Preconception Care

1. Preconception Care Prepared by : Ayda khader Feb.2017

2. Preconception care • According to WHO (2013), Preconception care is the provision of biomedical, behavioral and social health interventions to women and couples before conception occurs. • It aims at improving their health status, and reducing behaviors and individual and environmental factors that contribute to poor maternal and child health outcomes. • Its ultimate aim is to improve maternal and child health, in both the short and long term.

3. Even if preconception care aims primarily at improving maternal and child health, it brings health benefits to the adolescents, women and men. The preconception period refers to a time span of anything from 3 months to 1 year before conception (Bussell 2000) • The primary target population for preconception care is women of reproductive age, although men are also targeted by several components of preconception care.

4. The goal of preconception care is :- • Screening for risks • Health promotion and education • Interventions to address identified risks that might affect future pregnancies

5. Preconception health promotion should be directed toward all women, with or without known health risks. • Specific issues to be address with women before pregnancy are nutrition and weight; use of tobacco, alcohol, teratogenic agents (Any agent that can disturb the development of an embryo or fetus) e.g., isotretinoin, warfarin, and some antiseizure medications), and illicit drugs; occupational and environmental hazards; domestic violence; infections and immunization; screening for medical disease; family planning; and genetic risks

6. Preconceptual Interventions Targeted interventions have been effective for patients who wish to conceive. Interventions include: • folic acid supplementation, • testing for rubella seronegativity and vaccination if indicated, • tight control of pregestational diabetes, • careful management of hypothyroidism, • STD/HIV screening, avoidance of teratogenic agents (e.g., isotretinoin, warfarin, and some antiseizure medications), • eliminating alcohol use, tobacco cessation, • hepatitis B vaccination and obesity control.

7. PCC focusing in: *** General health factors 1. Body weight Assessment of body type is done by the body mass index (BMI) It is now recommended that BMI should be calculated at the beginning of pregnancy The aim of preconception care is to help such women achieve an appropriate BMI prior to conception to enhance pregnancy outcome.

8. 2. Principles of a healthy diet • Screening for anemia and diabetes • ƒFolate, folic acid and neural tube defects (eating more folate-rich foods and taking a daily folic acid supplement of 400 μg) • ƒInformation, education and counselling • Monitoring nutritional status • Supplementing energy- and nutrient-dense food • Vitamin A and calcium

9. 3. Immunization status: prevent the complication due to infection, Physician will recommended waiting 3 months after receiving theses vaccines before conceiving.

10. *** Pre-existing medical conditions and drugs • Diabetes: when left untreated theses conditions can increase risk for pregnancy complications still birth or low birth babies. • Epilepsy: when left untreated theses conditions can increase risk for pregnancy complications still birth or low birth babies. • Phenylketonuria: Phenylketonuria (PKU) is an inborn error of metabolism resulting from a deficiency of phenylalanine hydroxylase and characterized by mental retardation • Drug abuse: increase chance for miscarriage, still birth and poor fetal development and growth.

11. Environmental factors • Smoking and Alcohol : birth defect such as heart problem and mental retardation. • Exercise: Women who exercise regularly usually tolerate the stresses of labor better. • Workplace hazards and noxious substances: exposure to chemicals, lead, mercury and heat lead to teratogenic

12. Genetic Counselling Genetic counselling is a two-way communication process in which counsellor facilitates the understanding of genetic information pertinent to the counselee’s personal and family history, and assists the counselee in a non-biased manner to make an informed decision based on his/her own judgment regarding his/her reproduction and future.

13. Important of Genetic Counseling Genetic counselling can serve to: • Reassure people who are concerned about their children inheriting a particular disorder. • Allow people who are affected by inherited disorder to make informed choices about future production. • Educate people about inherited disorders and the process of inheritance. • Maternity nurse play important roles in assessing genetic disorders through offering support to women who seek genetic counselling and assisting couples in values clarification, planning and decision making based on test results.

14. Genetic analysis is done on fetal cells obtained from amniotic fluid when there are an enough amniotic fluid is present. Now can be done at 12 weeks of gestation. • Genetic counselling is the role for nurses only if they are adequately prepared in the study of genetic that without this background genetic counselling can be dangerous and destructive

15. *** Genetic counselling • Chromosome abnormalities • Taking a thorough family history to identify risk factors for genetic conditions • Family planning

16. Diagnostic testing for genetic disorder • Karyotyping: • Is a visual presentation of the chromosome pattern of an individual that a sample taken from peripheral venous blood or scrapping of cells from the buccal membrane. So itdescribes the number of chromosomes, and what they look like under a light microscope. • Barr Body Determination: • Used if the child born with ambiguous genitalia, a quick test to evaluate whether the child has two X chromosomes (Female) or X, Y chromosomes. Barr body occurs if one copy of X chromosome in a female somatic cell is inactive.

17. Alpha-fetoprotein analysis (AFA): • It is a glycoprotein produced by fetal liver. The level is elevated in amniotic fluid or maternal serum in case of spinal cord disease and decrease in case of chromosomal abnormality as trisomy 21. • Chorionic Villi Sampling: • A biopsy is taken from chorionic villi through catheter inserted abdominally or intravaginally for chromosome analysis; it’s done as early as 5 weeks of gestation. • Amniocentesis: • Withdrawal of amniotic fluid through abdomen wall for analysis at 12-16 weeks of gestation. Analysis may include the Karyotyping of skin cells or analysis of Alpha-fetoprotein analysis.