Preconception care involves identifying and addressing biomedical, behavioral, and social risks to a woman's health or future pregnancy outcomes before she becomes pregnant. It is important because many birth defects and problems develop very early in pregnancy, before most women even know they are pregnant. Key components of preconception care include screening for nutritional deficiencies, infectious diseases, genetic risks, lifestyle factors like smoking, alcohol and drugs, and treating any issues identified. The goal is to promote the healthiest outcomes for both mother and baby.

1. Objectives
• Define Preconception care
• Explain why it is important Identify essential
components of Preconception

2. PRECONCEPTION CARE
 preconception care 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.
 Identifying and intervening on risk factors that impact
pregnancy before pregnancy occurs
Decreases maternal and infant mortality
Reduces the risk of birth defects
Promotes the healthiest mothers and
babies

3. Importance o preconception care
 The embryo begins to develop at the same time a
woman expects her next period to start– before she
even knows she’s pregnant!
 Major birth defects can occur at that time
 Brain and heart are the first organs to develop
 All major organs form in the first 2 months of
development
 Prenatal care is often too late!

4. Components of Preconception care
Before pregnancy occurs:
1. Identification of risks
2. Provision of motivational education based on risks
3. Initiation of desired interventions

5. Identification of risks
1. Lifestyle screening
Nutrition
Exercise
hyperthermia (hot tubs)
Screen for domestic violence
2. Screening for environmental toxins
Smoking
Alcoholism
Occupational exposures
Household chemicals
Radiation exposure in early pregnancy

6. Identification of risks cont..
3. Genetic screening
Carrier screening (racial/ethnic background/family
history)
Sickle cell anemia
Cystic fibrosis
Thalassemia
Tay-Sachs disease
4. Screen for Infectious Diseases
HIV
Syphilis
Gonorrhea/Chlamydia
Hepatitis C
Cytomegalovirus

7. Areas addressed by the preconception care

8. Nutrition before conception
 Adequate nutrition is essential for tissue formation,
neurological development, bone growth, modeling, and
remodeling
 Helps to achieve peak physical and intellectual potential
in adult life
 Problems related to nutrient deficiency develop early

9. Micronutrients
• Micronutrients that are most critical during
pregnancy include:
– Folate
– Vitamin B12
– Vitamin C
– Vitamin A
– Vitamin D
• Calcium
• Iron
• Zinc
• Sodium
• Iodine

10. Folate
Required for cell division
Critical for development of the neural tube
(future brain and spinal cord)
Deficiency is associated with neural tube defects
(spina bifida, anencephaly) and macrocytic
anemia (immature blood cells)

11. Folate cont..
 Neural tube defects (NTD) refer to a set of conditions in
which an opening in the brain or the spinal cord remains
exposed from the very early stages of foetal development
 The commonly observed types of are-
 Encephaloceles
Hydranencephaly
Anencephaly
Spina Bifida.

12. Folate cont...

13. Folate cont...
 Higher Doses required ( 4 mg) of folic acid is taken daily
2–3 months prior to conception to the end of the first
trimester
 Pts on anti epileptic drugs/ other antifolate drugs
 Pts with h/o prev NTD
 0.4 mg of folic acid is taken daily 2–3 months prior to
conception to the end of the first trimester in a first.

14. Vitamin A
 Vitamin A is essential for your health, supporting cell
growth, immune function, fetal development and vision
 Deficiency linked to an increased risk of low birth
weight, growth problems, preterm delivery
 Excess preformed vitamin A exerts teratogenic effects
Excessive vit A≥10,000 IU/d

15. Iron
 Iron is a mineral, and its main purpose is to carry oxygen
in the hemoglobin of red blood cells throughout the
body so cells can produce energy.
 Iron also helps remove carbon dioxide.
 Iron-deficiency anemia
 Deficiency increases rate of
low birth weight
preterm birth
stillbirth

16. Iron cont..
 Heme-rich foods (meat, fish,
and poultry), iron-rich legumes,
iron-fortified foods with
vitamin-C rich foods, iron and
vitamin C supplements

17. Iodine
Iodine is a type of mineral that’s naturally found
in the earth’s soil and ocean waters.
It’s important to get enough iodine in the diet.
 It regulates hormones, fetal development
Balanced, healthful diet will provide all the iodine
needed during pregnancy

18. Additional health measures
• Maintain health weight
• Exercise
• Immunizations
 Tobacco
 Alcohol
 Caffeine
 mood-altering drug risks

19. Alcohol
 Alcohol is a known teratogen that crosses the placenta
 Immature liver cannot metabolize alcohol
 Alcohol is may be contributing factor for:-
 birth defects and developmental disabilities
 Miscarriage
 IUGR
 fetal alcohol spectrum disorders (FASD)
 Developmental disabilities-
 Mental retardation
 Low birth weight
 Birth defects

20. FASD

21. Screening of alcohol

22. Alcohol cont..

23. Alcohol cont..
 Assess all women at least annually for alcohol use
patterns and risky drinking behaviours, and provide
appropriate counselling.
 Advise all women of the potential risks of alcohol use
for their own health and the health of any future
pregnancies and offspring.

24. cigarette smoking
• Smoking is may be contributing factor for:-
 Low birth weight
 IUGR
 Abruption placentae
 Placenta previa
 PROM
 Perinatal mortality

25. cigarette smoking cont..
 Both partners should stop smoking 4 months prior to
conception
 Cigarette smoke contain nicotine, and carbon monoxide.
 Nicotine crosses the placenta and distributes freely to
the CNS, having direct and indirect effects on neural
development

26. cigarette smoking cont..
 Screening of women and girls for tobacco use (smoking and
smokeless tobacco) at all clinical visits using “5 As” (ask,
advise, assess, assist, arrange) ƒ
 Providing brief tobacco cessation advice, pharmacotherapy
(including nicotine replacement therapy, if available) and
intensive behavioural counselling services ƒ
 Interventions proven effective:_ Motivated women more
likely to quit

27. The 5 A’s of Tobacco Treatment
ASK about tobacco USE and EXPOSURE
ADVISE tobacco users to QUIT
ASSESS READINESS to make a quit attempt
ASSIST with the QUIT ATTEMPT
ARRANGE FOLLOW-UP care
Adapted from rxforchange.ucsf.edu

28. Illegal drugs cont..
 Obtain a careful history on all women to identify illegal
drug use.
 Counsel women of childbearing age about the risks of
illegal drug use for their own health and for the health
of any future pregnancies and offspring.
 Refer women to appropriate counselling and
treatment programs that support abstinence and
rehabilitation.
 Offer women contraception until they are drug-free
and desire conception

29. Maintaining health weight
 A healthful diet and appropriate levels of physical activity
before conception
 The body mass index (BMI) is still the recognized method
of estimating nutritional status.
Overweight
 Underweight
 The higher BMI, the higher your risk for certain diseases
such as :-
Heart disease
High blood pressure
Type 2 diabetes
Certain cancers.

30. Maintaining health weight cont..
 A woman's weight at conception can influence her
pregnancy and delivery as well as the infant’s health
 Maintaining good nutritional status before becoming
pregnant is an essential preconception care topic.
 Achieving ideal body weight, controlling eating disorders
and pica, and developing nutritionally balanced dietary
habits are all important preparation for growing a
healthy baby and the prevention of low birth weight

31. Exercise
Physical activity
 Exercise at least 30
minutes 3 times / week.
 Eat a balanced meal
from the Food Pyramid

32. Man nutrition
 A man's nutrition before conception is also important
 Sperm number and motility (ability to move) are
reduced by alcohol consumption and certain
prescription and illegal drugs
 Adequate nutrition keeps the immune system strong
and promotes fertility

33. Vegetarianism and Veganism
 Vegans need more attention to:
– Vitamin D (unless regularly exposed to sunlight
throughout the pregnancy)
– Vitamins B6 and B12
– Calcium, iron, zinc
 Supplements containing these nutrients are usually
necessary

34. Caffeine consumption
 Caffeine is a stimulant that crosses the placenta and
reaches the fetus
 1 or 2 cups of coffee (200 mg of caffeine) per day is not
likely to harm the fetus
 Higher amounts may slightly increase the risk of
miscarriage and impair fetal growth
 Can make one feel full
 Considerable calories (if sweetened)

35. Drugs
 Illegal, prescription, over-the-counter drugs and
supplements
 Pass through the placenta
 Accumulate in fetal tissues and organs
 Impaired placental blood flow (reduced transfer of
oxygen and nutrients to fetus)
 Effects: low birth weight, premature delivery, placental
defects, and miscarriage
 Children: risk for developmental delays, impaired
learning, behavioral problems
 No safe level of use for illegal drugs

36. Immunizations in the Preconception
 Ideally, all women should be up-to-date with their vaccinations
before they become pregnant
 It is known that approximately 50 percent of all pregnancies are
unplanned
 Therefore, it is important to keep women of reproductive age
current with immunizations, regardless of whether they are
actively trying to conceive.
 All live attenuated vaccines are contraindicated in pregnancy due
to a theoretical risk to the fetus, although no evidence of any harm
from live vaccines has been documented
 Pregnancy is not an absolute contraindication to any vaccination

37. Immunizations in the Preconception cont ..
A. Immunization
 Maternal immunity is transmitted passively to the fetus
for those agents for whom she has developed
antibodies.
 Vaccines should be administered in the preconception
period
 Tetanus
 Rubella
 Diphtheria
 Hepatitis B
 If vaccines are administered during childhood,
protection is conferred through the childbearing years

38. Rubella
 Rubella is very dangerous for a pregnant woman and her
developing baby.
 Anyone who is not vaccinated against rubella is at risk of
getting the disease.
 Women should make sure they are protected from rubella
before they get pregnant
 Congenital Rubella Syndrome (CRS)
Deafness
Cataracts
Heart defects
Intellectual disabilities
Liver and spleen damage
Low birth weight
Skin rash at birth

39. Rubella cont..
Women who are planning to become pregnant
should check with their doctor to make sure they are
vaccinated before they get pregnant.
Because MMR(measles-mumps-rubella) vaccine is an
attenuated (weakened) live virus vaccine, pregnant
women who are not vaccinated should wait to get
MMR vaccine until after they have given birth.
Adult women of childbearing age should avoid getting
pregnant for at least four weeks after receiving MMR
vaccine

40. Hepatitis B
 Hepatitis B is a serious liver infection caused by the
hepatitis B virus (HBV)
 Hepatitis B spreads through contact with blood,
semen or other body fluids from an infected person.
 Women at risk for hepatitis B virus (HBV) infection or
anyone who requests the vaccine should receive the
three-dose primary series at zero, one to two and
four to six months

42. Assessment and treatment of infections during the pre-
pregnancy period
 There should be prevention and treatment of infections
from the couple to ensure protection of adverse effects
on the foetus
 All couples and individuals requiring to conceive need
appropriate assessment on infections that affect the
foetus like
HIV
STIs
Toxoplasmosis
cytomegalovirus

43. Infectious diseases
 Infectious diseases can impact pregnancy-related
outcomes and the reproductive health of women
 The preconception period is an ideal time to assess
women for infectious diseases
 Gonorrhoeal and chlamydial infections, may impact the
ability to conceive or the site of implantation
 Bacterial vaginosis (BV) and periodontal disease, are
linked with adverse pregnancy outcomes
 Screening for particular infections as part of the
preconception risk assessment can identify a number of
potential risks to women’s reproductive health and their
future pregnancy outcomes

44. Infectious diseases cont...
 Infections with HIV, viral hepatitis, STDs, and TB can
complicate pregnancy and may have serious
consequences for a woman, her pregnancy outcomes,
and her baby.
 Screening and treatment for these infections, and
vaccinations against viruses, such as hepatitis
B and human papillomavirus, can prevent many bad
outcomes.

45. Infectious diseases cont...
A. HIV/AIDS
 Provider-initiated HIV counselling and testing, including male
partner testing
 If HIV infection is identified before conception, timely
antiretroviral treatment can be administered
 women (or couples) can be given additional information that
can help prevent mother-to-child transmission
 Promoting safe sex practices and dual method for birth
control (with condoms) and STI control ƒ
 It could also be argued that providing women with
information about their HIV status before conception could
alter their reproductive plans, with some women choosing
not to become pregnant as a result of a positive diagnosis.

46. Cytomegalovirus
 Human cytomegalovirus is the most common viral
infection in pregnancy
 Congenital cytomegalovirus is the leading cause of
hearing loss in children
 intrauterine growth restriction
cerebral palsy
 mental retardation
 hepatosplenomegaly
petechiae
 jaundice
hearing loss
anemia.

47. Cytomegalovirus cont...
 There is no vaccine at present.
 Preconception testing of cytomegalovirus is not
recommended because there is no evidence that this
reduces prenatal infection.
 However, testing for immunity might be considered to
stratify the risk of consequences of cytomegalovirus
infection in pregnancy and the need for prevention
efforts because primary infection poses a greater risk of
sequelae of congenital infection.

48. Sexually transmitted infections
 All women and their sex partners should be counseled and given
access to treatment if needed during preconception.
 Providing age-appropriate comprehensive sexuality education and
services ƒ
 Promoting safe sex practices through individual, group and
community-level behavioural interventions ƒ
 Promoting condom use for dual protection against STIs and
unwanted pregnancies ƒ
 Ensuring increased access to condoms ƒScreening for STIs ƒ
 Increasing access to treatment and other relevant health services

49. Genetic diseases
 Women whose ethnic background, race, or personal or
family history, places them at increased risk to a genetic
disease should receive appropriate counseling.
 Women who have a genetic disease usually require
additional counseling about their own risks by someone
knowledgeable about genetics.
 This is because genetic conditions are often associated
with unique medical problems that may be adversely
affected by pregnancy or that can adversely affect
pregnancy outcome.
 A variety of genetic resources can be accessed for
detailed information about many inherited disorders.

50. Genetic diseases cont…
 A complete blood count with mean red blood cell
volume will exclude most serious inherited anemias.
 Hemoglobin electrophoresis is performed in
individuals at increased risk, such as
African-Americans for sickle syndromes and
Women of Mediterranean or Asian origin for
thalassemias.
Women with Jewish ancestry are candidates for
carrier testing for Tay-Sachs and Canavan disease

51. Genetic diseases cont…
Caucasians of northern European descent need
screening for cystic fibrosis.
Partners of women discovered to be carriers of
autosomal-recessive diseases should be tested to
determine the risk to future offspring.
Couples discovered to be at significant increased risk
of having an affected child can then contemplate
their reproductive options before undertaking a
pregnancy.

52. The Thalassemias
 Syndromes in which the rate of synthesis of a globin
chain is reduced
 beta thalassemia - reduced beta chain synthesis
alpha thalassemia – reduced alpha chain synthesis
 Diminished or absent synthesis of normal globin chains
(α or β); genetically heterogeneous
 Unbalanced globin chain synthesis causes microcytosis,
ineffective erythropoiesis and hemolysis

53. Thalassemias cont..
• Decreasing globin chain production
– Increasing globin chain imbalance causing:
– ineffective erythropoiesis (precipitated α chains)
– hemolysis (β tetramers or Hb H)
– Worsening anemia

54. Thalassemias cont..
 A person with thalassemia will have too few red blood
cells and too little hemoglobin, and the red blood cells
may be too small.
 Anyone considering pregnancy should first seek genetic
counseling, especially if both partners have or may have
thalassemia

55. Effect of thalassemias cont..
 cardiomyopathy
 Diabetes.
 Fetal growth restriction,
 Hydrops fetalis

56. Thalassemias cont…
Diagnosis
Genetic testing:
– DNA analysis will show whether a person has
thalassemia or faulty genes.
A reticulocyte count
--how fast red blood cells, or reticulocytes, are
produced and released by the bone marrow
A complete blood count (CBC):
---check levels of hemoglobin and the level and size
of red blood cells.

57. Treatment
1. Blood transfusions
2. Iron chelation removing excess iron from the
bloodstream
3. Bone marrow, or stem cell, transplant
4. Gene therapy:
 Inserting a normal beta-globin gene into the
patient's bone marrow, or using drugs to reactivate
the genes that produce fetal hemoglobin.

58.  attend all their regular appointments
 maintain contact with friends and support networks, to
help keep a positive attitude
 follow a healthy diet to maintain good health
 get a suitable amount of exercise

59. Tay-Sachs
 Tay-Sachs disease is a rare inherited condition that
mainly affects babies and young children.
 It stops the nerves working properly and is usually fatal.
 Carrier screening prior to pregnancy is most
advantageous, as it enables a couple to seek resources,
and make an informed decision while having the
greatest number of reproductive options
 Counseling to promote informed choices and
adaptation to the risk or condition

60. Cystic fibrosis
 Genetic disease that mainly affects the lungs and
digestive system, but it can result in fatal complications
such as liver disease and diabetes.
 The body produces thick and sticky mucus that can clog
the lungs and obstruct the pancreas.
 The mucus also interferes with pancreatic function by
preventing enzymes from properly breaking down food.
 Digestive problems result, potentially leading
to malnutrition.
 mucus can also cause male infertility by blocking the vas
deferens, or the tube that carries the sperm from the
testes to the urethra.

61. Cystic fibrosis cont..
• Pregnant women with cystic fibrosis are at risk of
complications that include:
Preterm birth
Gestational diabetes
Hypertension
Inadequate weight gain
IUGR
Fetal anomalies
Jaundice in premature babies

62. Cystic fibrosis cont…
 Diagnosis
A. Sweat test.
 Sweat is collected and the amount of chloride, a
component of salt in the sweat, is measured.
 A high level of chloride is an indication of CF.
B. Genetic tests
 analyzing cheek cells or a blood sample
 Tests are mainly used to find out if a person carries the CF
gene

63. Cystic fibrosis cont…
Treatment
There is currently no cure for CF.
Treatment can manage the symptoms of the disease,
however, and improve quality of life
Nutritional therapy for digestive symptoms
Airway clearance
Preconception risk assessment and counselling

64. Preconception counseling: environmental exposure
The AIMS
 To detect and possibly eliminate environmental risk
factors associated with poor pregnancy outcome
 To reduce perinatal mortality and infant mortality my
and morbidity

65. Environmental health
 Environmental health focuses on the relationship
between the environment and human health.
Having knowledge about environmental health
will allow you to
– Protect you and your family from hazards in your
environment

66. Environmental Exposures
 Everyone is exposed to environmental substances, but
fortunately only a few agents have an impact on
pregnancy outcome
 Exposures to infectious organisms and chemicals impart
the greatest risk

67. Environmental teratogens
 Exposures
Home
workplace
Environment
A. Physical/chemical hazards
 Ionizing radiation
Lead
Mercury
Hyperthermia
Herbicides
Pesticides

68.  Many chemicals found in the home, workplace, and
outside can be harmful to fertility and pregnancy.
 Some chemicals can affect the quantity and quality of
sperm.
 They can also influence male sexual performance,
including the ability to achieve or maintain erections.
 For women, exposure to harmful chemicals can change
hormone balances and, in some cases, lead to infertility
Environmental toxin

69. Environmental toxin cont..
 The woman may be exposed to a myriad of chemicals,
temperature extremes, heavy metals, radiation,
infectious agents, and stress factors in the home or
workplace that may negatively affect a developing fetus
and cause congenital anomalies.
 Preconception care includes counseling a woman to
identify such risks and ascertain their teratogenic
potential prior to pregnancy

70. chemicals and pollutants cont...

71. Environmental toxins cont...
 Exposure to environmental chemicals at levels
encountered in daily life can have negative effects on
women’s reproductive and children’s developmental
health
 Exposure to certain environmental chemicals has been
linked to
birth defects
 premature deliveries
Stillbirths
infants with low birth weight
problems with nervous system development

72. Household chemicals
 We are surrounded by chemicals and toxins (poisons).
 They include pesticides in the garden, flame retardants
on furniture, lead, mercury and some cleaning products
 Long-term use of items, such as paint strippers,
adhesives, spot removers and waxes may cause cancer,
nerve damage or reproductive failures.

73. Pesticides
 Pesticides are chemical compounds that are used to kill
pests, including insects, rodents, fungi and unwanted
plants (weeds)
 Being in contact with pesticides is harmful, especially
during pregnancy.
 It may lead to miscarriages, preterm births, low birth
weight, birth defects and learning problems in children
 Living or working in an area with crops, you may be
exposed to large amounts of pesticides.

74. Pesticides cont..
 If a woman must have her home or property treated
with pesticides, a pregnant woman should:
Have someone else apply the chemicals
Leave the area for the amount of time indicated on
the package instructions
Remove food, dishes, and utensils from the area
before the pesticide is used
Following application of pesticides in the home have
someone wash the area where food is prepared
Open the windows and allow air flow into the house
after pesticides applied

75. Mercury
 Being exposed to very high levels of mercury can
damage your health and increase the likelihood of
brain damage, and hearing and vision problems in a
developing baby.
 Some fish contain mercury, including shark (flake),
broadbill, marlin and swordfish

76. Paint and lead-based products
o High levels of lead in the body can affect the health
of unborn babies and children.
o Very high levels can lead to
premature birth
low birth weight
stillbirth.
o It’s important to keep your exposure to lead as low
as possible.

77. Lead poisoning
 Especially toxic to infants since the brain and nervous
system are still developing
 Can result in decreased mental capacity, behavioral
problems, anemia-impaired growth
 Allow tap water to run a minute before use to clear
pipes of lead-contaminated water
 Use only cold tap water for drinking, cooking, and infant
formula preparation
 Professionally remove lead-based paint

78. hyperthermia
 Hyperthermia refers to an abnormally high body
temperature.
 Extremely heavy exercise or prolonged exposure (longer
than 10 minutes) to heat sources such as hot tubs, very
hot baths, or saunas can also raise body temperature.
 Increased risk for birth defects called neural tube
defects (NTD) in babies of women who had high
temperatures early in pregnancy

79. hot tubs

80. Radiation exposure
 Radiation is energy. It travels in the form of energy waves
or high-speed particles.
 Radiation can occur naturally or be man-made.
– Non-ionizing radiation, which includes radio waves,
cell phones, microwaves, infrared radiation and visible
light
– Ionizing radiation, which includes ultraviolet
radiation, radon, x-rays, and gamma rays

81. Radiation exposure cont..
 A fetus is most vulnerable to the effects of radiation.
 Infants, children, pregnant women, and people with
compromised immune systems are more vulnerable to
health effects than healthy adults.
 Most of the radiopharmaceuticals used will cross the
placental barrier.

82. Fetal radiation risk
 There are radiation-related risks throughout pregnancy
that are related to the stage of pregnancy and absorbed
dose
 Radiation risks are most significant during organogenesis
and in the early fetal period, somewhat less in the 2nd
trimester, and least in the 3rd trimester Less Least Most
risk