Pre-conception Counseling

 

 

Preconception care is defined as a set of interventions that aim to identify and modify biomedical, behavioral and social risks to the woman's health or pregnancy outcome through prevention and management. Certain steps should be taken before conception or early in pregnancy to maximize health outcomes.  

The goal of preconception care is to reduce the risk of adverse health effects for the woman, fetus, or neonate by optimizing the woman's health and knowledge before planning and conceiving a pregnancy. Because reproductive capacity spans almost four decades for most women, optimizing women's health before and between pregnancies is an ongoing process that requires access to and the full participation of all segments of the health care system.

Although most pregnancies result in good maternal and fetal outcomes, some pregnancies may result in adverse health effects for the woman, fetus, or neonate. Although some of these outcomes cannot be prevented, optimizing a woman's health and knowledge before planning and conceiving a pregnancy—also referred to as preconception care or pre pregnancy care—may eliminate or reduce the risk.

Therefore, the challenge of preconception care lies not only in addressing pregnancy planning for women who seek medical care and consultation specifically in anticipation of a planned pregnancy but also in educating and screening all reproductively capable women on an ongoing basis to identify potential maternal and fetal risks and hazards to pregnancy before and between pregnancies.

You can get started by making a preconception counseling appointment with your health care provider.

 

Preconception risk assessment :

 

Medical history

 

WOMEN WHO HAVE diabetes, hypertension, epilepsy or another seizure disorder, kidney disease, hepatitis or other liver disease, heart disease, a blood clotting disorder, lung disease, including asthma, thyroid disease, cancer, or a connective tissue disease such as lupus or rheumatoid arthritis?digestive problems?Have you ever had any operations? When and why? Have you ever had problems with anesthesia?

***Have you ever had a blood transfusion?

*** Are you being treated for any conditions right now?

*** Have you been exposed to any infectious diseases recently? Is there anyone in your household who has or has had hepatitis? Tuberculosis?

*** Has anyone in your family ever had diabetes, hypertension, a stroke, epilepsy or another seizure disorder, kidney disease, hepatitis or other liver disease, heart disease, a clotting disorder, lung disease including asthma, thyroid disease, cancer, or a connective tissue disease such as lupus or rheumatoid arthritis?

 

Age

 

Age is one of the most common factors that can add risk to a woman's pregnancy.

 

Young Women

 

Women under the age of 20 have a significantly higher risk of serious medical complications related to pregnancy than those over 20. Children born to teenage mothers are more likely to:

*** deliver prematurely

*** have a low birth weight

*** develop placenta previa

*** experience pregnancy-induced hypertension

*** contract toxemia

Some risk factors connected to young age include the following.

 

*** underdeveloped pelvis: Young women's bodies are still growing and changing. An underdeveloped pelvis can lead to difficulties during childbirth.

 

*** nutritional deficiencies: Young women are more likely to have poor eating habits. Nutritional deficiency can lead to extra strain on the body that causes more complications for both the mother and child.

 

*** high blood pressure: High blood pressure can trigger premature labor. This can lead to premature or underweight babies who require specialized care to survive.

 

Women over 35

 

As a woman ages, her chances of conceiving begins to decline. An older woman who becomes pregnant is also less likely to have a problem-free pregnancy. Common issues include the following:

 

*** underlying conditions: Older women are more likely to have conditions like high blood pressure, diabetes, or cardiovascular disease that can complicate pregnancy. When these conditions are not well controlled they can contribute to miscarriage, poor fetal growth, and birth defects.

 

*** chromosomal problems: A woman over 35 has a higher risk of having a child with birth defects due to chromosomal issues. Down syndrome is the most common birth defect related to chromosomes. It causes varying degrees of mental retardation and physical abnormalities. Prenatal screening and tests can help determine the likelihood of chromosomal complications.

 

*** miscarriage. A woman age 35–39 is more likely to have a miscarriage than a woman in her 20s. According to , a woman has about 20 percent risk of miscarriage at age 35. She has 80 percent risk of miscarriage at age 45.

 

*** other complications: Women over 35 are more likely to have complications commonly associated with pregnancy regardless of age. 

 

Fertility history

 

If you've had complications during a pregnancy, labor, or delivery that your practitioner is unaware of, try to get hold of the related medical records and bring them with you to your checkup. (But don't delay your preconception visit waiting for them, particularly if you're going to start trying to conceive soon).

 

*** Have you ever been pregnant before?

*** Have you ever had a miscarriage? If so, how many weeks pregnant were you? Did you have a D&C? Were there complications? Do you know the cause of the miscarriage?

*** Have you ever had an abortion? If so, in which trimester? Were there any complications?

*** Have you ever had an ectopic pregnancy? If so, how many weeks pregnant were you? Did you have surgery?

*** For each child you've given birth to: What was the birth date? Place of birth? How many weeks gestation? Gender? Birth weight? Was it a normal vaginal delivery, an assisted vaginal delivery, or a cesarean section?

*** Have you ever had pregnancy complications, such as gestational diabetes, preterm labor or delivery, preeclampsia, intrauterine growth restriction, or placental problems?

*** Did you suffer from depression during pregnancy or postpartum depression?

*** Did you have any complications during labor and delivery?

*** Did you have any postpartum complications, such as a postpartum hemorrhage?

 

Family history

 

What's your ethnic background? What's your partner's ethnic background? (The risk of some genetic disorders varies depending on your ethnic heritage, and there may be some variation in the emphasis and direction of the screening questions, depending on your and your partner's ancestry).

 

Drug use druging pregnancy

 

Alcohol, cigarettes, and OTHER drugs  are known to have harmful effects on the fetus. Any amount of these substances is considered unsafe during pregnancy. The best goal is to avoid them altogether. Quitting before you get pregnant is ideal, but stopping drug use at any point during pregnancy will benefit your baby.

Pregnancy can change how your body handles drugs, making some drugs even more harmful to you and your baby. Mothers who are substance abusers are more often involved in accidents, are more likely to overdose, and are more susceptible to certain diseases, especially if they share needles.

 

Workplace exposures

 

During a preconception visit, women should be asked about their workplace environment. Some workplace chemicals have been linked to adverse reproductive outcomes. Others are known to pass into breast milk, and could potentially be transmitted to an infant during breastfeeding. If potential exposures are identified, consultation with an occupational medicine specialist might assist with a more detailed investigation regarding recommendations for work modification.FDA currently advises that pregnant women and women of childbearing age, who may become pregnant, limit their consumption of shark and swordfish to no more that one meal per month. Many state government agencies issue fish advisories and bans relating to mercury concentrations in locally caught fish.

 

Weight

 

Obesity

 

Women who are obese are at a higher risk than normal-weight women of having babies with some birth defects, including spina bifida, heart problems, hydrocephaly, and cleft palate and lip. Obese women are also more likely to be diagnosed with gestational diabetes during the pregnancy. Obese women are also more likely to have high blood pressure. This can lead to a smaller than expected baby as well as increase the risk for pre-eclampsia and toxemia.

 

Underweight

 

Women who weigh less than 100 pounds are more likely to deliver prematurely or give birth to an underweight baby.

 

Food Dietary

 

vegetarian diets can cause protein deficiency and Egg and cheese before becoming pregnant should be added to their diet. Several studies have shown that there is relationship between caffeine consumption and pregnancy complications such as miscarriage and reduced fetal growth.

Women who are trying to conceive Or pregnant  women should not consume more than mg 200 per day.

 

Preconception irradation

 

Women who take x-rays periodically their graphs should be performed at the exact timing.

 

Vaccination history

 

Some vaccinations are recommended before you become pregnant, during pregnancy, or right after delivery. Having the right vaccinations at the right time can help keep you healthy and help keep your baby from getting very sick or having lifelong health problems.

Note: If you have a record of your immunizations or lab work documenting immunity, bring it with you to your appointment.

 

*** Have you ever had chicken pox or been vaccinated against it?

*** Did you complete your childhood vaccinations for measles, mumps, and rubella? Have you ever been tested for rubella immunity?

*** Have you ever been vaccinated against hepatitis B? Or human papillomavirus (HPV)?

*** When was your last tetanus booster? Did you receive the Tdap vaccine?

*** Have you had a flu shot this season?

*** Are you planning a trip out of the country that might require other vaccines?

Women able to get pregnant need 400 to 800 mcg or micrograms of folic acid every day, even if they are not planning to get pregnant. (This is the same as 0.4 to 0.8 mg or milligrams.) That way, if they do become pregnant, their babies will be less likely to have birth defects.

increasing the level of folic acid intake, along with a multivitamin, at least three months prior to conception. can dramatically reduce birth defects such as neural tube defects (e.g. spina bifida), and possibly other birth abnormalities such as congenital heart disease, urinary tract problems, oral facial clefts, limb defects.

 

 Prepregnancy Physical Activity


Regular physical activity is a necessary component of any healthy lifestyle plan, but it’s particularly useful for weight loss and weight control, reducing the risk of type 2 diabetes and management of blood glucose levels in type 1 and type 2 diabetes, reducing total and low-density lipoprotein cholesterol and raising high-density lipoprotein cholesterol, and keeping blood pressure in check.

Regular exercise before pregnancy is beneficial to both mom and baby.

 

Domestic Violence

 

Violence can lead to injury and death among women at any stage of life, including during pregnancy. The number of violent deaths experienced by women tells only part of the story. Many more survive violence and are left with lifelong physical and emotional scars.

If someone is violent toward you or you are violent toward your loved ones―get help. Violence destroys relationships and families.

 

Learn Your Family History

 

Collecting your family's health history can be important for your child's health. You might not realize that your sister’s heart defect or your cousin’s sickle cell disease could affect your child, but sharing this family history information with your doctor can be important.

Based on your family history, your doctor might refer you for genetic counseling. Other reasons people go for genetic counseling include having had several miscarriages, infant deaths, or trouble getting pregnant (infertility), or a genetic condition or birth defect that occurred during a previous pregnancy.

 

Preconception  laboratory Screening

 

Preconception screening can identify factors that could negatively affect your health or your pregnancy. A general history, including family history and laboratory testing, are essential to identify potential issues, which may need to be addressed prior to becoming pregnant.

A routine prenatal screen includes testing for anemia, blood type and infectious diseases. Based on your medical history and ethnic background, additional tests may be recommended.

The routine panel includes: a complete blood count (CBC), blood type and screen, testing for immunity to rubella and varicella (if you have never had chickenpox), and hepatitis B, HIV and syphilis infection testing

 

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