The document discusses preconception care, which aims to identify and modify health risks in women before pregnancy to improve pregnancy outcomes. It covers components of preconception care like screening for medical conditions and infections, ensuring proper nutrition, vaccinations, genetic screening, and modifying risk factors like smoking, alcohol and environmental exposures. The objectives are to maximize parent and baby health, reduce mortality and morbidity, provide information to help make informed choices, and evaluate any need for genetic counseling. Screening tests, nutrition requirements, vaccination needs, risk factors for various medical conditions, and lifestyle modifications are outlined to help prepare for a healthy pregnancy.
2. Preconception care
Set of interventions that aims to identify &
modify biomedical, behavioural & social
risks to
a woman’s health or pregnancy outcome
through prevention & management.
3. Components
Early detection & prevention of health risks
Management high risks before conception
Active management of fertility
Creation of awareness among women about
contraception
4. Objectives
Maximise the health of prospective parents
and hence their babies
Reduce perinatal mortality& morbidity
Provide information to prospective parents to
make informed choices & make them ready
to be parents
Evaluate need for genetic counselling
Reduce unplanned pregnancies
Inform about maternity services
6. Preconception health assessment
Health status
Sexual history
Family history-genetic,consanguinous marriage
Medical/surgical history
Psychological history
Substance use , occupation
History of infections
Obstetric & gynaecological history
Nutritional history
7. Screening Tests
BP,Weight,Urinalysis,Full blood count
Cardiac &Thyroid function
Respiratory function
Sexual health status
Cervical smear
Serum screening –
rubella,haemoglobinopathies,TB
Vitamin,Zn,lead levels
Hair analysis
Karyotyping
10. DAILY CALORIE REQUIREMENT
Weight in lb * 10 = calories for BMR A
A * 30% = calories for average activity B
A+B * 10% =calories for specific dynamic
action C
TOTALCALORIES
A+B+C
11. RECOMMENDED DAILY INTAKE
Protein – 0.8 g /kg
Iron -18 mg
Calcium -500mg
Zinc -12 mg
Iodine -150 micro gram
Vitamin A -5000 IU
Vitamin D- 200IU
16. EATING DISORDERS
Anorexia nervosa
Risks
Abortion
Low birth weight
Post partum depression
• Bulimia improves during pregnancy
ACHIEVE NORMAL BMI BEFORE
CONCEPTION
17. VITAMIN DEFICIENCIES
No need of supplements if healthy diet
Vitamin A is teratogenic
Avoid foods high in retinoids
18. FOLIC ACID DEFICIENCY
Higher dose if epileptic
Leafy vegetables & whole meat products
Supplements 2-3 monhs before pregnancy to
end of first trimester
4mg if epileptic/previous history of neural
tube defect
22. 2.Infections
Vaccination if non immune to rubella
Paternal mumps linked to infertility
High fever can result in spontaneous abortion
Eg: mumps,measles
24. Avoid contact with infected person 7 days
before&5 days after rash appears
Vaccinate prior to conception
Avoid pregnancy for 3 months after
vaccination
Higher fetal risk in first trimster
28. HIV/AIDS
Maintenance of low viral load & high CD4 count
prior to conception
Treated with zidovudine
No further unprotected sex
29. Varicella zoster
Prior maternal infection protects baby during
pregnancy
Test for vz antibody
Vaccinate if needed
No pregnancy for 3 months after vaccination
Can lead to spontaneous abortion
30. Hepatitis B
Vaccinate before conception if at high risk
LFT to assess severity of disease
Vaccination to uninfected family members
40. Hypertension
Control BP
Increase risk for preeclampsia,
fetal growth retardation
ACE inhiibitors & angiotensin 2 receptor
blockers cause fetal malformation
41. Systemic Lupus Erythematosus
Control associated kidney disease 6 months
prior to conception
Pregnancy contraindicated in active nervous
system involvement
46. GENETIC COUNSELLING
A communication process that deals with
human
problems associated with occurence or
recurrence of a genetic disorder in a family or
individual at increased risk for a condition that
has a genetic component
47. Indications
Parents of affected child
Positive family history
Women >35 years
Risky ethnic group
Consanguinous marriage
Affected couple
Concern about genetic disorder
48. TESTS
Biochemical testing-enzyme levels & activity
• DNA testing for mutation
• Chromosomal testing
Genetic pedigree
Testing cells of embryo after in vitro
fertilization
Karyotyping
51. • Autosomal dominant diseases: cystic fibrosis,
sickle cell anaemia , thalassemia
• Autosomal recessive disease:Tay sach’s
disease
Child will have the disease /Will be carrier
52. 5.Environment & lifestyle
AVOID JOBS INVOLVING:
Vibrating machines
Toxic substances
Excessive cold/heat
Heavy lifting
Long travelling times
Exposure to pesticides / phthalates
Prolonged standing
53. Chronic stress preterm birth
Exercise
No new exercise in pregnancy
Increased core body temperature
spontaneous abortion
No contact sports
54. Smoking
Reduces sperm count
Stop smoking 4 months before conception
:both
Away from smoky environment
55. • Alcohol
Reduces sperm count
Affect ovulation
Crosses placenta
Cause fetal alcohol syndrome
Result in abortion,growth restriction
Stop alcoholism 4 months prior to conception
56. Hazardous substances
Have organically grown foods
Wash all foods
No contact with pesticides /insecticides
No radiation exposure from 3 months prior to
conception
57. Lead
From drinking water,soil ,exhaust
fumes,utensils,battery,paint
Wear protective clothing
Mineral analysis before conception
>10mcg/dl : toxicity
Filter water
High levels in men : infertility
Lead content in mother moves to fetus
58. Cadmium
High levels in men : infertility
Reduce smoking, alcoholism , contact with
plumbing alloys, paint , batteries ,fertilizers
Filter water
Mineral analysis prior to conception
59. • Zinc
Found in red meat,cereals ,cheese,nuts.
Levels reduced in alcohol drinkers
Low levels in men : infertility
Mineral analysis prior to conception
60. Aluminium
Mineral analysis prior to conception
Derived from utensils while cooking ,antacids
Filter water
Use stainless steel / glassware
61. Mercurry
Derived from tinned tuna,large fishes,weed
killers,dental amalgam
Do dental procedures before
conception/involve non mercurry based
amalgam
Filter water
Mineral analysis prior to conception
65. Advice for men
Wear loose fitting shorts,trousers
Cold showers preferred than hot baths
No smoking and alcoholism
Ideal weight
No exposure to chemicals
66. PHYSICAL PREPARATION
AGE :>18 years for girls
>21 years in boys
Diet: balanced diet,not anaemic not
malnourished
No exposure to hazardous substances
Free of infections
Stop OCP 3 months before
GENETIC CONSELLING
69. BENEFITS
Increased fertility
Healthy conception,pregnancy,birth
Reduced risk of abortion ,premature birth
,abnormality
Reduced morning sickness
Improved success rate of IVF
More chance of natural,intervention free birth
Low risk for postpartum depression
Suceessful and long term breast feeding
Healthy children
70. Preparation of family
Sibling education classes
Grand parent preparation
Preparing fathers