vital issues for pre conception

1. BY
DEPARTMENT OF OBTETRICS AND
GYNAECOLOGY BMC, SAKI.

2. Outline
 INTRODUCTION
 TIMING (WHEN)
 COMPONENTS
 CONCLUSION

3. INTRODUCTION
 There were about 4million birth in the U.S
in 2003,with almost all born healthy but, the
infant mortality rate in the U.S ranked 28th
that year.
 Preconception care has been advocated as a
measure to improve pregnancy outcomes i.e
healthy child/children and mother with
happy family

4. TIMING
 The appropriate time for preconception care
include:
 Routine health maintenance visits
 Pre-appointment examination
 Pre-marital or family planning visit
 After negative pregnancy test
 Pre-school examination

5. COMPONENTS
 Components of preconception care
parallels that of prenatal care i.e :
 Risk assessment
 Health promotion
 Medical intervention
 Psychosocial intervention

6. NUTRITION
 A woman’s nutritional status may have a profound effect on
reproductive outcome
 The two forms of malnutrition are : over nutrition (obesity) and
under nutrition
 Obesity
poses the following risks:
 hypertensive disorders
 gestational diabetes
 UTI
 LGA babies
 Intrapartum complications
Obese patients should be advised to loose weight before
pregnancy

7. NUTRITION CONT’D
 Undernutrition
 Effects of under- nutrition include:
.LBW babies .SGA babies
.Anaemia .DM
.Cardiovascular diseases

8. NUTRITION CONT’D
 At preconception visit patient’s weight and
height should be measured and inquiries
should be made about Bulimia, Anorexia ,
Pica, Vegetarian eating habits ,
Megavitamins supplements e.g. vitamin A is
a known teratogen at high doses(>5000
iu/d).However , it should be noted that
retinol not B-carotene which is found in
fruits and vegetables is the teratogenic form.

9. Folic acid supplementation
 4000 pregnancies are affected in the U.S. by
neural tube defects(NTDs);spinal
bifida,anencephaly and encephalocele.Spinal
bifida is usually complicated with disabilities
like paraplegia, bowel incontinence,bladder
incontinence,hydrocephalus,and intellectual
impairment.
 Studies have shown a 72% reduction in
recurence of NTDs with 4mg daily dose of folic
acid.

10. Folic acid contd
 CDC recomends that all women of
childbearing age who are capable of
becoming pregnant take 0.4mg of folic acid
daily starting 1-3 month prior to planned
conception and through the 1st trimester.

11. EXERCISE
 Available data suggest that moderate
exercise is safe for pregnant women who
have no medical or obstetric complication
 Advantages of exercise include:
 decrease pregnancy related discomfort
 improve maternal fitness
 improve maternal self-esteem

12. MEDICAL CONDITIONS
 Diabetes mellitus
congenital anomalies is 2-6 times
commoner in pregnant diabetic patients
compared with non-diabetic pregnant
women.
RBS goal in pregnant diabetic is 110mg/dl
while 2hpp should not exceed 115mg/dl

13. Medical condition contd
 Hypertention
preconception hypertention should be
adequately managed
 Epilepsy
Epilepsy is the commonest neurological
problems in pregnancy. It leads to
menstrual irregularity ,ovulatory
dysfunction and infertility.

14. Phenylketonuria
Most common in-born error of
metabolism that leads to mental
retardation, seizures, microcephaly,
delayed speech, eczema and autistic-
like behavior.

15. Genetic counseling
The ideal time for genetic counseling is before a
couple attempt to conceive especially in advanced
maternal age, consanguinity or family history of
genetic diseases. e.g. Ashkenazi Jews have 1/25
chance of carrying gene for Tay sach ‘s disease
The U.S whites have 1/22 chance of caring gene for
Cystic fibrosis.
Africans ----------------Sickle cell diseases
Mediterranean -----------β- thalasemia
S/E Asia----------------------&-thalasemia

16. IMMUNIZATIONS.
The following vaccine are recommended in pre-
conception period:
• T.T
• Rubella
• Varicella
• Chicken Pox
• Hepatitis B among others.
-

17. LIFE STYLE CHANGES
 CAFFEINE
Caffeine is present in most beverages, in chocolates and in
over -the - counter, medications such as cold and headache
medicine. 1 cup of coffee contains only 120mg, a cup of tea
has 40mg and coke has 45mg per 12-02. consumption of
caffeine during pregnancy is quite common, but its
metabolism is slow. Cigarette smoking increases caffeine
metabolism leading to high intake.
EFFECTS.
• Decreased fertility
• Increased spontaneous abortion
• Decreased birth rate.

18. TOBACCO
12 -20% of woman smoke during pregnancy,
subjecting themselves and their infants to a
number of adverse effect. Woman
contemplating pregnancy should be advised
to quit smoking.

19. LIFE STYLE CHANGES CONTD.
 ALCOHOL
The most severe consequence of exposure to
alcohol during pregnancy is Fetal Alcoholic
Syndrome (FAS) consisting of a trial of
prenatal or postnatal growth retardation,
Neuro-developmental abnormalities and
facial abnormalities. It is the largest
preventable cause of birth defect and
mortality rate in western world. Intending
mothers should be counseled that there is
no safe level of alcohol consumption during
pregnancy. Effects include: Infertility,
spontaneous abortion, hypertension, stroke,

20.  ILLICIT DRUGS
At preconception visits, inquiry should be made
about drugs used and counseling, referred and
access to recovery program me should be offered as
the case may be. Examples of drugs are: Marijuana,
Heroine, Cocaine. Their effects are: Hyperactivity,
Inattention syndrome in older years, LBW, IUGR,
Preeclampsia, Abruptio Placenta, Fetal distress,
sudden infant death syndrome, GI dysfunction.

21. STI
The preconception visit is a good opportunity to
screen for genital infections such as: Chlamydia,
Gonorrhea, Syphilis, HIV.
EFFECTS
Chlamydia – Inclusion Conjunctivitis,
Pneumonia
Syphilis – Spontaneous abortion, non-immune
hydrops, still birth, neonatal death
Gonorrhea – Ophthalmia Neonatorium.
HIV

22. LIFESTYLE CHANGES CONT’D
• MEDICATION
Antihypertensive - ACEI (Renal impairment),
Diuretics (decreases maternal plasma volume).
Anticoagulants ---warfarin is a teratogen and it crosses
placenta.Heparin is better sustitute because it does not
cross placenta.–
Antithyroid drugs
Hypoglycaemics – oral hypoglycaemics should be
switched to Insulin.

23. LIFE STYLE CHANGES CONTD
 OCCUPATIONAL EXPOSURES
Increasing no of women are entering the workforce world-
wide and most in their reproductive years. The
preconception visit is the best time to identify and control
exposure that may affect parental health and pregnancy
outcome.
The 3 most common occupation exposure reported to
affect pregnancy are:
.Organic
solventse.g.painting,printing,varnishing,plastic etc
.Lead e.g.smelting,printing,battery.
.Video display terminals

24. DOMESTIC VIOLENCE
 Domestic violence is increasingly recognized
as a major public health issue. Findings from
the 1998 National Violence Against Women
Survey showed that in the United States 1.5
million women are raped or physically
assaulted by an intimate partner every year.
Domestic violence crosses all socioeconomic,
racial, religious, and educational boundaries.
:

25. Domestic violence cont’d
 Even physicians are not immune. In a survey, 17%
of female medical students and faculty had
experienced abuse by a partner in their adult life,
an estimate comparable to that of the general
population. Victims of domestic violence should
be identified preconceptionally, because the
pattern of violence may escalate during
pregnancy. The prevalence of domestic violence
during pregnancy ranges from 0.9% to 20.1%, with
most studies identifying rates between 3.9% and
8.3%.

26. DOMESTIC VIOLENCE CONT’DS
 Whereas violence in nonpregnant women is
directed at the head, neck, and chest, the
breasts and the abdomen are frequent
targets during pregnancy. Physical abuse
during pregnancy is a significant risk factor
for low birth weight and maternal
complications of low weight gain,
infections, anemia, smoking, and alcohol or
drug usage.

27.  If it is identified that a patient is the victim
of domestic violence, the physician should
assess her immediate safety and make
timely referrals to local community
resources and shelters.

28. CONCLUSION
Preconception care has been
advocated and is being practiced in
some developed countries,the
situation however is different in
this part of the world.Therefore
awareness and education should be
encouraged.

29. THANK YOU