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Application of preconceptional care in Korea Jung Yeol Han, June Seek Choi, Hyun Kyong Ahn, Jae Hyug Yang Mi Kyung Koong, Inn Soo Kang, Jae Uk Shim The Korean Motherisk Program, Departments of Obstetrics and Gynecology ,

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slide1

Application of preconceptional care

in Korea

Jung Yeol Han, June Seek Choi, Hyun Kyong Ahn, Jae Hyug Yang

Mi Kyung Koong, Inn Soo Kang, Jae Uk Shim

The Korean Motherisk Program, Departments of Obstetrics and Gynecology ,

Samsung Cheil Hospital & Women’s Health-Care Center, Sungkyunkwan University

School of Medicine, Seoul, Korea

introduction
Introduction
  • Population in South Korea
  • Birth rate
  • Birth defect Monitoring
  • Intake of folic acid
  • Unintended pregnancy
  • Termination of pregnancy and teratogens
birth rate in korea
Birth rate in Korea

1.7

1.6

1.5

Firtlity rate

1.4

1.3

1.2

1.1

2002

1994

1993

1995

1997

1999

2001

2003

1996

2000

1998

YEAR

Korea National Statistical office 2005

birth defect monitoring in korea
Birth defect Monitoring in Korea
  • 10 medical centers around Seoul
  • May 1999 ~ October 2002
  • All live birth, stillbirth,and spontaneous abortions after 16 weeks of gestation
  • 86,622 deliveries
  • Birth defects : 1,537
  • Incidence of Birth defects : 1.8%

J Korean med Sci 2004;19:509-13

slide6

Incidence of 19 congenital anomalies by ICBDMS in Korea and other countries

J Korean med Sci 2004

ICBDMS: International Clearinghouse for Birth Defects Monitoring System

intake of folic acid
Intake of folic acid
  • Intake of folic acid at periconceptional period
  • 10.3%(131/1,277)
  • Assoicated risk factors :
  • Previous spontaneous abortion : RR 1.88 ( 95%CI 1.1 to 3.1 )
  • Intended pregnancy : RR 5.2 ( 95%CI 3.0 to 9.3 )

Cross-sectional Survey at Maternity school 2005

unintended pregnancy in korea
Unintended pregnancy in Korea
  • Rate of Unintended pregnancy

48%(657/1,354)

  • Assoicated risk factors :

≤ 24 years of age: RR 2.5 (95%CI 1.3-4.7)

Lower household income: RR 1.3 (95%CI 1.0-1.6)

Birth defects Research (Part A) 2005

unintended pregnancy
Unintended pregnancy

Exposure to potential teratogens during the first trimester of pregnancy

Total number of surveys= 1,354. Data are n (%)

Birth defects Research (Part A) 2005

slide10

T

Termination of pregnancy among

pregnant women exposed to

potential teratogens

In pressJ of Obstetrics and Gynecology 2005

patients at clinic
Patients at Clinic
  • Setting : The korean Motherisk Program

Samsung Cheil Hospital

( 2% of Korean birth)

  • December 2004 - May 2005
  • 91 cases
  • Preconceptional counseling

Laboratory tests & Questionnaire

slide15

Description :

  • Characteristics of subjects
  • Reasons visited for preconceptional care
  • Positive rate of risk factors
slide17

Reasons visited for preconceptional care

Familty history of genetic

disease or mental retardation

2 (2.2%)

Previous baby anomaly & problem

14(15.4%)

No bad history

Maternal disease

35(38.5%)

19(20.9%)

22(24.2%)

N=91

Previous spontaneous abortion

slide18

Reasons

n

Details

Maternal disease

19

Psychotid disease(4) Diabetes(1)

Systemic lupus erythematosus(1)

Rheumatic arthritis(1)

Asthma(1) Psoriasis(1)

Hypothryroidism(1) Hypertension(1)

Known ovarian tumor(1)

Known uterine fibroids(2)

Known uterine didelphysis(1)

Known breast tumor(2)

Antimalaria drug exposure(1)

Methotrexate exposure(1)

Previous congenital

anomaly or adverse

pregnancy outcome

14

Acrania(1) Cleft lip(1)

Biliary tract agenesis(1)

T-E fistula and TOF(1)

Congenital heart anomaly(1)

Combined anomaly(holoprosencephaly..)(1)

Down syndrome(1)

Edward syndrome(1)

Anhydramnios(46,XX,add(22))(1)

IUGR(1), Preterm birth(2)

Abruptio placenta(1)

Previous baby: learning disability(1)

Family history of genetic

disease or mental retard

2

Duchenne muscular dystrophy(1)

Cerebral palsy(1)

Details of Reasons for preconceptional care

slide19

Laboratory tests

Questionnaire

Non immune hepatitis B (10)

Hepatitis B surface Ag(+) (1)

Non immune rubella (5)

Ureaplasma (13)

Mycoplasma (1)

Chlamydia (1)

Group B streptococcus (3)

E-coli (3)

CMV(-) (1)

Varicella Zoster Virus Ab(-) (1)

SGOT elevation (2)

SGPT elevation (3)

Abnormall TSH (5)

Antimicrosomal Ab (2)

Blood Irregular Ab(+) (1)

Pap smear (3)

Abnormal EKG (2)

Abnormal mammogram (2)

Diabetes (1)

Spontaneous abortion (22)

Matenral disease (19)

Elderly(≥35yo) (16)

Congenital anomaly (5)

Preterm delivery (1)

Abruptio placenta (1)

PPROM (1)

IUGR (1)

Down syndrome (1)

Edward syndrome (1)

46,XX,add(22) (1)

1st baby learning disability (1)

Obese(BMI>23) (13)

Low body weight(BMI<18.5) (5)

Alcohol (32)

Smoking (2)

Nutritional problem (8)

Herbal medicine (3)

Lead exposure (1)

Positive rate of risk factors

Positive

rate

85

91

(93%)

our preliminary data
Our preliminary data

suggest that preconceptional care is absolutely necessary to all women

who want a baby even though its evidence on improving pregnancy outcome is scarce yet in Korea.