Planned parenthood

planning to be parents
parenthood
motherhood and fatherhod
healthy parents

1. PLANNED PARENTHOOD Sharon Treesa Antony First year M.sc Nursing Govt. College of nursing Kottayam

2. Preconception care Set of interventions that aims to identify & modify biomedical, behavioural & social risks to a woman’s health or pregnancy outcome through prevention & management.

3. Components Early detection & prevention of health risks Management high risks before conception Active management of fertility Creation of awareness among women about contraception

4. Objectives Maximise the health of prospective parents and hence their babies Reduce perinatal mortality& morbidity Provide information to prospective parents to make informed choices & make them ready to be parents Evaluate need for genetic counselling Reduce unplanned pregnancies Inform about maternity services

5. EVERY WOMAN EVERY VISIT

6. Preconception health assessment Health status Sexual history Family history- genetic,consanguinous marriage Medical/surgical history Psychological history Substance use , occupation History of infections Obstetric & gynaecological history Nutritional history

7. Screening Tests BP,Weight,Urinalysis,Full blood count Cardiac &Thyroid function Respiratory function Sexual health status Cervical smear Serum screening – rubella,haemoglobinopathies,TB Vitamin,Zn,lead levels Hair analysis Karyotyping

8. Preconception classes

9. 1 . Nutrition Folic acid supplementation-400mcg/day Vitamin D(1000 IU/day) & calcium if low intake

10. DAILY CALORIE REQUIREMENT Weight in lb * 10 = calories for BMR A A * 30% = calories for average activity B A+B * 10% =calories for specific dynamic action C TOTAL CALORIES A+B+C

11. RECOMMENDED DAILY INTAKE Protein – 0.8 g /kg Iron -18 mg Calcium -500mg Zinc -12 mg Iodine -150 micro gram Vitamin A -5000 IU Vitamin D- 200IU

12. Thiamine – 1.1 mg Riboflavin – 1.1 mg Nicotinic acid = 15 mg Vitamin C -60 mg Folic acid – 200 micro gram Vitamin B 12 – 2 microgram

13. BODY MASS INDEX

14. Classification based on BMI

15. OBESITY Risks Neural tube defects Preterm delivery Fetal macrosomia Hypertension Diabetes mellitus ACHIEVE NORMAL BMI BEFORE CONCEPTION

16. EATING DISORDERS Anorexia nervosa Risks Abortion Low birth weight Post partum depression Bulimia improves during pregnancy ACHIEVE NORMAL BMI BEFORE CONCEPTION

17. VITAMIN DEFICIENCIES No need of supplements if healthy diet Vitamin A is teratogenic Avoid foods high in retinoids

18. FOLIC ACID DEFICIENCY Higher dose if epileptic Leafy vegetables & whole meat products Supplements 2-3 monhs before pregnancy to end of first trimester 4mg if epileptic/previous history of neural tube defect

19. CALCIUM DEFICIENCY 700mg calcium Milk, cheese, egg, yogurt,small fish

20. CAFFIENE Reduces implantation 3 cups/day -27% reduction in conception Reduce intake gradually

21. ANAEMIA Associated with fetal growth restriction Treat before pregnancy Diet rich in IFA

22. 2.Infections Vaccination if non immune to rubella Paternal mumps linked to infertility High fever can result in spontaneous abortion Eg : mumps,measles

23. RUBELLA Risks Deafness Cataract Cardiac malformation IUGR Retinopathy Microcephalus Cerebral palsy

24. Avoid contact with infected person 7 days before&5 days after rash appears Vaccinate prior to conception Avoid pregnancy for 3 months after vaccination Higher fetal risk in first trimster

25. Erythema Infectiosum Avoid children with disease Infectious period is 1week before& 1 week after symptoms

26. Toxoplasmosis Low risk for congenital infecion Wash hands after contact with soil, meat, fruits & vegetables Wear gloves while dealing with cat litter box

27. Tuberculosis Treat before conception Use barrier methods during treatment

28. HIV/AIDS Maintenance of low viral load & high CD4 count prior to conception Treated with zidovudine No further unprotected sex

29. Varicella zoster Prior maternal infection protects baby during pregnancy Test for vz antibody Vaccinate if needed No pregnancy for 3 months after vaccination Can lead to spontaneous abortion

30. Hepatitis B Vaccinate before conception if at high risk LFT to assess severity of disease Vaccination to uninfected family members

31. Group B streptococcus If present in vagina antibiotic therapy in labour/following ROM

32. Cyto megalo virus May be asymptomatic Wash hands before preparing meals

33. Tetanus Wash hands after contact with soil TT before /during pregnancy

34. Syphilis Risks Still birth Abortion Infected baby Antibiotic therapy during pregnancy

35. Gonorrhoea Risks Ophthalmia neonatoram Arthritis Diagnosed with cervical swabs Treated with penicillin during pregnancy

36. 3.MEDICAL CONDITIONS

37. Diabetes mellitus Risks Macrosomia Malformations Control preconception glycemia Measure HbA1C

38. Epilepsy Anticonvulsants are teratogenic Take folic acid

39. Phenylketonuria Maintain blood phenylalanine level 120-360 micromol /L Restrict milk, meat, fish , cheese & eggs

40. Hypertension Control BP Increase risk for preeclampsia, fetal growth retardation ACE inhiibitors & angiotensin 2 receptor blockers cause fetal malformation

41. Systemic Lupus Erythematosus Control associated kidney disease 6 months prior to conception Pregnancy contraindicated in active nervous system involvement

42. Thyroid disorders Hyperthyroidism leads to Hypertension, Fetal anomalies IUGR Preterm birth Hypothyroidism leads to Dwarfism Intellectual impairement SURVEILLANCE OF THYROID LEVELS ARE NEEDED

43. Cancer Cervical smear prior to conception Store sperms/ova before chemotherapy

44. Dental caries , ginguvitis Increased chance of preterm labour

45. 4.Genetics Screen for genetic disease among high risk group Genetic counselling

46. GENETIC COUNSELLING A communication process that deals with human problems associated with occurence or recurrence of a genetic disorder in a family or individual at increased risk for a condition that has a genetic component

47. Indications Parents of affected child Positive family history Women >35 years Risky ethnic group Consanguinous marriage Affected couple Concern about genetic disorder

48. TESTS Biochemical testing-enzyme levels & activity DNA testing for mutation Chromosomal testing Genetic pedigree Testing cells of embryo after in vitro fertilization Karyotyping

49. Ethnicity & Genetic conditions Asian – Thalassemia Asian:southeast / chinese -alpha thalassemia Asian :Indian-beta thalassemia African :sickle cell disease/ trait,thalassemia Ashkenazi Jewish :cystic fibrosis,Tay sachs disease,Gaucher’s disease,Niemann -pick disease,canavan disease,Fanconi anaemia,Blorm syndrome,

50. European,whitish : cystic fibrosis Mediterranean : thalassemia

51. Autosomal dominant diseases: cystic fibrosis, sickle cell anaemia , thalassemia Autosomal recessive disease: Tay sach’s disease C hild will have the disease / Will be carrier

52. 5.Environment & lifestyle AVOID JOBS INVOLVING: Vibrating machines Toxic substances Excessive cold/heat Heavy lifting Long travelling times Exposure to pesticides / phthalates Prolonged standing

53. Chronic stress preterm birth Exercise No new exercise in pregnancy Increased core body temperature spontaneous abortion No contact sports

54. Smoking Reduces sperm count Stop smoking 4 months before conception :both Away from smoky environment

55. Alcohol Reduces sperm count Affect ovulation Crosses placenta Cause fetal alcohol syndrome Result in abortion,growth restriction Stop alcoholism 4 months prior to conception

56. Hazardous substances Have organically grown foods Wash all foods No contact with pesticides /insecticides No radiation exposure from 3 months prior to conception

57. Lead From drinking water,soil ,exhaust fumes,utensils,battery,paint Wear protective clothing Mineral analysis before conception >10mcg/dl : toxicity Filter water High levels in men : infertility Lead content in mother moves to fetus

58. Cadmium High levels in men : infertility Reduce smoking, alcoholism , contact with plumbing alloys, paint , batteries ,fertilizers Filter water Mineral analysis prior to conception

59. Zinc Found in red meat,cereals , cheese,nuts . Levels reduced in alcohol drinkers Low levels in men : infertility Mineral analysis prior to conception

60. Aluminium Mineral analysis prior to conception Derived from utensils while cooking ,antacids Filter water Use stainless steel / glassware

61. Mercurry Derived from tinned tuna,large fishes,weed killers,dental amalgam Do dental procedures before conception/involve non mercurry based amalgam Filter water Mineral analysis prior to conception

62. Exercise Swimming is the best To maintain ideal weight

63. 5.Reproductive sexual health Barrier methods during preparation phase of pregnancy Oral contraception Cervical screening Cease the use 3 months prior to conception Reduces Zn,Mn,vitamin A&B Intrauterine contraceptive device Discontinue 3 months prior to conception May increase copper levels

64. Interpregnancy interval Ideally at least 18 months Short interval causes preterm birth,LBW

65. Advice for men Wear loose fitting shorts,trousers Cold showers preferred than hot baths No smoking and alcoholism Ideal weight No exposure to chemicals

66. PHYSICAL PREPARATION AGE :>18 years for girls >21 years in boys Diet: balanced diet,not anaemic not malnourished No exposure to hazardous substances Free of infections Stop OCP 3 months before GENETIC CONSELLING

67. PSYCHOLOGICAL PREPARATION Mentally prepared Away from violence Mature

68. FINANCIAL PREPARATION Ready to meet increasing demands Plan for maternity leave & benefits

69. BENEFITS Increased fertility Healthy conception,pregnancy,birth Reduced risk of abortion ,premature birth ,abnormality Reduced morning sickness Improved success rate of IVF More chance of natural,intervention free birth Low risk for postpartum depression Suceessful and long term breast feeding Healthy children

70. Preparation of family Sibling education classes Grand parent preparation Preparing fathers

71. THANK YOU