Preconceptional History and Counseling

PART 1

1OBSTETRICS

Section Outline

3Section I: OPD Rounds

Preconceptional History and CounselingChapter 1

Tania GSingh

HISTORY

Genetic History: Risk Factors

Risk Factors for Numerical Chromosomal Abnormalities and New Mutations

Risk Factors for Inherited Mutations

Presence of such an illness in either parent, in his or her family or in a previous child
Couple's ethnic background
Consanguinity—risk of autosomal recessive disorders increases.

Family History

Construct three-generation pedigree which includes the following:

Genetic Disorders in the Family

Multifactorial Congenital Malformations

Familial Diseases with a Major Genetic Component

Age: Women less than 20 or more than 35 years carry increased risks.

Health History

Chronic Conditions

Infectious Conditions

Rubella or varicella susceptible—offer vaccination, if not vaccinated
Hepatitis B and C—routine preconception testing is not currently recommended
Routine serologic testing for toxoplasmosis is not recommended
Evaluate (woman and her partner) for sexually transmitted disease (e.g., Chlamydia, HIV, gonorrhea, syphilis)
Periodontal screening
Nonpregnant women immunized with a live or live-attenuated vaccine should be counseled to delay pregnancy by at least four weeks.

Reproductive History

Menstrual history (regularity, duration and amount of flow, length of cycle, clots, dysmenorrhea)
Contraceptive; sexual history; infertility; abnormal Pap smears
In utero exposure to diethylstilbestrol
Past obstetric history.

Lifestyle Assessment

Counseling

Ideal BMI—19.6-26.0 kg/mt²
Laboratory testing
Folic acid (vitamin B9) to decrease the incidence of fetal congenital anomalies)
Vitamin D intake of minimum 5 μg/day for nonpregnant women with limited exposure to sunlight (i.e. those whose hands and face are exposed to the open air for <15 min/day) and 10 μg/day for pregnant women
Avoid exposure to cat feces, raw/undercooked meats and unpasteurized milk
Smoking and alcohol cessation
Consumption of vitamin A to less than 3000 μg/day
Polytherapy changed to monotherapy in case of epilepsy with prior consultation with aneurologist
Adequate glycemic control in a patient of pregestational diabetes
Consultation with cardiologist, if having cardiac disease
ACE inhibitors should be changed to a different drug.

No Personal Health Risks and Planned Pregnancy

Folate-rich foods-fortified grains, spinach, lentils, chick peas, asparagus, broccoli, peas, Brussels sprouts, corn, and oranges
A multivitamin with folic acid (0.4–1.0 mg) x 2–3 months before conception and throughout pregnancy and postpartum period (4–6 weeks and as long as breastfeeding continues)

Patients with Health Risks or a Family History of Neural Tube Defects or Belonging to a High-risk Ethnic Group (e.g., Sikh)

Require increased dietary intake of folate-rich foods
A multivitamin with 5 mg folic acid, beginning at least three months before conception, continuing throughout pregnancy and 4–6 weeks postpartum or as long as breastfeeding continues, supplementation should consist of a multivitamin with folic acid (0.4–1.0 mg)