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Preconception

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Preconceptional Counseling Counseling Session
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Page 1: Preconception

Preconceptional CounselingCounseling Session

Page 2: Preconception

Preconceptional careA set of interventions that aim to identify and

modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management “

CDC (Johnson, 2006)

Page 3: Preconception

The GoalsImprove knowledge, attitudes, and behaviors of men

and women related to preconceptional healthAssure that all women of childbearing age receive

preconceptional care services including evidence based risk screening, health promotion, and interventions that will enable them to enter pregnancy in optimal health

Reduce risks indicated by a previous adverse pregnancy outcome through interconceptional interventions to prevent or minimize recurrent adverse outcomes

Reduce the disparities in adverse pregnancy outcomes

Page 4: Preconception

Preconceptional CounselingThe American College of Obstetricians and

Gynecologists (2012) also has reaffirmed the importance of preconceptional and interpregnancy care

To illustrate potentially modifiable conditions, data that describe the health status of women who gave birth to liveborn infants in the United States in 2004 are reviewed. Table 8-1 demonstrates the high prevalence of many conditions that may be amenable to intervention during the preconceptional and interpregnancy periods (D’Angelo, 2007).

Page 5: Preconception
Page 6: Preconception

Preconceptional CounselingPreventative strategies (mitigate these potential

pregnancy risks) conception

Realizing pregnancy (1 to 2 weeks after the first missed period)—the embryo begun to form

prevention strategiese.g folic acid to prevent NTD will be ineffective if

initiated at this time

Up to half of all pregnancies are unplanned, and often these are at greatest risk

Page 7: Preconception

Preconceptional Counseling• Randomized trials : PCC efficacy• Withholding such counseling would be

unethical• Pregnancy outcomes are dependent on the

interaction of various maternal, fetal, and environmental factors

• Difficult to ascribe salutary outcomes to a specific intervention

Moos, 2004

• Prospective observational and case-control studies : demonstrate the successes of PCC (assessed the effectiveness of a PCC program administered during routine health care provision to reduce unintended pregnancies)

Moos and coworkers

(1996)

Page 8: Preconception

Preconceptional Counselingvan der Zee and associates (2013)

Ethical aspects of paternal lifestyle modification reviewed

456 counseled women had a 50% greater likelihood of subsequent pregnancies that they considered “intended” compared with 309 uncounseled women

Counseled group had a 65% higher rate of intended pregnancy compared with women who had no health care before pregnancy.

Page 9: Preconception

Counseling Session

Negative pregnancy test excellent time for education

GynecologistsInternistsFamily practitionersPediatricians

Best opportunity to prevent counseling during periodic health maintenance examinations

Page 10: Preconception

Jack and colleagues (1995)

Comprehensive preconceptional risk survey to 136 such womenReported at least one problem that could affect a future pregnancy (almost 95%)

Included medical or reproductive problems (52%)Family history of genetic disease (50%)Increased risk of human immunodeficiency virus infection (30%)Increased risk of hepatitis B and illegal substance abuse (25%)Alcohol use (17%)Nutritional risks (54%)

Page 11: Preconception

Counseling SessionCounselors’ knowledge :

• Relevant medical diseases• Prior surgery• Reproductive disorders/genetic interpret data

and recommendations provided by other specialistsRefer to appropriate counselor if the

practitioner is uncomfortable providing guidance

Page 12: Preconception

Counseling SessionInformation collection may be time consuming depending on the number and complexity of factors that require assessment• The intake evaluation review of :• medical• obstetrical• social• family histories

Useful information asking specific questions (history and each family member than by asking general, open-ended questions)

Page 13: Preconception

Counseling SessionSome important information questionnaires

Answers are reviewed with the couple to ensure appropriate follow-up, including obtaining relevant medical records


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