Ayurvedashram preconception health care program

Preconception care program

1. Ayurvedashram Preconception Health Care Program Site Preceptor Pari Mudiginty, R.Ph , M.Pharm , MBA, DAMS Sruthi Bhat MPH candidate, Nova South Eastern University

2. What is preconception health care? PCC is defined as "a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management, emphasizing those factors that must be acted on before conception or early in pregnancy to have a maximal impact”(CDC)

3. Why do we need preconception program? The health status of a woman during pregnancy as well before conception significantly influences maternal and fetal outcomes. In the U.S. half of all pregnancies are unintended, and the infant mortality rate is high compared to other developed countries. A study conducted at the department of obstetrics and gynecology, a division of obstetrics and prenatal medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands stated that many women realize that they are pregnant when they enter the fifth week of pregnancy and the first antenatal visit is relatively late to address perinatal risk factors.

4. Why do we need preconception health care Most women are not aware of their pregnancy until they miss their first period. Many pregnant women do not start prenatal care until organogenesis (formation of organs) is complete. The most critical period for organ development occurs before many women even know they are pregnant. The first contact with antenatal care is often too late for advice about health-promoting changes in lifestyle. There is a growing body of evidence that women’s and men’s health and lifestyle before conception can affect pregnancy outcome

5. Preconception Health Care Can Ensure best outcome for conception and pregnancy Helps to identify risky behaviors   Promote healthy practices Reduce the risk of miscarriage  Reduce the risk of stillbirth and birth defect  Lower the risk of incidence of low birth weight and childhood developmental disorders   Prevents unintended pregnancy  Enhance mental health of both mother and child

6. Preconception health care Focus Areas Nutrition / Exercise STI disease/immunization Chronic disease management Substance use/Smoking Mental health Sleep Stress

7. Some important facts According to a report by Singh et al., 4 out of 10 women in the United States report that their pregnancies are unplanned. Maternal undernutrition and iron-deficiency anemia increases the risk of maternal death. Rates of HIV transmission from mother to child is between 15 and 45% in the absence of intervention. According to the American heart association, higher blood pressure before conception may increase the risk of miscarriage.

8. Some important facts The women who underwent violence are at increased risk for premature delivery and low-birth-weight infants. Studies report that eliminating smoking before or during pregnancy could avoid 5–7% of preterm-related deaths and 23–24% of cases of sudden infant death syndrome. Preconception maternal mental disorders are associated with adverse obstetric, neonatal, and childhood physical and mental health outcome.

9. Rationale behind Ayurvedashram preconception Health Care Program Studies has reported that the stress, anxiety, sleep issues, mental disturbances that women and men experience while they are planning for pregnancy or before conceiving can affect their health and the health of their future children. These factors can lead to problems such as low birth weight, preterm birth, miscarriage, developmental issues in children, and postpartum depression. Sleep disorders are the most critical public health problem not being addressed in the United States. There are an estimated 40 million US citizens with chronic sleep disorders.

10. Rationale behind Ayurvedashram preconception Health Care Program Evidence suggests that using relaxation techniques can be helpful components of a successful strategy to improve sleep habits and reducing the stress levels. Mind and body ayurvedic practices have been studied for their effects on improving physical and mental health. For adults who are planning to conceive, there are several evidence-based implementation resources widely available to improve their health behavior . But limited strategies to tackle stress, sleep issues, anxiety and mental wellbeing

11. Ayurvedashram Preconception Health care program The preconception health program at Ayurvedashram is focused not only on educating the people about importance of preconception health but also in improving both physical and mental health. The preconception health care program includes, Dietary guidelines, physical stress relief through Yoga, Pranayama (breathing techniques), Ayurveda detoxifications therapies (massage, herbal steam baths etc ) and mindfulness counseling and practices to enhance emotional and spiritual well-being.

12. Ayurvedashram preconception program? Several lifestyle factors have been identified which can promote optimal fertility, including dietary behaviors, stress management, sleep issues and maintenance of a healthy weight. In addition, adequate nutrient status can influence not only the ability to get pregnant, but the health of the egg and sperm, and thus the health of the child. Both mother and her baby benefits from a preconception care program. It optimizes mothers health and reduces the risk of congenital disabilities, miscarriages, and other pregnancy-associated issues.

13. Ayurvedashram Preconception Health Care program Ayurvedashram preconception health care program is aimed at identifying and educating about risky health behavior of the couples related to preconception health and managing stress and sleep issues. The main components of Ayurvedashram preconception health care program (APCP) are Health risk assessment Non-clinical intervention Health promotion techniques using Ayurvedic principles

14. Ayurvedashram Preconception Health care program

15. Ayurvedashram Preconception Health care program Non clinical intervention includes using of Ayurvedic techniques(cross cultural medicine). Intervention to reduce stress, anxiety and sleep issues during preconception time-frame Enhancing mental health and physical health by using yoga, pranayama (breathing technique's and medication

16. Health risk assessment how we will do that ? The couples will be given a questionnaire to fill The questionnaire will cover the topics such as Nutrition assessment Exposure to environmental hazards Substance use, including tobacco and alcohol Medical conditions and medications Infectious diseases and vaccination Stress, anxiety and sleep

17. Preconception health counseling Based on the questionnaire, the Ayurvedic health consultant will talk about Importance of nutritional diet and diet advice. Techniques to reduce weight through Ayurvedic techniques. Determining the time of conception by an accurate menstrual history. Importance of STI screening, measures for preventing HIV infection and importance of vaccination for women found to be at risk for or susceptible to Rubella, Varicella, Hepatitis B Advice about how to maintain good control of any pre-existing medical conditions such as diabetes. Giving information about community resources.

18. Nutrition education Ayurvedic nutrition is a system of medicine that was developed centuries ago as the best means to prevent illness. According to Ayurvedic principles, diet is not unique for everyone Ayurvedic Specialist will asses the person's health using questionnaires and physical exam By evaluating a person’s body structure, Ayurvedic Specialist will design a specific diet for the couples. A diet rich in nutritious foods can help to ensure a healthy immune system, healthy weight and vitality levels fit for pregnancy. Certain foods contain specific nutrients which are essential to reproductive health, and certain foods contain substances that may actually lower fertility levels and consequently hinder the conception process.

19. Evidence?

20. Some important facts Dr. Lynch is the Director of Reproductive Epidemiology at The Ohio State University Medical Center. Her research, published in Human Reproduction in January 2014, determined that “Women who had the highest levels of stress took 29% longer to get pregnant compared to other women, and their risk of infertility doubled.” Stress appears to have a more pronounced effect in increasing the risk of delivering a low birth weight (LBW) infant as well as preterm birth PTB PTB and LBW offspring are more likely to experience asthma and allergies in later life

21. Stress reduction ?

22. Life style management? Ayurveda describes about the certain healthy practices things one must follow everyday. This daily routine is very elaborate, however Ayurvedic health consultant can advice you about dinacharya .(a daily ritual of self-care to be followed). Meditation Yoga exercise and Pranayama (breathing exercise)

23. Detoxifying therapy Oleation Therapy: One of the best therapies to reduce the stress level Whole body oil massage is the manipulation of the soft tissue of whole-body areas to bring about generalized improvements in health, such as relaxation or improved sleep, or specific physical benefits, such as relief of muscular aches and pains. ​ Studies have shown that hormone levels associated with relaxation and stress are significantly altered when massage therapy is introduced to women’s prenatal care. Yoga masters believe that: Meditation and breathing techniques can help moms to relax and cope with stress or anxiety. Pranayama can train the mind to stay calm and manage pain better, thereby making delivery more comfortable.

24. Evidence?

25. Some important facts Lauren Wise, a professor of epidemiology at Boston University School of Public Health did a research study among the couples to know the relation between sleep and getting pregnant. The study found that short sleep duration less than 6 hours per night was associated with a reduced probability of pregnancy. Poor sleep can also have an effect on labor and delivery. Researchers from the University of California at San Francisco recently found that women who slept fewer than 6 hours per night had longer labors and were 4.5 times more likely to have cesarean deliveries Less sleep can effect men also as it affect the sperm quality.

26. Shirodhara to improve Sleep issues? The word Shira means head and Dhara means stream Shirodhara is the process of pouring a stream of warm liquids over the forehead of person. Most commonly oils are used for this purpose. It is done for fomentation of head region to provide complete mental relaxation Shirodhara is used to treat a number of disorders as well as for relaxing purposes.

27. Evidence?

28. Ayurvedic preconception care in a nut shell Ayurvedic preconception care provide Preconception health assessment Ayurvedic preconception counseling Nutrition advice Stress reduction techniques Practices to improve sleep issues Detoxifying therapy Techniques for enhancing mental health Links to community resources

29. Conclusion It is becoming increasing evident that early interventions undertaken during pre-conception phase may be crucial to improve pregnancy outcomes. Organogenesis begins early in pregnancy and by the time of the first prenatal visit, it may be too late to prevent some placental development problems (linked to preeclampsia, pre-term birth) and birth defects. Ayurveda thousands of years ago established the importance of pre-conception care It elaborates detoxification therapies, nourishing diets, mind body practices to balance the body and mind ensuring that couples, especially the woman enters the pregnancy with balanced immunological and hormonal biological systems.

30. References Zee, B. V., Beaufort, I. D., Temel , S., Wert, G. D., Denktas , S., & Steegers,E . (2011). Preconception care: An essential preventive strategy to improve childrens and womens health. Journal of Public Health Policy, 32(3), 367 379. doi:10.1057/jphp.2011.13 Singh et al., Unintended Pregnancy: Worldwide Levels, Trends, and Outcomes, 2010. Studies in Family Planning, 2010; 41(4): 241–50. Coussons -Read M. E. (2013). Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstetric medicine , 6 (2), 52-57. Amelia K Wesselink , Elizabeth E Hatch, Kenneth J Rothman, Jennifer L Weuve , Ann Aschengrau , Rebecca J Song, Lauren A Wise. Perceived Stress and Fecundability: A Preconception Cohort Study of North American Couples. American Journal of Epidemiology , 2018; DOI: 10.1093/aje/kwy186 https:// www.sleepfoundation.org /sleep-topics/pregnancy-and-sleep/page/0/1

31. References Temel , S., Voorst, S. F., Jack, B. W., Denktaş , S., & Steegers , E. A. (2013). Evidence-Based Preconceptional Lifestyle Interventions. Epidemiologic Reviews, 36(1), 19-30. doi:10.1093/ epirev /mxt003 Hillemeier , M. M., Downs, D. S., Feinberg, M. E., Weisman, C. S., Chuang, C. H., Parrott, R., . . . Chinchilli , V. M. (2008). Improving Womens Preconceptional Health. Womens Health Issues, 18(6). doi:10.1016/j.whi.2008.07.008 Whitworth, M., & Dowswell , T. (2009). Routine pre-pregnancy health promotion for improving pregnancy outcomes. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd007536.pub2 Field, T., Diego, M., Hernandez- Reif , M., Medina, L., Delgado, J., & Hernandez, A. (2011). Yoga and massage therapy reduce prenatal depression and prematurity. Journal of bodywork and movement therapies,16(2), 204-9. Michalsen , A., Jeitler , M., Brunnhuber , S., Lüdtke , R., Büssing , A., Musial, F., Dobos , G., … Kessler, C. (2012). Iyengar yoga for distressed women: a 3-armed randomized controlled trial. Evidence-based complementary and alternative medicine : eCAM , 2012, 408727 Winter bottom JB. Etal . Preconception counseling for women with epilepsy to reduce adverse pregnancy outcome. July 2008. 16(3).