Obstetrics Book

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Preconception CounselingAka: Preconception Management

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  1. See Also
    1. Pregnancy Risk Assessment
  2. Evaluation: Tobacco, Alcohol, Caffeine and Substance Use
    1. Tobacco Cessation
      1. Most important single preventable U.S. risk:
        1. Low birth weight
        2. Perinatal mortality
      2. Epidemiology
        1. Women (especially ages 25-44) who smoke: 25%
        2. Women who stop smoking in pregnancy: 21%
        3. Women who resume smoking within 1 year: 70%
    2. Alcohol abstinence
    3. Caffeine reduction to under 3 cups per day
    4. Avoid Recreational Drug Use
      1. Marijuana
      2. Cocaine
      3. Heroin
  3. Evaluation: Infectious Disease
    1. Screen for Sexually Transmitted Diseases
      1. HIV
      2. Syphilis
      3. Hepatitis B
      4. Gonorrhea
      5. Chlamydia
    2. Immunizations (avoid conception within 4 weeks)
      1. Rubella Vaccine (if negative for Rubella IgG)
      2. Varicella Vaccine (if negative for Varicella IgG)
      3. Td Vaccine booster (if not given in last 10 years)
      4. Pneumococcal Vaccine (if high risk)
      5. Hepatitis B Vaccine
      6. Influenza Vaccine
    3. Avoid Toxin or Infection Exposures
      1. See Pregnancy Risk Assessment for occupational risk
      2. Toxoplasmosis (cat litter, garden soil, raw meat)
      3. Cytomegalovirus or Parvovirus (child care)
      4. Condoms or abstinence if partner has STD
  4. Evaluation: Miscellaneous Concerns
    1. Screen for Domestic Violence
    2. Avoid overheating (e.g. hot tubs)
    3. Recommend Exercise in Pregnancy
  5. Management: Dietary and Supplements
    1. Prenatal Vitamins with 400 ug Folic Acid
      1. See Folic Acid dosing for high risk populations
    2. Assess Vitamin Deficiency or overuse
      1. Avoid Vitamin A in excess of 3000 IU per day
      2. Avoid Vitamin D in excess of 400 IU per day
      3. Ensure well balanced diet
      4. Assess for iron deficiency
    3. Avoid herbals which are related to Miscarriage
      1. Devil's claw root
      2. Barberry
      3. Dong Quai
      4. High concentrations of Ruta, Hydrastis or Oregano
  6. Management: Preimplantation Genetic Diagnosis
    1. Indicated for single gene disorder risks
    2. Protocol
      1. Isolate single blastomere from Embryo at day 3
      2. Developing Embryo tested for single gene disorders
      3. Normal Embryos then implanted
  7. References
    1. Wilkins in Ryan (1999) Kistner's Gynecology, p. 451
    2. Brundage (2002) Am Fam Physician 65(12):2507
    3. Leuzzi (1996) Med Clin North Am 80:337
    4. Morrison (2000) Prim Care 27(1):1

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