Preconception Health with Crystal Roberts RN Part 2

                                                         Preconception Care

Preconception Care helps to decrease poor outcomes for mom and baby. It has been found that health decisions that are made prior to conception can decrease the likelihood of gestational diabetes, pre-eclampsia and other possible detrimental events. Ng et al. (2020) put it beautifully when they said “it is not the seed but the soil that makes the plant healthy”.

What should you expect from your healthcare provider?

Screening for Infectious Diseases, Treat, Immunize, Counsel

• HIV

• Syphilis

• Gonorrhea/Chlamydia

• Hepatitis C in those with tattoos and/or body piercings

• Immunizations:

• Rubella, varicella, hepatitis B

• Influenza vaccine if woman will be pregnant during influenza season

• Toxoplasmosis – avoid raw meat, cat litter, garden soil

• Cytomegalovirus, parvovirus B19 (fifth disease): - encourage frequent hand washing

Environmental Toxins

• Smoking cessation including Marijuana 7% (CDC, 2016-2017), Vaping etc.

• Screening for alcohol use or abuse

• use of illegal drugs

• Occupational exposures – Material Safety Data Sheets from employer

• Household chemicals – avoid paint thinners/strippers, other solvents, pesticides

• Radiation exposure in early pregnancy Medical Assessment

• Evaluate overall health and opportunities for improving health

• Labwork which will help determine if woman suffers from any undiagnosed or uncontrolled medical problems (e.g. diabetes, thyroid disease, dental caries or gum disease, heart disease, asthma)

• If history of Diabetes – optimize control HbA1C < 6.5

• If history of Hypertension – avoid ACE inhibitors, angiotensin II receptor antagonists

• If history (hx) of Epilepsy – consider increased dose of folic acid & possibly changing medications

• If hx of blood clots (DVT) – switch from warfarin (Coumadin) to heparin

• If hx of Acne – stop isotretinoins (e.g. Accutane)

• If hx of depression/anxiety and other mental health issues-discuss current benefit/risk medication data, need for therapy, need for specialist consult Lifestyle

• Recommend regular moderate exercise (75-150 minutes Walking!)

• Avoid hyperthermia (hot tubs)

• Maintain a healthy weight, lose weight as needed

• Assess risk of nutritional deficiencies:

• Vegan

• Pica

• Milk intolerance (calcium supplementation)

• Calcium or iron deficiency

• Avoid overuse of:

   • Vitamin A (750 micrograms for ages 14 to 18; 770 micrograms for ages 19 to 50)per day) ACOG

   • Vitamin D (limit to 600 IU per day) ACOG

   • Caffeine (limit to two cups of coffee or six glasses of soda per day) 

   • Screen for domestic violence (increases in pregnancy, 1 in 4 women) if this applies to you, let your          provider know.

    • Screen for social issues (e.g. place to live, child care, employment, transportation)

    • Counsel on the use of over-the-counter medications, nutritional supplements, and naturopathic                substances

 

Deep Dive into Pregnancy Hx

• All prior pregnancies (cerclage use, inpatient stay etc) & outcomes

• Cesarean section or vaginal delivery

• Premature delivery

• Hypertensive (high blood pressure) disorders of pregnancy

• Diabetes or Gestational diabetes

• Blood type? Rh incompatibility? or hx of receiving RhoGAM