Preconception Health:

1
Making the decision to have a child - its
momentous. It is to decide forever to have your
heart go walking around outside your
body. Elizabeth Stone
From www.B4Pregnancy.org
2
Preconception Health

• Clinical Applications for
• Advanced Practice Nurses

From www.B4Pregnancy.org
3
Catherine Francis-Baldesari CNM, MSN

• Preconception Care Resource Center
• Medical University of South Carolina

From www.B4Pregnancy.org
4
Preconception vs. Prenatal Care

• Unplanned pregnancy epidemic
• Period of greatest vulnerability
• Concept of All HCPs/All women childbearing age
• Informed decision-making vs. healthy baby

From www.B4Pregnancy.org
5
Goals of Preconception Health Care

• Prevention of unplanned pregnancy
• Risk identification/reduction/elimination
• Appropriate intervention/treatment/referral
• Ongoing education/counseling/support

From www.B4Pregnancy.org
6
A preconception visit should be an integral part
of an annual medical visit for all women of
childbearing age. March of Dimes Birth Defects
Foundation Committee of Perinatal Health
From www.B4Pregnancy.org
7
Elements of Preconception Health Care

• History and Physical
• Risk assessment and identification
• Risk reduction/elimination
• Follow-up support/involvement

From www.B4Pregnancy.org
8

• History
• OB/GYN
• Medical
• Partner
• Family
• Social

• Physical
• Complete and detailed exam
• Screening tests and Labs based on HP

From www.B4Pregnancy.org
9
Risk Assessment Screening

• Medical
• Social
• Nutritional
• Paternal

• Reproductive
• Genetic
• Infectious diseases

From www.B4Pregnancy.org
10
Medical Issues

• Hypertension
• Diabetes
• Asthma
• Epilepsy
• Lupus
• Medications

From www.B4Pregnancy.org
11
Social Issues

• ETOH
• Illicit drug abuse/addiction
• Tobacco
• Stress

• Teenager
• Environmental exposures
• Domestic violence

From www.B4Pregnancy.org
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Nutritional Issues

• Folic acid
• Obesity
• PKU
• Caffeine
• Vitamin A
• Eating disorders

From www.B4Pregnancy.org
13
Paternal Issues

• ETOH
• Illicit drugs
• Tobacco
• Epilepsy
• Environmental exposures

From www.B4Pregnancy.org
14
Reproductive Issues

• Recurrent SAB
• Maternal autoimmune disease
• Short interconception period

• Infertility
• Uterine/cervical abnormalities
• IUFD
• Preterm labor

From www.B4Pregnancy.org
15
Genetic Issues

• Tay-Sachs
• French Canadian
• Ashkenazic Jewish

• Beta-Thalassemia
• Mediterranean Greek and Italian

From www.B4Pregnancy.org
16

• Alpha-Thalassemia
• SE Asia
• India
• Pakistan
• Phillippines

• Sickle Cell
• African
• Mediterranean
• Middle Eastern
• Cystic Fibrosis
• Caucasian of Northern European descent

From www.B4Pregnancy.org
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Infectious Diseases

• HIV/AIDS
• Rubella
• Vericella
• STDs
• Hepatitis B
• Toxoplasmosis

From www.B4Pregnancy.org
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Risk Reduction/Elimination

• Partnerships
• HCP/HCP HCP/Pt
• Pt/Partner/Family

• Active participation by pt in process as
  important as clinical abilities knowledge of
  provider.

From www.B4Pregnancy.org
19
Ongoing Support Involvement

• Lifestyle choices major focus
• Community resources important
• Social values reflected in increased
  attention/care of women carrying a child vs. all
  women at all stages of life

From www.B4Pregnancy.org
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Why Advanced Practice Nurses?

• Experts in wellness and primary prevention
• More time available with pts
• Holistic approach to health
• Teachers
• Advocates

From www.B4Pregnancy.org
21
The preconception visit may be the single most
important health care visit, viewed in the
context of its effect on pregnancy. CARING
FOR OUR FUTURE THE CONTENT OF PRENATAL CARE,
U.S. PUBLIC HEALTH SERVICE
From www.B4Pregnancy.org
22
Implications for Preconception Health Promotion

• Personal empowerment
• Public health perspective
• Preconception health success stories

From www.B4Pregnancy.org
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Personal Empowerment

• Health care provider
• Patient
• Patients partner/family
• Future newborn/child/adult

From www.B4Pregnancy.org
24
Public Health Perspective

• Decreased infant mortality/morbidity
• Decreased maternal morbidity/mortality
• Patient future offspring
• Medical/Social/Economic/Educational/
• Legal ramifications

From www.B4Pregnancy.org
25
Preconception Success Stories

• Folic acid
• Diabetes
• Asthma
• HIV/AIDS
• ETOH/FAS
• PKU

From www.B4Pregnancy.org
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When you are a mother, you are never really
alone in your thoughts. A mother always has to
think twice, once for herself and once for her
child. Sophia Loren
From www.B4Pregnancy.org