Prevent
Preconception Counseling
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Preconception Counseling
, Preconception Management
See Also
Pregnancy Risk Assessment
Teratogen Exposure
Embryo Organ Development
Radiation Exposure in Pregnancy
Medications in Pregnancy
Substance Abuse in Pregnancy
Intimate Partner Violence
Genetic Syndrome
Mercury Content in Fish
Evaluation
Tobacco
,
Alcohol
,
Caffeine
and Substance Use
Tobacco Cessation
Most important single preventable U.S. risk:
Low birth weight
Perinatal mortality
Epidemiology
Women (especially ages 25-44) who smoke: 25%
Women who stop smoking in pregnancy: 21%
Women who resume smoking within 1 year: 70%
Alcohol
abstinence
Caffeine
reduction to under 3 cups per day
Avoid Recreational Drug Use
Marijuana
Cocaine
Heroin
Evaluation
Infectious Disease
Evaluate risk and screen as indicated for
Sexually Transmitted Disease
s and other infections
HIV Infection
Discuss universal screening and risk of vertical transmission
Syphilis
Screen high risk women
Hepatitis B
Screen if risk, especially if not immunized
Discuss risk of vertical transmission in
Chronic Hepatitis B Carrier
Gonorrhea
Screen high risk women
Chlamydia
Screen all women under age 25 years and those at increased risk
Herpes Simplex Virus
infection
Discuss risk of vertical transmission and recognition of genital outbreaks during pregnancy
Tuberculosis
Screen high-risk women
Treat active and
Latent Tuberculosis
prior to pregnancy
Immunization
s (avoid conception within 4 weeks)
Rubella
Vaccine
Indicated if negative for
Rubella
IgG and not pregnant
Avoid pregnancy for 3 months after
Rubella
Vaccine
Varicella Vaccine
Indicated if negative for Varicella IgG and not pregnant
Avoid pregnany for 1 month after
Varicella Vaccine
Tdap Vaccine
Vaccinate all pregnant women at 27-30 weeks gestation with each pregnancy
Pneumococcal Vaccine
Indicated if high risk for pneumococcus (e.g.
Asplenic
)
Hepatitis B Vaccine
Vaccinate all women prior to pregnancy if not already vaccinated
Influenza Vaccine
Vaccinate all women pregnant during
Influenza
season (as well as those with other indications)
Avoid Toxin or Infection Exposures
See
Teratogen Exposure
for occupational, household product risk (
Heavy Metal
s, solvents,
Pesticide
s)
Toxoplasmosis
(cat litter, garden soil, raw meat)
Cytomegalovirus
,
Parvovirus
,
Chicken Pox
(child care)
Listeria (cold cuts, undercooked or raw meats)
Condom
s or abstinence if partner has STD
Evaluation
Miscellaneous Concerns
Screen for
Domestic Violence
(
Intimate Partner Violence
)
Screen for
Mood Disorder
(
Major Depression
and
Anxiety Disorder
)
Avoid overheating (e.g. hot tubs, saunas) due to increased risk of
Neural Tube Defect
s and
Miscarriage
s
Recommend
Exercise in Pregnancy
Wear
Seat Belt
s (three point
Seat Belt
)
Work toward ideal body before pregnancy
See
Pregnancy Risk Assessment
regarding
Obesity
and underweight associated pregnancy risks
Management
Diet and Supplements
See
Nutrition in Pregnancy
(includes
Teratogen
ic foods)
See
Teratogen Exposure
(includes
Occupational Exposures in Pregnancy
and
Herbal Teratogen
s)
Prenatal Vitamin
s with 400 ug
Folic Acid
(600 Dietary
Folate
Equivalents or DFE) and 150 mcg
Iodine
See
Folic Acid
dosing for high risk populations
See
Iodine
for pregnancy recommendations
Start
Folic Acid
1-3 months before pregnancy and continue for at least 12 weeks postconception
High dose
Folic Acid
(4-5 mg daily) is indicated in women at high risk for
Neural Tube Defect
(e.g.
Epilepsy
)
Assess
Vitamin Deficiency
or overuse
Avoid
Vitamin A
in excess of 3000 IU per day
Avoid
Vitamin D
in excess of 400 IU per day
Ensure well balanced diet
Assess for
Iron Deficiency
Avoid
Herbals
which are related to
Miscarriage
See
Herbal Teratogen
s
Avoid excessive foods with increased risk
See
Nutrition in Pregnancy
See
Mercury Content in Fish
Management
Preimplantation
Gene
tic Diagnosis
Indicated for single gene disorder risks
Protocol
Isolate single blastomere from
Embryo
at day 3
Developing
Embryo
tested for single gene disorders
Normal
Embryo
s then implanted
References
Wilkins in Ryan (1999) Kistner's Gynecology, p. 451
Brundage (2002) Am Fam Physician 65(12):2507-14 [PubMed]
Farahi (2013) Am Fam Physician 88(8): 499-506 [PubMed]
Johnson (2006) MMWR Recomm Rep 55(RR-6): 1-23 [PubMed]
Leuzzi (1996) Med Clin North Am 80:337-74 [PubMed]
Morrison (2000) Prim Care 27(1):1-12 [PubMed]
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