Preconception Care:Preconception Care:

Providing Fetal/MaternalProviding Fetal/Maternal

Health Risk Assessments Health Risk Assessments Lecture 4Lecture 4

Preconception PlanningPreconception PlanningImportant because: Important because: Offers best protection against low birth-Offers best protection against low birth-weight & weight &

other poor pregnancy outcomes. other poor pregnancy outcomes. 1989 - federal panel advised women 1989 - federal panel advised women planning to conceive to visit health care planning to conceive to visit health care provider at least once before conception. provider at least once before conception. Healthy pregnancy closely related to Healthy pregnancy closely related to woman’s health before conception. woman’s health before conception. Improves chances for healthy baby.Improves chances for healthy baby.

Preconception counseling: Preconception counseling: Assess risks of medical & non-Assess risks of medical & non-

medical factors: GDM, HTN, heart medical factors: GDM, HTN, heart disease, psychiatric disorders, disease, psychiatric disorders, domestic abuse, depression, Genetic domestic abuse, depression, Genetic disorders.disorders.

Discuss nutrition, meds, exercise, Discuss nutrition, meds, exercise, tobacco, alcohol, drug use, family tobacco, alcohol, drug use, family support, unemployment, work-support, unemployment, work-related hazards related hazards

Most critical time for fetus is day 17 Most critical time for fetus is day 17 – 56 when organs, limbs, skeletal, – 56 when organs, limbs, skeletal, CNS forming. CNS forming.

Exposure to environmental risks Exposure to environmental risks harmful to embryo when woman may harmful to embryo when woman may not realize she is pregnant.not realize she is pregnant.

Pre & Post-Pregnancy Pre & Post-Pregnancy PlanningPlanning

Considerations for Potential Parents:Considerations for Potential Parents:Financial Responsibility:Financial Responsibility:Cost of prenatal care, delivery, loss of work Cost of prenatal care, delivery, loss of work

(both), child care (home or day care (both), child care (home or day care center), childrearing.center), childrearing.

Leaving workforce - does she plan to Leaving workforce - does she plan to return ?return ?

Employment benefits -are they adequate Employment benefits -are they adequate to support maternal/infant pre & post to support maternal/infant pre & post natal care ?natal care ?IMPORTANT COMPONENTS OF PRECONCEPTION IMPORTANT COMPONENTS OF PRECONCEPTION CARECARE

See a health care provider. Get physical See a health care provider. Get physical exam. exam.

Discuss risks. Maintain follow-up care. Discuss risks. Maintain follow-up care. Update Update

ImmunizationsImmunizations

Prenatal High-Risk FactorsPrenatal High-Risk Factors

Social/Personal: Low income level, Social/Personal: Low income level, poor diet, multiparity > 3, weight < poor diet, multiparity > 3, weight < 100lb; weight > 200 lb; age <16; 100lb; weight > 200 lb; age <16; age >35; smoking, addictionsage >35; smoking, addictions

Pre-existing medical hx: Diabetes Pre-existing medical hx: Diabetes mellitus, cardiac disease, anemia, mellitus, cardiac disease, anemia, hypertension, thyroid disorder, renal hypertension, thyroid disorder, renal disease.disease.

Obstetric: Previous stillborn, Obstetric: Previous stillborn, habitual abortion, cesarean delivery, habitual abortion, cesarean delivery, Rh or blood group sensitization. Rh or blood group sensitization. [ABO or Rh incomp.][ABO or Rh incomp.]

““TORCH” special group of infections” TORCH” special group of infections” Toxoplasmosis, Toxoplasmosis, Hepatitis B, Syphilis, Hepatitis B, Syphilis,

Varicella,Varicella, Rubella, Rubeola, Rubella, Rubeola, Cytomegalovirus, Herpes simplex Cytomegalovirus, Herpes simplex O = O = otherother

TORCH TORCH applies to pregnant women, applies to pregnant women, unborn child, newborn, children. unborn child, newborn, children. Common cause of birth defects. Common cause of birth defects.

Can cause stillbirth. Can cause stillbirth.

Infection causes Infection causes few symptomsfew symptoms in in pregnant woman. pregnant woman.

In infants - In infants - serious birth defectsserious birth defects result if result if infections contracted during infections contracted during pregnancy/delivery. pregnancy/delivery.

11stst trimester – more severe defects trimester – more severe defects

Current pregnancyCurrent pregnancy: Check titers: vaccines : Check titers: vaccines available but most available but most notnot during preg. during preg.

Toxoplasmosis – rare; toxoplasma gondii Toxoplasmosis – rare; toxoplasma gondii [protozoal infec] transmitted to mom thru [protozoal infec] transmitted to mom thru raw meat or exposure to infected cat’s raw meat or exposure to infected cat’s feces. Severity > in 1st trimes. feces. Severity > in 1st trimes.

Varicella - member of herpesvirus; worse in Varicella - member of herpesvirus; worse in 1st trimes. Infant may have life-1st trimes. Infant may have life-threatening disease.threatening disease.

Hep.BsAg – + Hepatits B in mom; infant Hep.BsAg – + Hepatits B in mom; infant gets Hep.B vaccine & Immunoglobulin @ gets Hep.B vaccine & Immunoglobulin @ delivery; followed by 2 more Hep.B delivery; followed by 2 more Hep.B vaccines in 1st yr. vaccines in 1st yr.

Syphilis – untreated can cause fetal death. Syphilis – untreated can cause fetal death. Tx PCN Repeat VDRL > tx.Tx PCN Repeat VDRL > tx.

Rubella Rubella (1st trimester) 50% rate of (1st trimester) 50% rate of

malformation. malformation. (2(2ndnd tri) 6% rate of damage tri) 6% rate of damage If non- immune, avoid anyone w. If non- immune, avoid anyone w.

active disease. active disease. NO vaccine while pregnant but NO vaccine while pregnant but

immunize > del.immunize > del.No preg. for 3 mos. No preg. for 3 mos. Defects: Hearing loss, Deafness, Defects: Hearing loss, Deafness,

Blindness, Heart & Neuro defects, Blindness, Heart & Neuro defects, Mental Retardation Mental Retardation

CytomeglovirusCytomeglovirus – part of herpesvirus family. – part of herpesvirus family. Defects: Mental retardation, hydrocephaly , Defects: Mental retardation, hydrocephaly , microcephaly, microcephaly, blindness; deafness. blindness; deafness. May be May be picked up during 1picked up during 1stst year or > 1 yr of age. year or > 1 yr of age. If 1st trimes.infection, may consider AB.If 1st trimes.infection, may consider AB.

HSV 2 HSV 2 [genital ]. [genital ]. Valtrex -Valtrex - suppress lesions; C/S suppress lesions; C/S if lesions @ time of del. Blindness, MR, deathif lesions @ time of del. Blindness, MR, death

Vaccines you can get during Vaccines you can get during pregnancy: pregnancy:

Tetanus & influenza vaccine [flu]Tetanus & influenza vaccine [flu] Rubella vaccine: only after deliveryRubella vaccine: only after delivery If equivocal [aka borderline] pt. gets If equivocal [aka borderline] pt. gets

vaccine. vaccine. MD order, consent signed by pt. MD order, consent signed by pt. Explain risks of birth defects Explain risks of birth defects

pregnant within 3 mos.of vaccine. pregnant within 3 mos.of vaccine. Live virus. SC injection Live virus. SC injection

HIV: test done in HIV: test done in NYSNYS to all newborns - to all newborns - Newborn Screening Test Newborn Screening Test

36% of HIV-infected women using illicit 36% of HIV-infected women using illicit drugs during pregnancy had no prenatal drugs during pregnancy had no prenatal care. care.

# of infants with AIDS (d/t perinatal # of infants with AIDS (d/t perinatal transmission) declined from 122 in 2000 transmission) declined from 122 in 2000 to 47 in 2004.to 47 in 2004. (CDC) (CDC)

CDC, AWHONN, Institute of Medicine & CDC, AWHONN, Institute of Medicine & ACOG support policy of universal HIV ACOG support policy of universal HIV testing as routine component of prenatal testing as routine component of prenatal care. [2001] care. [2001]

Retest for HIV in 3Retest for HIV in 3rdrd trimester (new trimester (new practice) practice)

Do ELISA (screen) then Western Blot Do ELISA (screen) then Western Blot (confirm). (confirm).

Seroconversion: Usually by 12-22 days Seroconversion: Usually by 12-22 days after infection. All by 6 mos.after infection. All by 6 mos.

Offer Offer HIV HIV test @ initial visit. Mom can test @ initial visit. Mom can refuse. refuse.

Discuss Discuss riskrisk of not taking test . of not taking test .HIV+ - treat with ZVD (zidovudine) in 2-3rd HIV+ - treat with ZVD (zidovudine) in 2-3rd

trimesters. Transmission ~ 25% without trimesters. Transmission ~ 25% without Rx; with tx ~ 8.3 %. Rx; with tx ~ 8.3 %.

If Rx begun @ del. or only to newborn, rate If Rx begun @ del. or only to newborn, rate = 15%. = 15%.

Treat in antepartum, intrapartum & infant Treat in antepartum, intrapartum & infant x 6 weeks.x 6 weeks.

Monotherapy (ZVD) for viral load < 1,000. Monotherapy (ZVD) for viral load < 1,000.

New (2003): 3 drug tx reduces rate to 1-2 New (2003): 3 drug tx reduces rate to 1-2 %. Start in 2%. Start in 2ndnd trimester. For viral load > trimester. For viral load > 1,000.1,000.

Woman must deal with guilt, depression, Woman must deal with guilt, depression, stigma.stigma.

Common Discomforts of Common Discomforts of PregnancyPregnancy

11stst Trimester Trimester

Nausea & vomitingNausea & vomiting Causes: hormonal, fatigue, changes Causes: hormonal, fatigue, changes

in carb metabolism in carb metabolism Interventions: sm. freq. meals; eat Interventions: sm. freq. meals; eat

slow; dry toast ; deep breaths.slow; dry toast ; deep breaths. Ends by 2Ends by 2ndnd trim; if severe, trim; if severe,

hospitalize & hydratehospitalize & hydrate

Nasal StuffinessNasal Stuffiness:: Causes: edema of nasal mucosa d/t ^ Causes: edema of nasal mucosa d/t ^ estrogen levelsestrogen levels

Interventions: saline drops; humidifier. Interventions: saline drops; humidifier. Pseudafed 2Pseudafed 2ndnd/ 3rd trimester./ 3rd trimester.

Breast Enlargement & TendernessBreast Enlargement & Tenderness [cold [cold weather]weather] Causes: ^ estrogen & progesterone Causes: ^ estrogen & progesterone levelslevels

Interventions: Support bra with wide Interventions: Support bra with wide shoulder straps; jacket/sweater.shoulder straps; jacket/sweater.

Urinary Frequency & UrgencyUrinary Frequency & Urgency Causes: pressure of uterus on bladder; Causes: pressure of uterus on bladder;

lasts 3 mos. & disappears; reappears in lasts 3 mos. & disappears; reappears in late preg. when head is engaged. + late preg. when head is engaged. + blood/burning on urination - signs of UTI. blood/burning on urination - signs of UTI.

InterventionsInterventions: UA & urine Cx & Tx with : UA & urine Cx & Tx with AB. AB.

Reduce caffeine. Do Kegel’s. Plan Reduce caffeine. Do Kegel’s. Plan frequent BR stops.frequent BR stops.

Increased vaginal discharge: “leukorrhea”Increased vaginal discharge: “leukorrhea” Causes: ^ estrogen & ^ blood supply to Causes: ^ estrogen & ^ blood supply to

vagina; hyperplasia of vag.mucosa.vagina; hyperplasia of vag.mucosa. InterventionsInterventions: daily bath; sanitary pads : daily bath; sanitary pads

OK but no tampons, tight pants or OK but no tampons, tight pants or underwear > infection. Pruritis/erythema underwear > infection. Pruritis/erythema - poss. fungal infection. - poss. fungal infection.

Common Discomforts Of 2nd & 3rd Common Discomforts Of 2nd & 3rd TrimestersTrimesters

HeartburnHeartburn Causes: Relaxation of cardiac Causes: Relaxation of cardiac

sphinter, ↓ GI mobility; ↑ sphinter, ↓ GI mobility; ↑ progesterone & gastric displacement. progesterone & gastric displacement. Food backs up from stomach into Food backs up from stomach into esophagus, irritates lining; “burning”.esophagus, irritates lining; “burning”.

Interventions: Small, freq. meals; Interventions: Small, freq. meals; chew slowly; avoid extra weight gain, chew slowly; avoid extra weight gain, avoid tight fitting clothes, avoid fried avoid tight fitting clothes, avoid fried & fatty foods; sleep with HOB ^; & fatty foods; sleep with HOB ^; Take antacid if all else fails. Take antacid if all else fails.

HemorrhoidsHemorrhoids [varicosities rectal veins] [varicosities rectal veins]Causes: Pressure on pelvic veins; in ^ Causes: Pressure on pelvic veins; in ^ 3rd trimes3rd trimesInterventions: modified Sim’s position; Interventions: modified Sim’s position; stool softeners; witch hazel/cold stool softeners; witch hazel/cold compresses.compresses.

ConstipationConstipationCauses: oral iron supplements; ↓ Causes: oral iron supplements; ↓ peristalsis; displacement of bowels by peristalsis; displacement of bowels by fetus.fetus.Interventions: No mineral oil; interferes Interventions: No mineral oil; interferes with vitamin metabolism. ^ po fluids; ^ with vitamin metabolism. ^ po fluids; ^ roughage; attempt regular BM’s.roughage; attempt regular BM’s.

Backache: *R/O UTI 1stBackache: *R/O UTI 1st Causes: Posture changes during Causes: Posture changes during

preg.d/t ^ uterine enlargementpreg.d/t ^ uterine enlargement Interventions: Low heels; walk with Interventions: Low heels; walk with

pelvis tilted forward; squat when pelvis tilted forward; squat when lifting; don’t bend. Firm mattress; lifting; don’t bend. Firm mattress; heat therapy; Tylenol.heat therapy; Tylenol.

Leg CrampsLeg Cramps Causes:Pressure from enlarging Causes:Pressure from enlarging

uterus, poor circulation; fatigue, ↓ uterus, poor circulation; fatigue, ↓ Ca & ↑ Phosphorus Ca & ↑ Phosphorus

Interventions: dorsiflex affected Interventions: dorsiflex affected foot; elevate legs.foot; elevate legs.

Aluminum hydroxide [Amphogel] Aluminum hydroxide [Amphogel] binds phosphorus & reduces it in binds phosphorus & reduces it in circulation. circulation.

Shortness of Breath : DyspneaShortness of Breath : Dyspnea Causes: pressure of uterus on diaphragm Causes: pressure of uterus on diaphragm & & compression of lungs; more @ night when compression of lungs; more @ night when flat.flat. Interventions: 2-3 pillows @ night; sitting Interventions: 2-3 pillows @ night; sitting upright.upright.

Ankle EdemaAnkle Edema Causes: fluid retention & poor venous Causes: fluid retention & poor venous return from lower extremities; return from lower extremities; aggravated by prolonged sitting oraggravated by prolonged sitting or standing & warm weather. Occurs near standing & warm weather. Occurs near term.term. Interventions: ^ legs, avoid tight fitting Interventions: ^ legs, avoid tight fitting pantspants

CONTROLLABLE RISK FACTORSCONTROLLABLE RISK FACTORS

Nutrition: Nutrition: Know ideal weight for your Know ideal weight for your height. Instruct client to keep food diary. height. Instruct client to keep food diary. Examine food choices in daily diet.Examine food choices in daily diet.

If underweight/overweight before conception, If underweight/overweight before conception, counsel about proper nutrition.counsel about proper nutrition.

CalciumCalcium//zinczinc - beneficial for long-term health - beneficial for long-term health needs & growth/development of baby. needs & growth/development of baby.

Folic acid:Folic acid: protects against neural tube defects protects against neural tube defects aka spina bifida. aka spina bifida.

GOOD SOURCES:GOOD SOURCES:Folic acid:Folic acid: broccoli, collard greens, broccoli, collard greens, dried peas, beans, citrus fruits and dried peas, beans, citrus fruits and juices.juices.ZincZinc: whole grains, oats, wheat, barley, : whole grains, oats, wheat, barley, peas, beans.peas, beans.Calcium:Calcium: milk, yogurt, cheese, tofu, milk, yogurt, cheese, tofu, sardines with bones, soy milk, OJ, sardines with bones, soy milk, OJ, legumes.legumes.

US Public Health ServiceUS Public Health Service & & March of DimesMarch of Dimes recommends all women of childbearing age - recommends all women of childbearing age - 0.4 mg [400mcg] of folic acid daily - reduce risk 0.4 mg [400mcg] of folic acid daily - reduce risk

of neural tube defects. No more than 1 mg. of neural tube defects. No more than 1 mg. Supplement Supplement Folic Acid intake if you Folic Acid intake if you

are:are: Of child bearing ageOf child bearing age Planning pregnancyPlanning pregnancy 800-1000 mcg daily 800-1000 mcg daily duringduring pregnancypregnancy

PNV contain all requirements needed for PNV contain all requirements needed for pregnancy pregnancy

including folic acid & iron.including folic acid & iron.

NutritionNutrition

RDA: add 300 kcal in 2RDA: add 300 kcal in 2ndnd & 3 & 3rdrd trimester. trimester. Total Calories = 2500kcal/day (pregnant); Total Calories = 2500kcal/day (pregnant);

2200 non-pregnant2200 non-pregnant Underweight clients >300 kcal. increase. Underweight clients >300 kcal. increase.

(~ 2800 kcal/day)(~ 2800 kcal/day) RDA for protein/minerals/vitamins: ^ 60 RDA for protein/minerals/vitamins: ^ 60

g./dayg./day Daily iron requirement doubles in preg. Daily iron requirement doubles in preg.

(15 to 30 mg)(15 to 30 mg) Minerals (Ca, phos, iodine, Fe, Z) from Minerals (Ca, phos, iodine, Fe, Z) from

fruits/veg.fruits/veg. Calcium/phosphorous stays same if client Calcium/phosphorous stays same if client

follows daily recommended intake; * follows daily recommended intake; * teens < 19 need 1300mg./day. teens < 19 need 1300mg./day.

VegetarianismVegetarianism Vegen diet – no food from animal Vegen diet – no food from animal

sources (eggs, fish, chicken) most sources (eggs, fish, chicken) most challenging for health care challenging for health care providers.providers.

Adequate “pure” vegan diet: nuts, Adequate “pure” vegan diet: nuts, grains, vegetables, fruits, legumes, grains, vegetables, fruits, legumes, rice, soy milk. rice, soy milk.

May be anemic & not get enough May be anemic & not get enough calories.calories.

FFISH: up to 12 oz/wk of low mercury fish. ISH: up to 12 oz/wk of low mercury fish. Canned light tuna, shrimp, salmon, Canned light tuna, shrimp, salmon, catfish is ok.catfish is ok.

No swordfish, shark, tilefish, king No swordfish, shark, tilefish, king mackerel mackerel (high mercury) (high mercury)

Lactose intolerance or cultural Lactose intolerance or cultural avoidanceavoidance can lead to lowered calcium can lead to lowered calcium intake; recommend yogurt, cheese, intake; recommend yogurt, cheese, sardines, beans, collard greens, figs, OJ, sardines, beans, collard greens, figs, OJ, tofu, Lactaid. (commercial lactose).tofu, Lactaid. (commercial lactose).

* Few demands placed on maternal * Few demands placed on maternal nutrition in 1nutrition in 1stst trimester. trimester.

RDA RDA fluidsfluids = 6-8 glasses (1500-2000 ml); = 6-8 glasses (1500-2000 ml); water, milk, juices.water, milk, juices.

> 200mg caffeine daily doubles risk for > 200mg caffeine daily doubles risk for miscarriage miscarriage

1 cup ~ 100 mg ~ 250ml1 cup ~ 100 mg ~ 250ml

Weight Gain Weight Gain (new slide)(new slide)

Women of Normal weight: 25 - 35 lbs. Women of Normal weight: 25 - 35 lbs. (11.5 - 16 kg)(11.5 - 16 kg)

Underweight women: 28 - 40 lbs. Underweight women: 28 - 40 lbs. (12.6 - 18 kg)(12.6 - 18 kg)

Overweight women: 15 - 25 lbs. (7 - Overweight women: 15 - 25 lbs. (7 - 11.5 kg)11.5 kg)

Twins or Multifetus: woman should Twins or Multifetus: woman should gain 4 to 6 lbs. in 1st trimester, 1.5 gain 4 to 6 lbs. in 1st trimester, 1.5 pounds per week in 2nd and 3rd pounds per week in 2nd and 3rd trimester, for total of 35 to 45 lbs. trimester, for total of 35 to 45 lbs.

PICAPICA: eating non-food substances (dirt, : eating non-food substances (dirt, clay, laundry clay, laundry

starch, paint chips) or foods of low starch, paint chips) or foods of low nutritional value (ice, cornstarch)nutritional value (ice, cornstarch)

In US, most common in African In US, most common in African Americans, women from rural areas, or Americans, women from rural areas, or women with family hx pica. women with family hx pica.

Interferes with normal consumption of Interferes with normal consumption of nutrients; causes anemia in mom. Possible nutrients; causes anemia in mom. Possible lead poisoning.lead poisoning.

In depth diet analysis – nutrition In depth diet analysis – nutrition counselingcounseling

RN discusses cravings. 24 hr. diet re-call.RN discusses cravings. 24 hr. diet re-call. Follow up done @ prenatal visits. Follow up done @ prenatal visits. Folic Acid for ^ RBC production. 50% Folic Acid for ^ RBC production. 50%

more in pregnancy (800 ug/day); enriched more in pregnancy (800 ug/day); enriched grain products.grain products.

Controllable Risk Factors: Drug, Controllable Risk Factors: Drug, Alcohol, Tobacco UseAlcohol, Tobacco Use

Alcohol:Alcohol:. . Avoid all alcohol during Avoid all alcohol during time attempting time attempting conception/pregnancy. conception/pregnancy.

No known safe level during pregnancy. No known safe level during pregnancy. AsAssociated with malformation, slow fetal sociated with malformation, slow fetal growth, fetal death, low birth-weight, growth, fetal death, low birth-weight, CNS abnormalities, neurologicaldefects, CNS abnormalities, neurologicaldefects, spontaneous abortion, abruption. spontaneous abortion, abruption.

Tobacco: Tobacco: AAssociated with ssociated with spontaneous abortion, ectopic spontaneous abortion, ectopic pregnancy; low birth-weight, infant pregnancy; low birth-weight, infant mortality. Can potentially decrease mortality. Can potentially decrease fertility. Vasoconstriction restricts blood fertility. Vasoconstriction restricts blood flow to fetus & reduces % of oxygen & flow to fetus & reduces % of oxygen & nutrients carried by blood.nutrients carried by blood.

Illicit or Street Drugs:Illicit or Street Drugs: May be May be associated with severe medical & associated with severe medical & developmental problems in newborns. developmental problems in newborns.

1. Marijuana, most common - tend to 1. Marijuana, most common - tend to have babies earlier & may be smaller have babies earlier & may be smaller than term babies.than term babies.

2. Cocaine: associated with miscarriage, 2. Cocaine: associated with miscarriage, abruption, low birth-weight, premature abruption, low birth-weight, premature birth, brain damage. birth, brain damage.

3. Heroin - IV drug users - evaluate for 3. Heroin - IV drug users - evaluate for AIDS & Hep B. In HIV + women, AIDS & Hep B. In HIV + women, studies show treatment with AZT studies show treatment with AZT reduces ransmission to baby from ~ reduces ransmission to baby from ~ 25% to 8%.25% to 8%.

Exercise in ModerationExercise in Moderation

Boosts self-image, reduces tension, Boosts self-image, reduces tension, decreases physical discomfort. decreases physical discomfort.

Get medical clearance before starting Get medical clearance before starting exercise program.exercise program.

Don’t exercise in hot/humid weather or Don’t exercise in hot/humid weather or to point of exhaustion.to point of exhaustion.

Avoid exercise with risk of traumatic Avoid exercise with risk of traumatic injury: downhill skiing, horseback injury: downhill skiing, horseback riding, water skiing, tennis, etc. riding, water skiing, tennis, etc.

Recommended: walking, cycling on Recommended: walking, cycling on stationary bike, swimming stationary bike, swimming

Avoid High Internal Body TempAvoid High Internal Body Temp During early pregnancy, can During early pregnancy, can interfere with normal embryonic interfere with normal embryonic development.development.

Study published August 1992: use of Study published August 1992: use of hot tubs & saunas found to raise hot tubs & saunas found to raise body temperature to 102ºF if body temperature to 102ºF if women stayed in tubs for up to 15 women stayed in tubs for up to 15 minutes. ^ risk of neural tube minutes. ^ risk of neural tube defects in offspring. defects in offspring.

Stress Management Stress Management TechniquesTechniques

Relaxation & deep breathing. Relaxation & deep breathing. PPlanning pregnancy can be lanning pregnancy can be stressful.stressful.

Stress reduction enhances Stress reduction enhances chances of conception. chances of conception.

Excessive stress can lead to premature Excessive stress can lead to premature birth & low birth weight. Sleep 8-10 birth & low birth weight. Sleep 8-10 hr.with frequent rest periods a day.hr.with frequent rest periods a day.

Common STDs & effects to baby if Common STDs & effects to baby if untreateduntreated::

ChlamydiaChlamydia: Ear/eye infections, : Ear/eye infections, pneumonia.pneumonia.

Genital HerpesGenital Herpes: Active infection - baby : Active infection - baby born thru vaginal opening with open born thru vaginal opening with open sores – leads to severe skin infections, sores – leads to severe skin infections, nervous system damage, blindness, nervous system damage, blindness, mental retardation, death can occur.mental retardation, death can occur.

Genital WartsGenital Warts: (If infection is active : (If infection is active during delivery): Warts can grow in voice during delivery): Warts can grow in voice box & block windpipe.box & block windpipe.

GonorrheaGonorrhea: Eye Infections, blindness.: Eye Infections, blindness. SyphilisSyphilis: Damage to bone, lung, liver, : Damage to bone, lung, liver,

blood vesselsblood vessels Other Infections that can cause PTL: Other Infections that can cause PTL: UTI UTI

& BV& BV

Exposure to ContraceptivesExposure to Contraceptives Controversial adverse effects on fetus. Do not Controversial adverse effects on fetus. Do not

use.use.

Prescription and Over-the-Counter Prescription and Over-the-Counter DrugsDrugs

Often unsafe during pregnancy: Accutane (acne) Often unsafe during pregnancy: Accutane (acne) birth defects.birth defects.

Avoid drugs used for headaches/common colds.Avoid drugs used for headaches/common colds.

Environmental Reproductive Environmental Reproductive HazardsHazards

Avoid unnecessary environmental risks at Avoid unnecessary environmental risks at home/work.home/work.

Paint Thinners, Varnish Removers, Cleaning Paint Thinners, Varnish Removers, Cleaning Solvents, GlueSolvents, Glue

X-rays, Radioactive materials, Cat litter X-rays, Radioactive materials, Cat litter (toxoplasmosis)(toxoplasmosis)

Leave job with questionable hazards.Leave job with questionable hazards. Use protective equipment/safety protocols.Use protective equipment/safety protocols.

FDA Pregnancy Risk FDA Pregnancy Risk Category for DrugsCategory for Drugs

Category A: no risk to fetus in any Category A: no risk to fetus in any trimestertrimester

Category B: no adverse effects in Category B: no adverse effects in animals; no human studies availableanimals; no human studies available

Category C: Only prescribed after Category C: Only prescribed after risks to fetus are considered. Animal risks to fetus are considered. Animal studies have shown adverse reaction; studies have shown adverse reaction; no human studies availableno human studies available

Category D: Definite fetal risks, may Category D: Definite fetal risks, may be given in spite of risks in life-be given in spite of risks in life-threatening situationsthreatening situations

Category X: Absolute fetal Category X: Absolute fetal abnormalities. Do not use anytime in abnormalities. Do not use anytime in pregnancy (Lithium, Accutane)pregnancy (Lithium, Accutane)

Male Role in Preparing for PregnancyMale Role in Preparing for Pregnancy

Male planning to become father Male planning to become father should:should:

Review family medical & genetic hxReview family medical & genetic hx Practice STD risk-reduction Practice STD risk-reduction

behaviors.behaviors. Avoid tobacco, alcohol, illicit/street Avoid tobacco, alcohol, illicit/street

drugs, chemical exposure.drugs, chemical exposure. Assess financial status.Assess financial status. Be supportive of partner.Be supportive of partner. Play active role in pre-pregnancy Play active role in pre-pregnancy

planning.planning.

Age is a Big FactorAge is a Big Factor

Teenagers and WTeenagers and Women over 40 omen over 40 years - greatest risk.years - greatest risk.

Women over 40 years Women over 40 years Have decreased fertility.Have decreased fertility. Have increased risk for Downs Have increased risk for Downs

Syndrome Syndrome & hypertension. & hypertension. Should talk with health care Should talk with health care

provider about Prenatal testing. provider about Prenatal testing. HealthyHealthy pregnant women > 40 yrs pregnant women > 40 yrs

who follow recommended practices who follow recommended practices have about same chances as younger have about same chances as younger women for healthy pregnancy women for healthy pregnancy outcome. outcome.

TEENS: more likely [than women in 20’s] TEENS: more likely [than women in 20’s] to have to have labor, delivery & low-birth-weight labor, delivery & low-birth-weight problems. problems.

Almost half of all pregnant teens do not Almost half of all pregnant teens do not get prenatal care in 1st trimester of get prenatal care in 1st trimester of pregnancy.pregnancy. Teens less likely to gain appropriate Teens less likely to gain appropriate weight & often practice unhealthy weight & often practice unhealthy eating habits.eating habits.