T.ANANTHAKUMAR
4TH YEAR Msc
BMS14312

 Preconception counseling and care is intended
to optimize a woman’s health for pregnancy,
ideally commencing before conception, with a
preconception visit
 During this visit a thorough family and
medical history of both parents is obtained, as
well as a physical examination of the
prospective mother

 The goal of this visit is to minimize adverse
health effects for the mother and fetus and to
promote a healthy pregnancy.
 Preexisting conditions that may affect
conception, pregnancy, or both are identified
and addressed.
 For example, neural tube defects (NTDs) are
associated with folic acid deficiency

Neural tube defects are birth defects of the brain, spine, or spinal
cord. They happen in the first month of pregnancy, often before a
woman even knows that she is pregnant.

 Discussion about folic acid supplementation is
an essential component of preconception.
 In addition, women with conditions such as
maternal phenylketonuria or diabetes can
reduce the risks of adverse fetal effects by
establishing strict metabolic control before
conception and continuing it throughout the
pregnancy.

The following maternal assessments may serve as
the basis for this counseling:
• Family planning and pregnancy spacing
• Family history
• Genetic history
• Medical, surgical, psychiatric, and neurologic
histories
• Current medications

• Nutrition
• Environmental and occupational exposures
• Immunity and immunization status
• Risk factors
• Physical examination
• Assessment of socioeconomic, education, and
culture context

 Vaccinations should be offered to women
found to be at risk for or susceptible to rubella,
varicella, and hepatitis B.
 All pregnant women should be tested for HIV
infection, unless they decline the test.
 A number of other tests can be performed for
specific indications:
 Screening for sexually transmitted diseases

 Testing for maternal diseases based on medical
or reproductive history
 Mantoux test with purified protein derivative
for tuberculosis
 Screening for genetic disorders based on racial
and ethnic background:
 sickle hemoglobinopathies (African Americans)

 Beta-thalassemia (individuals of Mediterranean
and Southeast Asian descent; African
Americans)
 Alpha-thalassemia (individuals of Southeast
Asian and Mediterranean descent; African
Americans)

 Patients should be counseled regarding the
benefits of the following activities:
 Exercise
 Reducing weight before pregnancy, if obese;
increasing weight, if underweight
 Avoiding food faddism
 Avoiding pregnancy within one month of
receiving a live attenuated vaccine (e.g.,
rubella)

 Preventing HIV infection
 Determining the time of conception by an
accurate menstrual history
 Abstaining from tobacco, alcohol, and illicit
drug use before and during pregnancy
 Maintaining good control of any preexisting
medical conditions (e.g., diabetes,
hypertension, asthma, systemic lupus
erythematosus, seizures, thyroid disorders,
inflammatory bowel disease).

 Taking 0.4 mg of folic acid daily while
attempting pregnancy and during the first
trimester of pregnancy for prevention of NTDs
 women who have had a prior NTD-affected
pregnancy should consume 4 mg of folic acid
per day in the preconception period.

 This amount can be achieved by adding a
separate supplement to a single multivitamin
tablet to provide a total of 4 mg of folic acid
while avoiding excessive intake of fat-soluble
vitamins, which may have adverse fetal effects
if taken in high doses

 Repeated pregnancy loss(RPL):
 To treat the cause for abortion
 Immunological Adversity(autoimmune disease
-erythroblastosis fetalis)
 Genetic Defects
 Review of past history
 Menstrual history

 Risk assessment is an important part of the
initial antenatal evaluation.
 Questions about history and chronic medical
conditions are important in order to identify
the pregnant woman who is at risk for
complications and to initiate a management
plan at the appropriate time.

 In addition to understanding the medical risks,
it is important to understand each woman’s
social circumstances, some of which may place
her at risk for both physical and emotional
complications.
 Patients should be questioned about the
following aspects of their lifestyle that could
pose a risk and receive appropriate counseling,
if indicated:

 Nutrition and weight-gain counseling
 Sexual activity
 Exercise
 Smoking
 Environmental and work hazards
 Tobacco
 Alcohol
 Seat belt use