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Preconceptional CounselingCounseling Session
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)
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
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).
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
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)
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.
Counseling Session
Negative pregnancy test excellent time for education
GynecologistsInternistsFamily practitionersPediatricians
Best opportunity to prevent counseling during periodic health maintenance examinations
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%)
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
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)
Counseling SessionSome important information questionnaires
Answers are reviewed with the couple to ensure appropriate follow-up, including obtaining relevant medical records