The Importance of Preconception Care

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  • At my WIC rotation I came across an adolescent pregnant female who didn’t find out about her pregnancy till she was in her 5th month. I had seen shows like “I didn't’t know I was pregnant” but to meet someone who actually experienced no symptoms, quickening ,etc of pregnancy made me think about what could be amiss from her diet and how it could affect her own health, pregnancy, labor, delivery and the health and wellbeing of her unborn baby. Hence, I chose to divulge into the concept of pre conception care and its importance.
  • Interventions: maternal assessment (e.g., family history, behaviors, obstetric history, general physical exam); vaccinations (e.g., rubella, varicella and hepatitis B); screening (e.g., HIV, STD, genetic disorders); and counseling (e.g., folic acid consumption, smoking and alcohol cessation, weight management)Source: Atrash HK, Johnson K, Adams M, Cordero JF, Howse J (2006) Preconception care for improving perinatal outcomes: the time to act. Matern Child Health J 10: S3–11.
  • Source:Martin, J., Kirmeyer, S., Osterman, M., & Shepard, R. (n.d.). Retrieved from website: http://www.cdc.gov/nchs/data/databriefs/db24.pdf
  • Low birthweight is less than 2500 grams
  • Source: Atrash, H. K., Johnson, K., Adams, M., Cordero, J., & Howse, J. (2006). Preconception Care for Improving Perinatal Outcomes: The Time to Act. Maternal & Child Health Journal, 103-11. doi:10.1007/s10995-006-0100-4
  • Folic Acid Supplements Reduce the occurrence of neural tube defects by two thirdsReference:Source:Wilson, S., Bivins, B., Russell, K., & Bailey, L. (2011). Oral contraceptive use: impact on folate, vitamin B6, and vitamin B12 status. Nutrition Reviews, 69(10), 572-583. doi:10.1111/j.1753-4887.2011.00419.x
  • Source:March of Dimes Folic Acid Surveys, conducted by Gallup.Retrieved May 08, 2013, from website: www.marchofdimes.com/peristats.In 2008, 39.0% of women age 18-45 reported taking a vitamin containing folic acid daily in the United States.  . 
  • SourceMarch of Dimes Folic Acid Surveys, conducted by Gallup.Retrieved May 08, 2013, from www.marchofdimes.com/peristats.To better understand what women knew about folic acid, those who were aware of folic acid were asked what they recalled hearing or reading. 
  • Source: Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314.When a pregnant woman contracts an infectious disease, her developing fetus can be affected. Making sure the immunization status of all your reproductive agepatients is up to date will go a long way toward protecting their offspring from harm.Rubella (German measles):can cause fetal anomalies and spontaneous abortion if contracted during the first half of pregnancy. Varicella. Maternal varicella (chicken pox) can cause fetal harm, particularly if symptoms appear just before or during delivery.
  • Source: Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314.DM: Diabetes Mellitus: Improving glycémie control prior to conception is linked to a 3-fold decrease In the prevalence of birth defects. Hypothyroidism: Poorly controlled hypothyroidism may cause developmental growth, and neurologic abnormalities. Patients with thyroid abnormalitiesshould have their medication dosage optimizedbefore they conceive.Hypertensive disorders: may lead to pregnancy-induced hypertension, growth restriction, and renal disease. Switching to safe medications and screening women for cardiacdisease (via EKG) and nephropathy before conception can help manage these diseases better.Medications and their potential harmful effects on the unborn child.
  • Source: Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314.Patients from certain ethnic groups are more susceptible to specific genetic mutations.Maternal PKU: Low phenylalanine diet before 
conception and throughout pregnancy prevents 
mental retardation in infants born to mothers 
with PKU.It has been suggested that dietary control should be implemented at least three months prior to conception to help prevent fetal structural defects, cardiac defects, low birth weight, microcephaly, and mental retardation. (Source : Maternal phenylketonuria. ACOG Committee Opinion No. 230 American College of Obstetricians and Gynecologists. Jan. 2000)
  • During pregnancy, obese women are at increased risk for several adverse perinatal outcomes, including anesthetic, perioperative, and other maternal and fetal complications. Source: Obesity in Pregnancy. (2005). Obstetrics & Gynecology, 106(3), 671-675.Underweight: Being underweight also poses risk during pregnancy. It increases having the risk of low birth weight baby. These babies are at risk of problems during labor and delivery and may have health and behavioral problems that last into childhood and adulthood. Being underweight during pregnancy also increases the chances of preterm birth. By proper weight management prior to conception, women will be able to improve their chances of a healthy pregnancy and baby.Source: Good health before pregnancy: Preconception care.2012. American College of Obstetrics and Gynocology. Retrieved from http://www.acog.org/~/media/For Patients/faq056.pdf?dmc=1&ts=20130508T2238494476Source: Obesity in Pregnancy. (2005). Obstetrics & Gynecology, 106(3), 671-675.
  • The goal for prenatal care are:Assess the risk factors to attempt to predict complicationsInsure the health of the motherAssess the growth of the fetusTo educate the patientTo establish an EDDTo treat conditions that could affect the outcome of the pregnancy.
  • The U.S government has set a goal to raise the level of prenatal care by 10% by the year 2020. Source: Child Trends Data Bank. (n.d.). Retrieved from http://www.childtrendsdatabank.org/sites/default/files/25_Prenatal_Care.pdf
  • Health professionals can support the goals of preconception care by:Screening for risks.Recommending interventions to address identified risks.Promoting health and providing education.
Source: (n.d.). Retrieved from website: http://www.cdc.gov/preconception/hcp/index.html
  • The Importance of Preconception Care

    1. 1. + By : Sadia Kazimi
    2. 2. +  Age: 17 years old  Height: 5 feet 2 ¾ in  Weight: 125 lbs  BMI: 22.8  Unaware of pregnancy till 5 months
    3. 3. + From: To:
    4. 4. +  Maternal Assessment: family history, behaviors, obstetric history, general physical exam, etc.  Vaccinations:  Screening: Rubella, varicella, influenza, etc. HIV, STD, genetic disorders, etc.  Counseling: folic acid consumption, smoking and alcohol cessation, weight management, etc. Source: Atrash HK, Johnson K, Adams M, Cordero JF, Howse J (2006) Preconception care for improving perinatal outcomes: the time to act. Matern Child Health J 10: S3–11.
    5. 5. +  Preterm deliveries are increasing: Source: Martin, J., Kirmeyer, S., Osterman, M., & Shepard, R. (n.d.). Retrieved from website: http://www.cdc.gov/nchs/data/databriefs/db24.pdf
    6. 6. +  Low birthweight births are increasing. Low birthweight: United States, 2000-2010 Source: Martin, J., Kirmeyer, S., Osterman, M., & Shepard, R. (n.d.). Retrieved from website: http://www.cdc.gov/nchs/data/databriefs/db24.pdf
    7. 7. +  Leading causes of infant death have changed – Maternal complications are now third leading cause of infant death. Percent of Infant Deaths Source: Atrash, H. K., Johnson, K., Adams, M., Cordero, J., & Howse, J. (2006). Preconception Care for Improving Perinatal Outcomes: The Time to Act. Maternal & Child Health Journal, 103-11. doi:10.1007/s10995-006-0100-4
    8. 8. + Critical Periods of Fetal Development 4 5 6 7 8 9 10 Central Nervous System Central Nervous System Heart Heart Arms Arms Eyes Eyes Legs Legs Teeth Teeth Palate Palate External genitalia External genitalia Ear Ear  Missed Period  Mean Entry into Prenatal Care 11
    9. 9. +  Folate metabolism impacts Embryogenesis  Neural tube closes around 28 days post conception  Neural tube, heart & orofacial tissue are folate sensitive regions  Folate requirements much higher for rapidly dividing cells associated with early embryonic development.  Folic Acid Supplements Reduce the occurrence of neural tube defects by two thirds Source: Wilson, S., Bivins, B., Russell, K., & Bailey, L. (2011). Oral contraceptive use: impact on folate, vitamin B6, and vitamin B12 status. Nutrition Reviews, 69(10), 572-583. doi:10.1111/j.17534887.2011.00419.x
    10. 10. + Source: March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved May 08, 2013, from website: www.marchofdimes.com/peristats.
    11. 11. + Source: March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved May 08, 2013, from website: www.marchofdimes.com/peristats.
    12. 12. +  Rubella (German measles): can cause fetal anomalies and spontaneous abortion if contracted during the first half of pregnancy.  Varicella (chicken pox): can cause fetal harm, particularly if symptoms appear just before or during delivery. Source: Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314.
    13. 13. +  Diabetes Mellitus: Improving glycemic control prior to conception is linked to a 3-fold decrease In the prevalence of birth defects.  Hypothyroidism: Poorly controlled hypothyroidism may cause developmental growth, and neurologic abnormalities.  Hypertensive disorders: may lead to pregnancy-induced hypertension, growth restriction, and renal disease.  Medications: can have various effects on the health of the fetus early in pregnancy. Source: Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314.
    14. 14. +  Patients from certain ethnic groups are more susceptible to specific genetic mutations.  Maternal PKU: Low phenylalanine diet before conception and throughout pregnancy prevents mental retardation in infants born to mothers with PKU Source: Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314. Source : Maternal phenylketonuria. ACOG Committee Opinion No. 230 American College of Obstetricians and Gynecologists. Jan. 2000
    15. 15. +  Obesity: Increased risks of maternal and fetal complications  Underweight: increases risk of low birth weight baby, maternal and fetal complications  Goal: Proper weight gain or reduction prior to conception that leads to a normal pregnancy, uncomplicated labor and delivery and a healthy baby. Preconception care aims to help women reach and maintain healthy weight Source: Good health before pregnancy: Preconception care.2012. American College of Obstetrics and Gynocology. Retrieved from http://www.acog.org/~/media/For Patients/faq056.pdf?dmc=1&ts=20130508T2238494476 Source: Obesity in Pregnancy. (2005). Obstetrics & Gynecology, 106(3), 671-675.
    16. 16. +  Assess the risk factors to attempt to predict complications  Insure the health of the mother  Assess the growth of the fetus  To educate the patient  To establish an EDD  To treat conditions that could affect the outcome of the pregnancy
    17. 17. + Source: Child Trends Data Bank. (n.d.). Retrieved from http://www.childtrendsdatabank.org/sites/default/files/25_Prenatal_Care.pdf
    18. 18. + Preconception care is amiss: Most providers don’t provide it Most Insurances don’t pay for it Most consumers don’t ask for it Prenatal Care is available: Yet many women don’t receive it in the first trimester.
    19. 19. +  Screen for risks.  Recommend interventions to address identified risks.  Promote health and provide education.

    20. 20. +
    21. 21. + References:  Atrash, H. K., Johnson, K., Adams, M., Cordero, J., & Howse, J. (2006). Preconception Care for Improving Perinatal Outcomes: The Time to Act. Maternal & Child Health Journal, 103-11. doi:10.1007/s10995-006-0100-4  Carl, J., & Hill, D. (2009). Preconception counseling: Make it part of the annual exam. Journal Of Family Practice, 58(6), 307-314.  Child Trends Data Bank. (n.d.). Retrieved from http://www.childtrendsdatabank.org/sites/default/files/25_Prenatal_Care.p df  Good health before pregnancy: Preconception care.2012. American College of Obstetrics and Gynocology. Retrieved from http://www.acog.org/~/media/For Patients/faq056.pdf?dmc=1&ts=20130508T2238494476  Escott-Stump, S. (2012). Nutrition and diagnosis-related care. Lippincott Williams & Wilkins.  Mahan, L. K., Escott-Stump, S., & Raymond, J. L. (2011). Krause's food and the nutrition care process. (13th ed.). W.B. Saunders Company.
    22. 22. + References:  March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved May 08, 2013, from website: www.marchofdimes.com/peristats.  Martin, J., Kirmeyer, S., Osterman, M., & Shepard, R. (n.d.). Retrieved from website: http://www.cdc.gov/nchs/data/databriefs/db24.pdf  Maternal phenylketonuria. ACOG Committee Opinion No. 230 American College of Obstetricians and Gynecologists. Jan. 2000  Obesity in Pregnancy. (2005). Obstetrics & Gynecology, 106(3), 671-675.  Preconception. Retrieved from website: http://www.cdc.gov/preconception/hcp/index.html  Wilson, S., Bivins, B., Russell, K., & Bailey, L. (2011). Oral contraceptive use: impact on folate, vitamin B6, and vitamin B12 status. Nutrition Reviews, 69(10), 572-583. doi:10.1111/j.17534887.2011.00419.x

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