Preconceptional counselling

1. PRECONCEPTIONAL
COUNSELLING

2. WHAT IS PRE CONCEPTIONAL COUNSELLING?
A set of interventions that aim to
identify and modify biomedical,
behavioural and social risks to a
woman’s health or pregnancy
outcome through prevention and
management

3. IS IT IMPORTANT?
• Improving the mother’s preconceptional
health results in improved reproductive
health outcomes
• Reduced maternal morbidity and
mortality
• Prevents LBW, premature birth and
infant mortality

4. WHEN TO INITIATE PRECONCEPTIONAL CARE
• Any visit to a doctor in the reproductive
years
• Annual health check up
• Postpartum check up
• A visit for a pregnancy test (esp if test
negative)
• Emergency visit
• Visit for infertility treatment
• Premarital Counselling

5. GOALS OF PRECONCEPTIONAL CARE
• Screening for high risk factors
• Medical and surgical history
• Previous Obstetric History
• Personal history
• Family history
• Physical examination
• Laboratary screening

6. PREVENTIVE HEALTH
Nutrition and Supplementation
• Folic Acid 400mcg per day
• Reduces occurrence of NTD
• Higher Doses required in
• Pts on anti epileptic drugs/
other antifolate drugs
• Obese
• Pts with h/o prev NTD

7. PREVENTIVE HEALTH
• Optimizing Weight in Overweight and
obese women
• Reduces risk of of NTD
• preterm deliveries
• Diabetes, Hypertension
• Cesarean Section

8. PREVENTIVE HEALTH- VACCINATION
• Hepatitis B Vaccination for at risk
women
• Rubella vaccination- prevents
Congenital Rubella Syndrome

9. SCREENING AND TREATMENT OF INFECTIONS
• HIV/ AIDS Screening and treatment
• Screening and Treatment of STD
• Reduces risk of ectopic pregnancy,
infertility, chronic pelvic pain
• Reduces risk of preterm birth, PPROM
• Reduces possible risk of fetal death,
neonatal sepsis and long term physical
and developmental disabilities

10. SPECIFIC INDUVIDUAL ISSUES
• Chronic Diseases
• Medications
• Addictions

11. CHRONIC MEDICAL ILLNESS
RISK FACTOR INTERVENTION
Anti epileptic Drug use Change to less teratogenic treatment regimen
Diabetes Achieve and maintain HbA1C < 7
Hypertension Avoid ACE-I, ARB
Assess for renal disease, cardiac function,
Retinopathy
Hypothyroidism Thyroxine supplementation.
Target TSH<3
Hyperthyroidism Prefer PTU to carbimazole
Maintain FT4 in high normal and TSH in low
normal levels
SLE >6 months of quiescence on stable therapy

12. CHRONIC MEDICAL ILLNESS
RISK FACTOR INTERVENTION
Cardiac Illness Rule out conditions where pregnancy is absolutely
contraindicated
Advice regarding surgery for optimizing the cardiac
lesion prior to pregnancy if indicated
If on warfarin switch to heparin
Genetic Counselling in Congenital Cardiac disease
Cancer Fertility preservation options prior to therapy

13. RECURRENT PREGNANCY LOSS
• Check for APS and congenital thrombophilias
• Correction of anatomic problems like uterine septum, fibroid
removal, etc

14. GENETIC PROBLEMS
• Parental Karyotyping
• Carrier Screening based on ethnicity
or family history (Sickle Cell,
Thalassemia, etc)
• Dietary Advice (Eg; Phenylketonuria)

15. ADDICTIONS
• Smoking cessation
• Eliminating alcohol use before
and during pregnancy

16. TERATOGENICITY
• Any agent that that acts during embryonic
or fetal development to produce a
permanent alteration of form or function
• Drugs
• Chemicals
• Radiation
• maternal medical conditions,
• Infectious agents
• Genetic factors

17. FDA CLASSIFICATION OF DRUGS IN PREGNANCY- 1979