Pre-conception / Inter-conception Care
Training Curriculum 2
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:
- Vaccinations for Rubella, varicella, and hepatitis
- Hemoglobin and Hematocrit
- Urine screen for protein and glucose
- Papanicolau cervical cytology (Pap Smear)
- Screening for Gonorrhea, Syphillis, 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:
To assess proven etiologies of recurrent pregnancy loss
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 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
Potential options of donor egg or sperm or early genetic testing
General Preconception Counseling Include:
Family planning, pregnancy spacing
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 (eg, 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.
Substance Use and Preconception care
Patient education must be directed to the:
The effects of substance on the fetus
Screening for substance use and abuse
Referrals to a treatment program
Pregnancy may be a strong motivator for change
Preconception Care as it Relates to Alcohol Intake in Pregnancy
Patient must be counseled that:
- Fetal Alcohol Syndrome is the leading cause of preventable mental retardation
- No level of alcohol consumption is considered safe
- To abstain when attempting to conceive and during pregnancy
- Assessment for problem drinking will be conducted with a standardized screening tool.
Preconception care as it Relates to Tobacco Use
Patient must be counseled that:
- Smoking is the leading preventable cause of low birth-weight- for every 10 cigarettes smoked daily, the risk of delivering an SGA infant increases by a factor of 1.5.
- Smoking is associated with placental abruption, pre-term delivery, placenta previa, and miscarriage.
- Smoking cessation results in increased birth weight
- Exposure to environmental smoke in the household is associated with SIDS, childhood respiratory illness, asthma and otitis media
Preconception Care for Men must include counseling regarding the following:
- Alcohol - may be associated with physical and emotional abuse, and may decrease fertility
- Genetic counseling - Sickle Cell trait/disease
- Sexually transmitted diseases - syphillis, herpes, HIV, gonorrhea
- Preparedness for parenthood - pyschological, financial, life plans for education, career.