Preconception Care for Women
Preconception health should be encouraged by health measures and education, including encouragement of a reproductive life plan for all couples. These efforts should include improved health coverage for all and in particular low-income women.
All couples planning a pregnancy should attend for preconception clinical couselling and care. couseeling should be for all couples not only after a negative pregnancy outcome. At these visits, clinicians should focus on the most efficacious interventions for preconception health.
Such interventions may include:
Folic acid supplementation: supplementation with folic acid can reduce the risk for neural tube defects by two thirds.
Rubella vaccination.
Diabetes control: improved control of diabetes can reduce the risk for birth defects 3-fold.
Hypothyroidism management: the requirement for thyroid replacement therapy increases during pregnancy, and early intervention promotes healthy neurologic development of children.
Hepatitis B vaccination for at risk women.
HIV screening and treatment.
Screening for Neisseria gonorrhoea and Chlamydia trachomatis. Elimination of these bacteria can reduce the risk for ectopic pregnancy and infertility as well as mental retardation and blindness of the newborn.
Maternal phenylalanine management among women with phenylketonuria. Elevated levels of maternal phenylalanine may promote mental retardation in childhood.
Oral anticoagulant change to Heparin if possible prior to conception: warfarin is associated with an increased risk for birth defects and hemorrhage in pregnancy. If at all possible, women should stop treatment with warfarin prior to pregnancy.
Oral antiepileptic medication management: clinicians should attempt to minimize the teratogenic potential of these medications by use of les teratogenic medication such as.
Cessation of Isotretinoin treatment.
Smoking cessation counseling: smoking is associated with preterm birth, low birth weight, and other negative perinatal outcomes.
Stopping alcohol use.
Obesity control: a healthy weight prior to pregnancy reduces the risks for neural tube defects, preterm delivery, diabetes, Cesarean delivery, hypertension, and thromboembolic disease.
