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A Preconception Care Health Strategy Addressing STIs and Other Infections . Julia Lange Kessler, CM, MSM Maternal Fetal Medicine Outreach Coordinator Maria Fareri Children’s Hospital at Westchester Medical Center. What is preconception health care? .
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Julia Lange Kessler, CM, MSM
Maternal Fetal Medicine Outreach Coordinator
Maria Fareri Children’s Hospital
at Westchester Medical Center
Health care for women and men that takes place prior to pregnancy.
Prevention infant mortalities and morbidities
Prevention of maternal mortalities and morbidities
AAP and ACOG classified the main components of PCC:
Physical assessment, risk screening, vaccinations and counseling.
How did that concept evolve?
1962 legislation was passed so that the FDA could scrutinize drugs more carefully and from that a drug classification system evolved that for pregnancy and lactation.
A: Controlled studies in ♀- no risk to fetus or newborn
B: Animal studies – no risk but studies in ♀ have not been done
C: Animal studies indicate adverse effects but there are no studies in ♀ - give only when the risks outweigh the benefits
D: There is + risk to the human fetus. Use only in life threatening situations
X: Studies have shown abnormalities in fetus.
“In one study, the
reduced overall health
status (including poorer
physical and emotional health)
of women with low income
during the month before
pregnancy was associated
with and increase risk for
Haas JS, et al. Outcomes and health status of socially disadvantaged women during pregnancy. J Womens Health Gender Based Med 1999;8:547-53.
Preconception risk factors as a % of total risks at the time of negative pregnancy test.
Brian, J. et al. The Journal of Family Practice.47(1), July 1998, p. 33-8.
Atrash HK, Johnson K, Adams MM, Cordero JF, Howse J. reconception Care for Improving Perinatal Outcomes: The Time to Act. Matern Child Health J. 2006 Jun 14.
March 2008: A CDC study estimates that one in four (26 percent) young women between the ages of 14 and 19 in the United States – or 3.2 million teenage girls – is infected with at least one of the most common sexually transmitted diseases (human papillomavirus [HPV] 18%, chlamydia 4%, herpes simplex virus, and trichomoniasis).
March 11, 2008 – Press Release – CDC.
In 2005, the national rate (115.6 cases per 100,000 population) increased for the first time since 1999
Diets high in sugar
Diets high in dairy
NOTE: The creams and suppositories used to treat candiasis are oil based and may weaken latex condoms and diaphragms.
BV is associated with having multiple sex partners, douching; it is unclear whether BV results from acquisition of a sexually transmitted pathogen.
active are rarely affected.
BV is the most prevalent cause of vaginal discharge or malodor; however, up to 50% of women with BV may not report symptoms of BV.
The established benefits of therapy for BV in non-pregnant women are to:
is associated with adverse pregnancy
“Effective oral treatment of BV during pregnancy reduces the rate of preterm birth by 30% to 50%.”http://www.midwife.org/display.cfm?id=586
even more solutions!