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  2.  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
  3.  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
  4. 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.
  5.  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.
  6. 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
  7. • Nutrition • Environmental and occupational exposures • Immunity and immunization status • Risk factors • Physical examination • Assessment of socioeconomic, education, and culture context
  8.  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
  9.  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)
  10.  Beta-thalassemia (individuals of Mediterranean and Southeast Asian descent; African Americans)  Alpha-thalassemia (individuals of Southeast Asian and Mediterranean descent; African Americans)
  11.  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)
  12.  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).
  13.  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.
  14.  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
  15.  Repeated pregnancy loss(RPL):  To treat the cause for abortion  Immunological Adversity(autoimmune disease -erythroblastosis fetalis)  Genetic Defects  Review of past history  Menstrual history
  16.  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.
  17.  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:
  18.  Nutrition and weight-gain counseling  Sexual activity  Exercise  Smoking  Environmental and work hazards  Tobacco  Alcohol  Seat belt use