Preconceptional counselling

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