Preconception Care in Family Practice PDF

Preconceptio n Care in Family Practice Dr. Kelli Stephenson, CNM, FNP, DNP  + Preventative Preconception + Social changes + Goal: decreased Healthcare maternal and neonatal mortality Challenges / Barriers + Lack of coverage + Access to ca...

Preconceptio n Care in Family Practice Dr. Kelli Stephenson, CNM, FNP, DNP  + Preventative Preconception + Social changes + Goal: decreased Healthcare maternal and neonatal mortality Challenges / Barriers + Lack of coverage + Access to care + Inadequate training for healthcare professionals + Stigma: pregnancy care only needed when pregnancy Benefits & Evidence + “Life course” perspective Folate supplementation Vaccinations; Treatment of STIs Control of chronic disease Health History + 3 generations Pregnancy outcomes Health outcomes Psychosocial history Jordan pg 52 Table 5.2 Physical Exam & Labs Mental Health + Every woman should be screened for mental health issues Especially critical during reproductive years Adverse effects of mom & baby Many adverse outcomes + Assess meds -> consider alternatives Substance Use / Abuse + Tobacco + Marijuana + Prescription opioids + Alcohol + Illicit substances IPV + Annual Exams + First Prenatal visit + Once each trimester + Postpartum Infections + Screen women & partner + Infections to avoid while pregnant & TTC Toxoplasmosis, cytomegalovirus, listeria + Jordan text pg 66 table 5.3 Chronic Health Conditions  CVD & HTN Primary cause of death among women BP @ every visit Diabetes  Increased risk of: stillbirths; miscarriage; congenital malformations, neonatal death Childhood diabetes Thyroid + Hyper or hypo Increased maternal and neonatal Disorders risks + Achieve normal thyroid before pregnancy + Medications are safe during pregnancy Conception counseling: + Conception -> most fertile 6 days before ovulation. + Intercourse every 1-2 days + Have sex outside of this period + Infertility may exist after 12 months -> refer Counseling: Nutrition; Vitamins; Weight; Activity + Nutrition -> consider their beliefs + Vitamins -> review frequently; Jordan pg. 73 for folic acid + Weight -> encourage normal BMI + Activity -> Regular exercise = better births Genetic Screening Preconception – ideal time Carrier test -> more affordable now Place on birth control and refer to GC as needed References Hollier, A. D. (2018). CLINICAL GUIDELINES IN PRIMARY CARE (3rd ed.). Advanced Practice Education Associates, Inc. Jordan, R. G., Engstrom, J., Marfell, J., & Farley, C. L. (2018). Prenatal and Postnatal Care (2nd ed.). Wiley-Blackwell.