The Fourth Trimester NP Show by Judith Wafe NP

March 17, 2023 Preconception Health with Crystal Roberts RN Part 2

Preconception Care

Preconception Care helps to decrease poor outcomes for mom and baby. It has been found that health decisions that are made prior to conception can decrease the likelihood of gestational diabetes, pre-eclampsia and other possible detrimental events. Ng et al. (2020) put it beautifully when they said “it is not the seed but the soil that makes the plant healthy”.

What should you expect from your healthcare provider?

Screening for Infectious Diseases, Treat, Immunize, Counsel

• HIV

• Syphilis

• Gonorrhea/Chlamydia

• Hepatitis C in those with tattoos and/or body piercings

• Immunizations:

• Rubella, varicella, hepatitis B

• Influenza vaccine if woman will be pregnant during influenza season

• Toxoplasmosis – avoid raw meat, cat litter, garden soil

• Cytomegalovirus, parvovirus B19 (fifth disease): - encourage frequent hand washing

Environmental Toxins

• Smoking cessation including Marijuana 7% (CDC, 2016-2017), Vaping etc.

• Screening for alcohol use or abuse

• use of illegal drugs

• Occupational exposures – Material Safety Data Sheets from employer

• Household chemicals – avoid paint thinners/strippers, other solvents, pesticides

• Radiation exposure in early pregnancy Medical Assessment

• Evaluate overall health and opportunities for improving health

• Labwork which will help determine if woman suffers from any undiagnosed or uncontrolled medical problems (e.g. diabetes, thyroid disease, dental caries or gum disease, heart disease, asthma)

• If history of Diabetes – optimize control HbA1C < 6.5

• If history of Hypertension – avoid ACE inhibitors, angiotensin II receptor antagonists

• If history (hx) of Epilepsy – consider increased dose of folic acid & possibly changing medications

• If hx of blood clots (DVT) – switch from warfarin (Coumadin) to heparin

• If hx of Acne – stop isotretinoins (e.g. Accutane)

• If hx of depression/anxiety and other mental health issues-discuss current benefit/risk medication data, need for therapy, need for specialist consult Lifestyle

• Recommend regular moderate exercise (75-150 minutes Walking!)

• Avoid hyperthermia (hot tubs)

• Maintain a healthy weight, lose weight as needed

• Assess risk of nutritional deficiencies:

• Vegan

• Pica

• Milk intolerance (calcium supplementation)

• Calcium or iron deficiency

• Avoid overuse of:

• Vitamin A (750 micrograms for ages 14 to 18; 770 micrograms for ages 19 to 50)per day) ACOG

• Vitamin D (limit to 600 IU per day) ACOG

• Caffeine (limit to two cups of coffee or six glasses of soda per day)

• Screen for domestic violence (increases in pregnancy, 1 in 4 women) if this applies to you, let your provider know.

• Screen for social issues (e.g. place to live, child care, employment, transportation)

• Counsel on the use of over-the-counter medications, nutritional supplements, and naturopathic substances

Deep Dive into Pregnancy Hx

• All prior pregnancies (cerclage use, inpatient stay etc) & outcomes

• Cesarean section or vaginal delivery

• Premature delivery

• Hypertensive (high blood pressure) disorders of pregnancy

• Diabetes or Gestational diabetes

• Blood type? Rh incompatibility? or hx of receiving RhoGAM

• Postpartum hemorrhage

• Thrombotic event (DVT/PE)

• Mood changes in perinatal (during and after pregnancy) period

What can you do to get ready today?

- Start taking a multivitamin that has at least 400 mcg of folic acid

- Maintain healthy diet and weight

- Be physically active more days per week

- Quit smoking anything 😊 includes vaping

- Avoid alcohol

- Screen all medications & supplements with your healthcare provider

- See your medical team for chronic health conditions

I’m pregnant now what???

-establish prenatal care ASAP

-seek childbirth, newborn and parenting education

About our guest Crystal-Ann Roberts

Crystal-Ann Roberts is a Registered Nurse currently practicing in the field of High-Risk Obstetrics in South Florida. She is also the founder and childbirth educator with Jonah’s Birth. Crystal-Ann Roberts received her Bachelors in Psychology from Nova Southeastern University and her Associate Degree in Nursing from Miami Dade College. She obtained her certification as a Hypnobirthing Childbirth Educator because of her love for maternity and her passion to influence the birthing world. Crystal-Ann has been married for 11 years and has 2 children. It was the birth of her sons that influenced the founding of Jonah’s Birth. She believes every woman has the right to safe maternal care and should have access to evidenced based birthing education. Look her up on IG @Jonahsbirth

References

The American College of Obstetricians and Gynecologists. (2019). Prepregnancy Counseling. Retrieved from Prepregnancy Counseling | ACOG

Centers for Disease Control and Prevention. Planning for Pregnancy (2023). Retrieved from Planning for Pregnancy | Preconception Care |

New York State Department of Health. (2009). Components of preconception care. Retrieved from Components of Preconception Care (ny.gov)

Ng, S. W., Norwitz, G. A., Pavlicev, M., Tilburgs, T., Simón, C., & Norwitz, E. R. (2020). Endometrial Decidualization: The Primary Driver of Pregnancy Health. International journal of molecular sciences, 21(11), 4092. https://doi.org/10.3390/ijms21114092

World Health Organization Regional Office for South-East Asia. (‎2013)‎. Preconception care to reduce maternal and childhood mortality and morbidity. Retrieved from Preconception care to reduce maternal and childhood mortality and morbidity (who.int)

Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice.

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