PROPER PREPARATION (PRECONCEPTION CARE)
It's goals are:
- Determine and address any factors that can be changed to improve pregnancy and childbirth.
- Increase the likelihood of conception when pregnancy is desired and to help prevent unintended pregnancies.
- Focuses on decreasing morbidity and mortality for both the patient and the fetus.
- Offers contraceptive counseling.
- Educate couples about risks and effective ways to avoid them.
The key components are:
Risk evaluation (e.g., immunizations, medication use, genetic carrier screening, environmental risks),
Promotion of a healthy lifestyle (e.g., counseling on proper nutrition, regular exercise, smoking cessation, alcohol use),
Counseling and intervention in health and social issues (e.g., chronic disease management, folic acid supplementation, psychosocial risks),
Physical examination.
Examine your medical history and note any ongoing conditions that might have an impact on your pregnancy (e.g., hypothyroidism, diabetes mellitus, chronic hypertension) and treat accordingly.
Examine for hereditary risk factors (such as familial adenomatous polyposis, cystic fibrosis, or breast cancer caused by the BRCA gene, for example), and refer partners with a positive history to genetic counseling (for more information, see below under "Genetic carrier screening" and "Genetic counseling").
Review existing prescriptions, including herbal remedies, naturopathic treatments, and nutritional supplements.
If at all feasible, stop using teratogenic medications and replace them with safer ones.
Adjust your prescription schedule as needed, and think about utilizing potentially dangerous substances at their lowest effective dose.
Pregnancy and vaccination
BEFORE CONCEPTION
MMR vaccine, which protects against measles, mumps, rubella, and varicella
Antibody titers should be used to check for immunity in all pregnant women.
Pregnant women who are immune should get vaccinated.
Encouragement not to conceive for 28 days following the final dosage of the vaccine.
WHILE PREGNANT
Shots for MMR
At their initial prenatal visit, all patients should be checked for a history of rubella infection.
Vaccinations should be administered to nonimmune people during the postpartum period.
Congenital rubella syndrome is prevented by postpartum immunization.
Influenza: All pregnant women should be administered the yearly inactivated influenza vaccine because it is safe in all trimesters.
Tetanus, diphtheria, and pertussis (Tdap vaccine): Those who intend to get pregnant should follow the recommended schedule for receiving the Tdap vaccine.
Those who are pregnant and at high risk for hepatitis B should receive the hepatitis B vaccine.
Note The administration of MMR vaccine, varicella vaccine, human papillomavirus vaccine, and zoster vaccine is contraindicated during pregnancy.
Psychiatric disorders
Review history of psychiatric disorders.
Inform about the risks of medication during pregnancy.
Screen pregnant individuals with no history of mental health conditions for anxiety and depression.
Lifestyle modifications
keep a healthy body weight before getting pregnant.
Regular moderate-intensity exercise is encouraged.
Nutrition
Check your consumption of macro- and micronutrients to ensure you're getting enough (calcium, iron, vitamin B12, vitamin B9, vitamin D).
Make sure not to consume too much vitamin A.
0.4 mg of folic acid per day is advised, ideally starting 4 weeks before conception and continuing for at least the first 2-3 months of pregnancy.
Use of drugs
Check for recreational drug usage in all pregnant women and couples (including alcohol and tobacco).
Inform patients of the harmful effects of recreational drug use on fetal and mother health, as well as male and female fertility.
Give advice on how to stop using recreational drugs and/or suggest professionals.
MANAGE EXPOSURE
Encourage patients to check their homes and workplaces for possibly dangerous substances (e.g., heavy metals, solvents, chemicals).
Inform the patient about avoiding dangerous substances and, if necessary, send them to programs offered by occupational medicine.Each time you visit, check for family violence.
If persistent misuse is found, service providers should:
provide the patient with community resources
Report the incident as necessary.
Physical examination
- Periodontal examination,
- Thyroid examination,
- Cardiovascular examination,
- Breast and pelvic examinations,
Laboratory studies
- CBC, glycemia
- Urinalysis
- Blood type and screen
- Other: TSH, HIV, gonorrhea, and chlamydia
IN CONCLUSION
Preconception care is provided to individuals and couples planning to conceive in the near future and typically involves risk assessment, the promotion of a healthy lifestyle, and physical assessment.