1. +
By : Sadia Kazimi

2. +
 Age:
17 years old
 Height:
5 feet 2 ¾ in
 Weight:
125 lbs
 BMI:
22.8
 Unaware
of pregnancy till 5 months

3. +
From:
To:

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. +
 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. +
 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. +

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. + 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. +

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. +
Source: March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved May 08, 2013, from website: www.marchofdimes.com/peristats.

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Source: March of Dimes Folic Acid Surveys, conducted by Gallup. Retrieved May 08, 2013, from website: www.marchofdimes.com/peristats.

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. +

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. +

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. +

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. +
 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. +
Source: Child Trends Data Bank. (n.d.). Retrieved from http://www.childtrendsdatabank.org/sites/default/files/25_Prenatal_Care.pdf

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. +
 Screen
for risks.
 Recommend
interventions to address identified
risks.
 Promote
health and provide education.

20. +

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. +
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