Preconception care

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
Health assessment consists of
Preconception health assessment by Ayurvedic health
consultant(Questionnaire, physical exam)
Followed by Ayurvedic preconception counseling and
Personalized nutrition advice

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?
Participants in the central Pennsylvania women’s health study’s program
reported increases in their intent to eat healthier and be physically
active, as well as increased physical activity, consumption of folic acid,
and self-efficacy following the program’s six bi-weekly pre-conception
education sessions
A study was conducted on preconception counseling for women with
epilepsy to reduce adverse pregnancy outcome, revealed that the value
of advice to women with epilepsy before conception mitigate the risk
of adverse outcome and change in both maternal and infant outcome.
There is a growing evidence that preconception education
interventions increase healthy behaviors among women who are
planning to conceive . Preconception interventions that address
multiple risk factors(smoking, alcohol consumption, STIs) appear to
alter targeted behaviors .

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 ?
Ayurvedic way of
management of
stress is done by
Lifestyle
management
Detoxifying
therapy

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?
Researchers Medina, Delgado, and
Hernandez conducted a study to
know the effect of Yoga and massage
therapy on maternal depression for
women who where pregnant..
Eighty-four depressed women were
randomly assigned to yoga, massage
therapy or standard prenatal care
control groups.
This study found that both yoga and
herbal massage therapy would lower
depression and anxiety

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?
A standardized Shirodhara leads to
a state of alert calmness similar to
the relaxation response observed in
meditation.
The clinical benefits observed with
Shirodhara in anxiety neurosis and
stress aggravation due to chronic
degenerative diseases is documented

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.

31. 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

32. 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).