PRECONCEPTIONAL COUNSELLING

WHAT IS PRE CONCEPTIONAL COUNSELLING?

A set of interventions that aim to

identify and modify biomedical,

behavioural and social risks to a

woman’s health or pregnancy

outcome through prevention and

management

IS IT IMPORTANT?

• Improving the mother’s preconceptional

health results in improved reproductive

health outcomes

• Reduced maternal morbidity and

mortality

• Prevents LBW, premature birth and

infant mortality

WHEN TO INITIATE PRECONCEPTIONAL CARE

• Any visit to a doctor in the reproductive years

• Annual health check up

• Postpartum check up

• A visit for a pregnancy test (esp if test negative)

• Emergency visit

• Visit for infertility treatment

• Premarital Counselling

GOALS OF PRECONCEPTIONAL CARE• Screening for high risk factors• Medical and surgical history• Previous Obstetric History• Personal history• Family history• Physical examination• Laboratary screening

PREVENTIVE HEALTHNutrition and Supplementation• Folic Acid 400mcg per day• Reduces occurrence of NTD• Higher Doses required in• Pts on anti epileptic drugs/

other antifolate drugs• Obese• Pts with h/o prev NTD

PREVENTIVE HEALTH

• Optimizing Weight in Overweight and

obese women

• Reduces risk of of NTD

• preterm deliveries

• Diabetes, Hypertension

• Cesarean Section

PREVENTIVE HEALTH- VACCINATION

• Hepatitis B Vaccination for at risk

women

• Rubella vaccination- prevents

Congenital Rubella Syndrome

SCREENING AND TREATMENT OF INFECTIONS

• HIV/ AIDS Screening and treatment

• Screening and Treatment of STD

• Reduces risk of ectopic pregnancy,

infertility, chronic pelvic pain

• Reduces risk of preterm birth, PPROM

• Reduces possible risk of fetal death,

neonatal sepsis and long term physical

and developmental disabilities

SPECIFIC INDUVIDUAL ISSUES

• Chronic Diseases

• Medications

• Addictions

CHRONIC MEDICAL ILLNESSRISK FACTOR INTERVENTION

Anti epileptic Drug use Change to less teratogenic treatment regimen

Diabetes Achieve and maintain HbA1C < 7

Hypertension Avoid ACE-I, ARBAssess for renal disease, cardiac function, Retinopathy

Hypothyroidism Thyroxine supplementation.Target TSH<3

Hyperthyroidism Prefer PTU to carbimazoleMaintain FT4 in high normal and TSH in low normal levels

SLE >6 months of quiescence on stable therapy

CHRONIC MEDICAL ILLNESSRISK FACTOR INTERVENTION

Cardiac Illness Rule out conditions where pregnancy is absolutely contraindicatedAdvice regarding surgery for optimizing the cardiac lesion prior to pregnancy if indicatedIf on warfarin switch to heparinGenetic Counselling in Congenital Cardiac disease

Cancer Fertility preservation options prior to therapy

RECURRENT PREGNANCY LOSS

• Check for APS and congenital thrombophilias

• Correction of anatomic problems like uterine septum, fibroid

removal, etc

GENETIC PROBLEMS

• Parental Karyotyping

• Carrier Screening based on ethnicity

or family history (Sickle Cell,

Thalassemia, etc)

• Dietary Advice (Eg; Phenylketonuria)

ADDICTIONS

• Smoking cessation

• Eliminating alcohol use before

and during pregnancy

TERATOGENICITY• Any agent that that acts during embryonic

or fetal development to produce a permanent alteration of form or function

• Drugs• Chemicals• Radiation• maternal medical conditions,• Infectious agents• Genetic factors

FDA CLASSIFICATION OF DRUGS IN PREGNANCY- 1979