The document discusses preconception care, which aims to identify and modify health risks in women before pregnancy to improve pregnancy outcomes. It covers components of preconception care like health assessments, screening tests, nutrition education, managing infections and medical conditions, addressing genetics and environmental factors. The objectives are to maximize parental health and reduce perinatal mortality and morbidity. Assessments cover things like medical history, vaccinations, nutrition levels. Women are advised to attain normal BMI and address any infections, diseases or genetic risks before conception. Lifestyle factors like stress, smoking, alcohol and environmental exposures are also addressed.

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. EVERYWOMAN
EVERYVISIT

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
 TOTALCALORIES
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
BMI=
weight in
kg /height
in( meter)2

14. Classification based on BMI
< 18.5
kg/ m 2
- under
weight
18.5-
24.9
kg/m 2
–
normal
25 –
29.9
kg/m 2
–
overwei
ght
>30.0
kg/m 2
- obese

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 OFTHYROID 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
Child 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