College of Obstetricians and Gynecologists. Jan. 2000
Obesity in Pregnancy. (2005). Obstetrics &
Gynecology, 106(3), 671-675.
Preconception. Retrieved from website:
http://www.cdc.gov/preconception/hcp/index.html
Wilson, S., Bivins, B., Russell, K., & Bailey, L. (2011). Oral
contraceptive use: impact on folate, vitamin B6, and vitamin B12
status. Nutrition Reviews, 69(10), 572-583. doi:10.1111/j.17534887.2011.00419.x
Editor's Notes
At my WIC rotation I came across an adolescent pregnant female who didn’t find out about her pregnancy till she was in her 5th month. I had seen shows like “I didn't’t know I was pregnant” but to meet someone who actually experienced no symptoms, quickening ,etc of pregnancy made me think about what could be amiss from her diet and how it could affect her own health, pregnancy, labor, delivery and the health and wellbeing of her unborn baby. Hence, I chose to divulge into the concept of pre conception care and its importance.
Interventions: maternal assessment (e.g., family history, behaviors, obstetric history, general physical exam); vaccinations (e.g., rubella, varicella and hepatitis B); screening (e.g., HIV, STD, genetic disorders); and counseling (e.g., folic acid consumption, smoking and alcohol cessation, weight management)Source: Atrash HK, Johnson K, Adams M, Cordero JF, Howse J (2006) Preconception care for improving perinatal outcomes: the time to act. Matern Child Health J 10: S3–11.
Source:Martin, J., Kirmeyer, S., Osterman, M., & Shepard, R. (n.d.). Retrieved from website: http://www.cdc.gov/nchs/data/databriefs/db24.pdf
Low birthweight is less than 2500 grams
Source: Atrash, H. K., Johnson, K., Adams, M., Cordero, J., & Howse, J. (2006). Preconception Care for Improving Perinatal Outcomes: The Time to Act. Maternal & Child Health Journal, 103-11. doi:10.1007/s10995-006-0100-4
Folic Acid Supplements Reduce the occurrence of neural tube defects by two thirdsReference:Source:Wilson, S., Bivins, B., Russell, K., & Bailey, L. (2011). Oral contraceptive use: impact on folate, vitamin B6, and vitamin B12 status. Nutrition Reviews, 69(10), 572-583. doi:10.1111/j.1753-4887.2011.00419.x
Source:March of Dimes Folic Acid Surveys, conducted by Gallup.Retrieved May 08, 2013, from website: www.marchofdimes.com/peristats.In 2008, 39.0% of women age 18-45 reported taking a vitamin containing folic acid daily in the United States. .
SourceMarch of Dimes Folic Acid Surveys, conducted by Gallup.Retrieved May 08, 2013, from www.marchofdimes.com/peristats.To better understand what women knew about folic acid, those who were aware of folic acid were asked what they recalled hearing or reading.
Source: Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314.When a pregnant woman contracts an infectious disease, her developing fetus can be affected. Making sure the immunization status of all your reproductive agepatients is up to date will go a long way toward protecting their offspring from harm.Rubella (German measles):can cause fetal anomalies and spontaneous abortion if contracted during the first half of pregnancy. Varicella. Maternal varicella (chicken pox) can cause fetal harm, particularly if symptoms appear just before or during delivery.
Source: Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314.DM: Diabetes Mellitus: Improving glycémie control prior to conception is linked to a 3-fold decrease In the prevalence of birth defects. Hypothyroidism: Poorly controlled hypothyroidism may cause developmental growth, and neurologic abnormalities. Patients with thyroid abnormalitiesshould have their medication dosage optimizedbefore they conceive.Hypertensive disorders: may lead to pregnancy-induced hypertension, growth restriction, and renal disease. Switching to safe medications and screening women for cardiacdisease (via EKG) and nephropathy before conception can help manage these diseases better.Medications and their potential harmful effects on the unborn child.
Source: Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314.Patients from certain ethnic groups are more susceptible to specific genetic mutations.Maternal PKU: Low phenylalanine diet before conception and throughout pregnancy prevents mental retardation in infants born to mothers with PKU.It has been suggested that dietary control should be implemented at least three months prior to conception to help prevent fetal structural defects, cardiac defects, low birth weight, microcephaly, and mental retardation. (Source : Maternal phenylketonuria. ACOG Committee Opinion No. 230 American College of Obstetricians and Gynecologists. Jan. 2000)
During pregnancy, obese women are at increased risk for several adverse perinatal outcomes, including anesthetic, perioperative, and other maternal and fetal complications. Source: Obesity in Pregnancy. (2005). Obstetrics & Gynecology, 106(3), 671-675.Underweight: Being underweight also poses risk during pregnancy. It increases having the risk of low birth weight baby. These babies are at risk of problems during labor and delivery and may have health and behavioral problems that last into childhood and adulthood. Being underweight during pregnancy also increases the chances of preterm birth. By proper weight management prior to conception, women will be able to improve their chances of a healthy pregnancy and baby.Source: Good health before pregnancy: Preconception care.2012. American College of Obstetrics and Gynocology. Retrieved from http://www.acog.org/~/media/For Patients/faq056.pdf?dmc=1&ts=20130508T2238494476Source: Obesity in Pregnancy. (2005). Obstetrics & Gynecology, 106(3), 671-675.
The goal for prenatal care are:Assess the risk factors to attempt to predict complicationsInsure the health of the motherAssess the growth of the fetusTo educate the patientTo establish an EDDTo treat conditions that could affect the outcome of the pregnancy.
The U.S government has set a goal to raise the level of prenatal care by 10% by the year 2020. Source: Child Trends Data Bank. (n.d.). Retrieved from http://www.childtrendsdatabank.org/sites/default/files/25_Prenatal_Care.pdf
Health professionals can support the goals of preconception care by:Screening for risks.Recommending interventions to address identified risks.Promoting health and providing education. Source: (n.d.). Retrieved from website: http://www.cdc.gov/preconception/hcp/index.html