Pre-Conception Counselling

    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

     

    Lifestyle

    • 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)

     

     

    Important Comorbidities

    Hypothyroidism

    • 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)

     

    Genetic History

    • Tay Sachs Disease - Ashkenazi Jewish and French Canadian
    • SE Asian - alpha-Thalessemia (test if MCV<80)
    • Mediterranian/Middle Ease - beta-Thalessemia  (test if MCV<80)

     

    Pavrovirus B19

    • 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.
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