health

1. 1/28/2024 1

2. Definition
 preconception care: is care received by mothers before they get
pregnant.
Conception: the action of conceiving a child or of a child being
conceived.
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3. Preconception care importance
1. Provides women & families information and opportunities to modify
unhealthy behaviors and thus potentially improve the quality of their
lives and babies
2. Increase reproductive choices, possibly decreased unintended &
unwanted pregnancies. 1/28/2024 3

4. CONT…
3. Improve pregnancy outcome by decreasing infant mortality &
morbidity
4. Reduces the probability of damage during organogenesis
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5. Preconception Care focus
1. Finding and taking care of any problems that might affect mother and her
baby later, like diabetes or high blood pressure
2. Increasing the amount of folic acid to prevent neural tube defects
3. Getting up to date on vaccines
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6. CONT…
• Avoiding smoking, drinking alcohol, or taking drugs
• Trying to reach a healthy weight
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7. Controllable risks before conception
 Smoking
 Alcohol
 Drugs
 Weight
 Diabetes
 Infections
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8. • All mothers should stop all tobacco before attempting to
conceive and during pregnancy.
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9. • Tobacco and reproductive outcomes:
• One of the leading preventable causes of infant mortality
• Preventable cause of low birth weight and prematurity
• Associated with placental abnormalities
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10. Obstetric risks
Ectopic pregnancy
Placenta previa
Abruptio placenta
Preterm delivery
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11. CONT…
Perinatal mortality
Low birth weight
Intrauterine growth retardation
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12. Infant risks
 Low birth weight
 Sudden infant death syndrome (SIDS)
 Respiratory illnesses
 pulmonary and asthma
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13. School problems
lower scores on spelling & reading tests
decreased attention
risk for hyperactive behavior
Increased hospitalizations 1/28/2024 13

14. If smoking during pregnancy eliminated, estimated there is :
10% reduction in perinatal mortality
11% reduction in the incidence of low birth weight
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15. SMOKING:
Evidence based counseling
 Ask every patient about tobacco use
 Advise them to quit
 Assess willingness to quit
 Assist them in quitting
 Arrange follow up 1/28/2024 15

16. • All mothers should stop alcohol before attempting to conceive
and during pregnancy.
• “No amount of alcohol consumption can be considered safe during
pregnancy.
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17. Alcohol consumed during pregnancy increases the risk of alcohol-related birth
defects, including:
 Growth deficiencies
 Facial abnormalities
 Central nervous system impairment
 Impaired intellectual development.
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18. Fetal alcohol syndrome (FAS) which is characterized by:
1. Central nervous system problems
2. Low birth weight and height
3. Typical facial features
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20. 1/28/2024 20

21. Medications
• Association with some medications with some birth defects
• Some women on anti-seizure medications for years of seizure free
might be able to discontinue.
• Lowest possible effective dose
• Single drug instead of multiple drugs
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22.  Risks of underweight
 If mothers BMI is less than 18.5 before she became pregnant, she may be
advised to gain more weight than someone who is in the normal range.
 Being underweight can bring a small increased risk of pregnancy problems
such as premature birth (before 37 weeks) or having a baby that
is underweight. 1/28/2024 22

23. Weight
Obesity (mother with BMI>30) and pregnancy :there is increased
risk of :
• Glucose intolerance of pregnancy
• Pregnancy induced hypertension
• Thrombophlebitis 1/28/2024 23

24. CONT…
Neural tube defects
Prematurity
Higher rates of difficult births
Fetal injury from birth difficulty
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25. General population
• 2-3% risk of severe birth defects
Diabetics prior to pregnancy
• POORLY CONTROLLED [ hgb a1c>7]
• Risk increases to 6-9%
• Heart disease, spina bifida, others
Well controlled preconceptionally
• Back to baseline rate in the general population!
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26. Risks of infant with diabeteic mother
• Respiratory distress
• Macrosomia or SGA
• Hypocalcemia or hypomagnesemia
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27. • Polycythemia, jaundice
• Hypertrophic cardiomyopathy
• Hypoglycemia
• Malformations
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28. Macrosomia
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29. Malformations;
myelomeningocele, anencephaly and caudal regression syndrome
myelomeningocele
caudal regression
syndrome
anencephaly
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30. Diabetes :
maternal councelling
• Pre-conception care and good glucose control before and during pregnancy can
reduce these risks. (Hba1c level below(6.5%).
1/28/2024 30

31. CONT…
• Women with diabetes who are planning to become pregnant should take
5 mg folic acid daily until 12 weeks of gestation, to reduce the risk of
neural tube defects.
• Good antenatal care
• Timing of delivery <38 weeks. 1/28/2024 31

32. DIABETES :
MATERNAL COUNCELLING
• All other hypoglycaemic agents should be discontinued before
pregnancy, and insulin substituted.
• Offer pregnant women with diabetes ultrasound monitoring of fetal
growth and amniotic fluid volume every four weeks from 28-36 weeks.
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33. Diabetes :
maternal councelling
Importance of preconception and post- conception supplementation of
folic acid:
Decreases rate of spina bifida by 50-70%
Decreases rate of cleft lip
Decreases rate of heart disease 1/28/2024 33

34. Infections
Hepatitis B
 90% chronic carriers are without symptoms
 Pregnancy doesn’t alter course of disease
 Identify neonates for full vaccination and prophylaxis
 High risk women who are hbv-neg can be vaccinated 1/28/2024 34

35. HIV
 Help infected women make informed reproductive decisions.
 Begin maternal care program.
 High risk women can be counseled for risk reduction approaches.
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36.  Disclosure of HIV diagnosis
 Partner testing
 Screening other STI
Contraception, as needed, to delay pregnancy while health issues are
addressed
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37. Risk factors for MTCT and strategies to reduce those risks
• ARV medications
• C-section
• Avoidance of breastfeeding
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38. HIV-Optimize preconception health
 Perform clinical staging, CD4 testing and viral load as indicated
 Assess and treat opportunistic infections
 Assess need for prophylaxis against opportunistic infections
 Optimize treatment/control of other chronic diseases
 Review all medications for safety in pregnancy
•
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39. HIV-Optimize preconception
health
 Initiate/modify ARV treatment for women who need it for their own health:
 Consider the regimen’s effectiveness for treatment of HIV potential for
teratogenicity and possible adverse outcomes .
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40. STD’S
• Laboratory screaning
• Apropriate treatment
Varicella and rubella:
• If negative antibody, can immunize
• Wait three months prior to conception
Toxoplasma preconception testing
-apropriate treatment
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41. Importance of antenatal care:
To ensure that the pregnant woman and her fetus are in the best
possible health.
To detect early and treat properly complications
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42.  Offering education for parenthood
To prepare the woman for labor, lactation and care of her infant
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