Chapter 20 Preconception care
Introduction
With the developing public health role of the midwife in providing total care for the family, every health promotion activity undertaken must include elements of preconception advice. Preconception care must be included in routine health screening activities offered by a variety of healthcare professionals, in health promotion literature and classes, in schools, during family planning or cervical screening sessions (Kierman 2006), in pregnancy testing kits, at post-abortion counselling and in any potential health education experience. Reproductive sexual health is already discussed in schools, with the aim of reducing teenage pregnancy, and this example could be applied to components of preconception care, to inform adolescents of the importance of planning and preparing for pregnancy. Women who have negative pregnancy tests should be targeted for preconception information in readiness for subsequent pregnancy. Preconception advice should be offered to women during the antenatal and postnatal periods.
Preconception care varies considerably internationally, nationally and locally, reaching a small segment of the community, usually clients who are motivated, articulate and aware of their needs, or clients who have had a compromised pregnancy and are preparing for future pregnancy. The type of screening available to women and their partners varies; thus, advising women on preconception care is often confusing. The difficulty with preconception care is that it is not perceived as a priority by healthcare professionals and is not readily available to women. Only in retrospect when pregnancy outcome is compromised do women and their partners seek information or advice on care for subsequent pregnancy. With appropriate preconception care, the care and treatment required during pregnancy is significantly reduced. For example, providing preconception care to women with diabetes reduces hospital admissions, length of stay in hospital, intensity of care of newborn infants and subsequently shortens the infant’s period of hospitalization (Kendrick 2004).
Aim of preconception care
Organogenesis
This is the period of early fetal development (17–56 days following conception) where the early cell mass of conception becomes organized into three layers: ectoderm, mesoderm and endoderm; each responsible for development of different organs or body parts in the developing baby (see Ch. 29).
Objectives of preconception care
The objectives of preconception care are to:
Taking a preconception history
The preconception care assessment
Nutrition
The importance of an adequate diet at conception and during pregnancy is identified as a key factor in adult health, with associated links to illness such as coronary heart disease (DH 2000). There is a direct relationship between nutritional intake, malnutrition and suboptimal nutrition in pregnancy and maternal and child health (Reifsnider & Gill 2000). Women with conditions requiring specific diets or nutritional requirements are referred or advised to seek specialist advice from a dietician. The aim is to ensure that women have a healthy body weight, sensible eating habits and suitable nutritional stores at the point of conception (Cuco et al 2006). Diet in pregnancy is influenced by morning sickness, hyperemesis, pica (food cravings) and dislike of certain foods. Nutritional assessment is important because of the increase in malnutrition and the recognition that someone who is obese can also be malnourished.
Table 20.1 outlines the information, advice and further reading on nutrition that a midwife may find helpful when offering preconception advice on nutritional intake.
Table 20.1 Nutrition: preconception care, advice and further reading
| Information and advice | Further information | |
|---|---|---|
| Obesity | Lack of essential nutrients in the first trimester influences organogenesis and fetal formation Advise women to achieve a BMI of 21–29 prior to conception Unsupervised dieting is not advised during pregnancy although a healthy low-fat diet may help regulate weight gain Refer to dietician | Galtier-Dereure et al 2000 |
| Discussion of eating habits, although women may be reluctant to disclose information Advise women to achieve a BMI of 21–29 prior to conception Refer to general practitioner for referral to dietician, psychologist or psychiatrist Bulimia often improves during pregnancy, with 34% no longer suffering after pregnancy | Siega-Riz et al 2008 | |
| Vitamin deficiency and supplements | If following a healthy diet, vitamin supplements are unnecessary unless medically indicated Advise women that some medications contain vitamin A, which can be teratogenic, for example, treatment for acne Avoid foods high in retinoids, such as liver and fish liver oil, as they contain high levels of vitamin A | http://www.nutrition.org.uk/ |
| Folic acid deficiency | Advise to take folic acid, remembering to take higher dose if epileptic Alcoholics, smokers and lactating women are at increased risk of folic acid deficiency. 4 mg of folic acid is taken daily 2–3 months prior to conception to the end of the first trimester following a previous neural tube defect or if epileptic. 0.4 mg of folic acid is taken daily 2–3 months prior to conception to the end of the first trimester in a first or subsequent pregnancy where there is no history of neural tube defects Increase consumption of leafy vegetables and wholemeal products | Lumley et al 2000 |
