Pre-Conception Counselling

Table of Contents

Pre-Conception Counselling

Prevention

Important Immunizations:
- Varicella
- Rubella
- dTap
- HepB (titre)
Folic Acid:
- Decreases risk of neural tube defects (i.e. spina bifida)
- Ideally start 3 months prior to pregnancy
- General dose: 0.4-1mg (in prenantal vitamins)
  - Increase dose to 5mg if high risk for neural tube defects:
    - Poor nutrition status
    - Epilepsy (on medication)
    - Irish / Sheikh
    - Family history of neural tube defects
    - Unplanned (too late, may need to load with higher dose)
- Continue to take for entire pregnancy
- Potential risk: none, but some reports indicate predispostion to colon polyposis.
Vitamin D
- Recommended 1000-2000 IU if pregnant or breastfeeding.
- Almost everyone deficient in Canada.
- Requirement increases in pregnancy

Alcohol: Effects unclear. Best to avoid alcohol consuption when attempting to conceive.
Smoking: Increased risk of IUGR
Caffeine: small amounts OK (guideline: 150mg/day, see specific beverages).
Exercise
- Low intensity, low impact
- Avoid: elite athleticism (refer); lifting >30lb on regular basis; high heart rate; falling/diving
Avoid foods: (due to decrased gut immunity)
- High Bacterial Load: Soft Cheezes, runny egg yolk, non-pasteurized dairy, uncooked meat (sushi is ok)
- Mercury: big fish such as Tuna, Shark, Swordfish (salmon is OK)
Avoid hot tubs / saunas (utero-relaxant, poor temp regulation)

It is important to check TSH in pregnancy because thyroid hormone demand increases.
Inadequate thyroid hormone levels in pregnancy shown to have soft developmental effects (school performance, IQ, etc.)
TSH target <2 (Normal level 0.5-5)

Causes "Slapcheek" aka Fifth Disease
Primarily affects school age children, but can cause infection in non-immune pregnant women.
50% of women are immune, especially those around kids (previous mothers and teachers)
Infection is usually mild illness, but in rare cases (5% of infected) associated with severe fetal anemia (hydrops fetalis), and intrauterine fetal death
Can check immunity, and may need close monitoring.