Conderations, Lab Tests, Recommended Tests, Genetic Screening, Counseling

Preconception Care When Pregnancy is Contemplated Considers the Following:

  • Future pregnancy when choosing medications for patients
  • Immunizing teenage girls against rubella
  • Teaching males and females about safe sex practices and HIV prevention

Routine Pre-conceptual Laboratory tests include

  • Vaccination(s) should be offered to women pre-conception at risk for, more are susceptible to rubella, varicella, and hepatitis
  • Hemoglobin and Hematocrit
  • Urine screen for protein and glucose
  • Papanicolau cervical cytology (Pap Smear)
  • Screening for Gonorrhea, Syphilis, Chlamydia
  • Screening for human immunodeficiency virus (HIV) infection is recommended.

If positive, counseling and partner testing should be offered along with treatment. If negative, HIV prevention strategies should be reviewed.

Tests recommended for specific indications are as follows:

  • Testing to assess proven etiologies of recurrent pregnancy loss
  • Testing for maternal diseases based on medical or reproductive history
  • Mantoux skin test with purified protein derivative for TB

Recommended Testing for Families at Risk for Specific Genetic Based Diseases or Racial/Familial risk factors:

  • Sickle cell hemoglobinopathies (People of African Descent)
  • Thalassemia (Mediterraneans, Southeast Asians, and People of African descent "-thalassemia (People of African descent, and Thailanders
  • Tay-Sachs disease (Ashkenazi Jews, French Canadians, and Cajuns)
  • Gucher's Canavan, and Niemann-Pick disease (Ashkenazi Jews)
  • CF, fragile X syndrome for family history of nonspecific, predominantly male-affected, mental retardation, Duchenne muscular dystrophy.

Preconception Genetic Counseling and Screening Include

  • Family history of genetic diseases
  • Discussion of age-related risks
  • Discussion of disease-related risks
  • Carrier Screening
  • Potential options of donor egg or sperm or early genetic testing

General Preconception Counseling Include:

  • Family planning, pregnancy spacing
  • Exercise
  • Obesity - weight reduction before pregnancy
  • Increasing weight before pregnancy if underweight
  • Nutrition - Healthy eating
  • Abstinence from tobacco, alcohol, and illicit drugs
  • Advise administration of daily vitamin supplement containing 400mcg Folic Acid, and 30mg of elemental iron beginning at least one month before conception.
  • Women who have had a pregnancy with neural tube defect, should be advised to take 4.0mg of Folic Acid daily. (American Family Physician, June 15, 02)
  • Maintaining good control of any preexisting medical conditions (e.g., diabetes, hypertension, systemic lupus erythematosus, asthma, seizures, thyroid disorders, and inflammatory bowel. disease) Determining the time of conception by obtaining an accurate menstrual history, and providing instruction by using a menstrual calendar.