Table of contents
- 1. Prevention
- 2. Lifestyle
- 3. Important Comorbidities
- 3.1. Hypothyroidism
- 3.2. Genetic History
- 3.3. Pavrovirus B19
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)
- Increase dose to 5mg if high risk for neural tube defects:
- 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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