Preconception Care PDF

PRECONCEPTION CARE BY: Mesganew. A 1  Outlines Definition of preconception care Components of preconception care Barriers of preconception care 2  Objectives  At the end of the session the...

PRECONCEPTION CARE BY: Mesganew. A 1  Outlines Definition of preconception care Components of preconception care Barriers of preconception care 2  Objectives  At the end of the session the learners will be able to:  Define preconception care  Discuss components of preconception care  Identify barriers of preconception care  Recognize implications of medical disorders on pregnancy 3  Brainstorming What is preconception care ? 4  Preconception care Definition It’s the provision of biomedical, behavioral and social health interventions to women and couples before conception occur. A set of interventions to identify & modify risks that affects the women’s health or pregnancy outcome through prevention and management  Preconception care aims  Improve their health status: minimizing behaviors and individual as well as environmental factors that contribute to poor maternal and child health outcomes.  Opportunities to prevent and control diseases  To secure optimal health and nutritional conditions in both parents  Ensure that the couples are in optimal state of physical and emotional health at the onset of pregnancy 6  Preconception care aims…  Access health by child bearing women  Promote the prenatal health such as developing positive attitude about sexuality, womanhood and child bearing  Benefit women being treated for a conditions like sickle cell anemia, HTN,DM, cardiac disorders 7  Why Preconception care is needed  Preconception care is important for healthy pregnancy outcome  Prevent unintended pregnancy  Prevent vertical transmission of HIV/STI  Reduce maternal and neonatal morbidity and mortality  Prevent complications during pregnancy and delivery 8 Why Preconception care is needed… Prevent birth defect Prevent neonatal infection Enhance optimal weight Lessen the risk of childhood cancers Lower the risk of chronic diseases 9  Components of preconception care According to CDC, 2007 majorly classified in to the following I. Risk screening Identification of risk factors related to poor pregnancy out comes II. Health promotion Providing information and discussing health issues to help the couples make informed decisions III. Intervention Treating identified risk factors and complications 10  What preconception care packages should be addressed? Nutritional conditions  Female genital mutilation Vaccine preventable  Too early and unwanted diseases pregnancy Genetics condition  Sexually transmitted Environmental health infections Infertility  Interpersonal violence Substance abuse  Mental health 11  Nutritional conditions  Maternal undernutrition and iron-deficiency anemia account for at least 20% of maternal mortality  Assess the ABCD of nutrition Anthropometric factors e.g. BMI (18.5-24.9) Biochemical factors e.g. anemia Clinical factors Dietary risks 12  Nutritional conditions…  Counselling on nutrition  Ensure variety items  Screen for anemia, DM & HTN  Iodization of salt  Promoting exercise  Supplement energy & nutrient dense food 13  Nutritional conditions… Folic acid supplementation All individual of reproductive age should take folic acid Individual at high risk of neural tube defects( anencephaly and spinal bifida) should take high level of folic acid women of reproductive age take 0.4mg of folic acid daily both before conception & during the first trimester of pregnancy. 14  Substance use  Screening for substance use  Providing brief interventions when needed  Treating substance use disorders including pharmacological & psychological interventions  Establishing prevention programs to reduce substance use in adolescents 15  Substance use…  Alcohol misuse: alcohol consumption have  Higher risk of cardiac and hepatic complications  Any amount of alcohol results in fetal alcohol syndrome during pregnancy (facial anomalies, microphthalmia, congenital heart malformations, microcephaly, and mental retardation)  Leads to low birth weight, preterm, IUGR, abortion, mental retardation, neurodevelopmental defects, other fetal anomalies 16  Substance use…  Tobacco use: Screening women for tobacco use  Counselling on tobacco use cessation  Advising about the harm of second hand smoke & its effect on pregnant women & unborn child  Eliminating smoking before or during pregnancy could avoid 5-7% preterm related death and 23-24% sudden infant death syndrome. 17  Substance use…  It leads to negative effects such as  low birth weight  IUGR  preterm birth  abruption placenta  Premature rupture of membrane 18  Sexually transmitted infections  Provide age appropriate comprehensive sexuality education and services  Promoting safe sex practice  Promoting condom use for dual protection  Ensuring increased access to condom  Screening for STIs  Increasing access to treatment and other services  Providing male circumcision 19  Sexually transmitted infections…  Screening and treating of STI have various benefit:  Reduces risk of ectopic pregnancy  Lower the risk of vertical transmission  Reduces fetal complication  Lessen congenital malformation 20  Sexually transmitted infections…  All reproductive age group women and their partner need to be screened for:  Chlamydia trachomatis  Hepatitis B  Syphilis  Neisseria gonorrhoeae  HIV 21  Mental health  Assessing psychosocial problems  Providing educational and psychosocial counselling before and during pregnancy  Counselling and treating depression in woman planning pregnancy and child bearing ages  Strengthening community network and empowering women  Reducing economy insecurity of women of childbearing age 22  Vaccine preventable disease  Vaccination against:  Rubella: protect against congenital rubella syndrome (microcephaly, fetal growth restriction, cardiac malformation)  Should be administered to all rubella susceptible women of reproductive age  Not recommended during pregnancy & women should be advised to avoid conception for one month following immunization  Tetanus & diphtheria  Hepatitis B: prevent transmission of infection to infant 23  Vaccine preventable disease…  Varicella: prevent disease in the offspring, reduce the risk of women developing severe pneumonia  Risk of congenital varicella is 2%  Human papilloma virus: for female aged 9 years  Influenza: Women who will be pregnant during the influenza season should be vaccinated with the influenza vaccine 24  Laboratory investigation  Testing should include  CBC  Urinalysis  Blood type  When indicated screen for rubella, syphilis, hepatitis B, HIV, gonorrhea, chlamydia, diabetes 25  Genetic conditions  Detail family history to identify risk factors for genetic condition  Appropriate treatment of genetic conditions  Genetic screening based on family history, ethnics background and age  Mass screening among populations at high risk  Cystic Fibrosis:  Single gene mutation with autosomal recessive inheritance pattern  Screening should be done for both partners 26  Genetics conditions …  Sickle Cell Anemia:  is inherited structural abnormality involving primarily the β chain of HbA  associated with an increased risk of morbidity and mortality  Need increased folic acid supplementation  May pass to offspring  Effects on pregnancy: abortion, prematurity, IUGR and fetal loss  Thalassemia: inherited defect in the synthesis and production of globin 27  Interpersonal violence  Providing age appropriate comprehensive sexuality education that addresses gender equity, human right and sexual relation  Providing health care services (post rape care, referral and psychosocial support to victims)  Changing individual and social norms 28  Too early and unwanted pregnancy  Influencing cultural norms that encourage early marriage and coerced sex  Provide age appropriate comprehensive sexuality education  Providing contraceptives  Empowering girls to resist coerced sex  Educating couples the danger to baby and mother of the short birth interval 29  Environmental health  Providing guidance & information on environmental hazards & prevention  Refraining from radiation exposure in occupational, environmental & medical settings  Avoiding unnecessary pesticides  Radiation and radioactive compounds are associated with spontaneous abortion, birth defects, and childhood leukemia 30  Infertility  Awareness creation of fertility and infertility and their preventable & unpreventable causes  Avoiding stigmatization of infertility & its fate  Screening couples for infertility 31  Chronic disease  Asthma: educating patients preconceptionally would be beneficial to the patients’ pregnancy outcome  Environmental factors that exacerbate asthma attacks should be discussed during preconception to limit exposures  Hypertension: should be counseled risks associated with pregnancy  May leads to preterm, low birth weight, IUGR, fetal death, abruption placenta, maternal death, DIC 32  Chronic disease…  Diabetes mellitus: Preconceptional counseling should focus on the importance of euglycemic control before pregnancy, as well as the adverse obstetric and maternal outcomes  Fetal complications: small for gestational age, preterm, fetal death, congenital malformation, macrosomia, hypoglycemia, hypothermia, hypocalcemia, hypomagnesemia, polycythemia  Past obstetrics history  History & physical examination to rule out obstetrics history  Parity: nulliparous are at risk of pregnancy-induced hypertension  Multiparous are at risk of placenta previa, postpartum hemorrhage secondary to uterine atony, and dizygotic twins  Ectopic pregnancy  Twin pregnancy  Abortion  Preterm birth: with 50% recurrence rate  Cesarean section 34  Medications  Medication use should be continued to control disease in women during the preconception period.  Switching medication during the preconception period if suitable alternatives exist with less risk to pregnant women  Preconceptionally taken drugs may be a risk factor for negative pregnancy outcomes.  Oral Anticoagulants: Warfarin has teratogenic effect  Anti-Epileptic Drugs: valproic acid 35  Medications…  Talk to your patient about her use of over-the-counter medications, herbal products, vitamins, or nutritional supplements.  Certain vitamins in excess are harmful.  Vitamin A in doses greater than 10,000 international units cause severe birth defects when taken during pregnancy.  Female genital mutilation  Discouraging the practice  Providing information to couples about the complication of FGM 37  Barriers to preconception care I. Patient aspects  High rate of unintended pregnancy  Ignorance about the importance of good health habits prior to conception  Limited access to health service 38  Barriers to preconception care… II. Provider aspects Unpreparedness of health care providers Lack of awareness of how to integrate preconception care in to practice Feeling of having inadequate knowledge Perception of it being time consuming 39  Barriers to preconception care… III. Other barriers Availability of contraceptives Health insurance coverage 40  Integration of preconception care into practice  As part of any routine medical visits  Negative pregnancy test  Family planning encounter  Infertility evaluation  Following poor pregnancy outcome 41  Who should get preconception care? All reproductive age individual should get preconception care 42  Preconception care for male  Alcohol : may associate with physical and emotional abuse, decrease fertility  Genetics counselling  Occupational exposure  STI 43 THANK YOU!