Preparing for Pregnancy

Chapter 6 Preparing for Pregnancy


Preparing for pregnancy is a positive step towards enhancing pregnancy outcome and provides prospective parents with options that may not be available once a pregnancy is confirmed.



Preconception care


The aims of preconception care are:



image to ensure that the woman and her partner are in an optimal state of physical and emotional health at the onset of pregnancy


image to provide prospective parents with a series of options that may not be available once a pregnancy is confirmed.


The preconception period refers to a timespan of anything from 3 months to 1 year before conception.


Box 6.1 outlines the information and investigations that may be required.



Box 6.1 Information and investigations in a preconception programme



History




• Family history


• Medical history


• Menstrual history


• Obstetric history


• Method of contraception


• Medication


• Occupation


• Diet


• Smoking


• Alcohol



Observations/investigations




• Height and weight


• Blood pressure


• Urinalysis


• Stool sample


• Blood tests:


image Haemoglobin

image Folic acid and vitamin levels

image Rubella immunity

image Venereal disease research laboratory (VDRL)

image Haemoglobinopathies

image Lead and trace elements

• Hair analysis (controversial)


• Male – semen analysis


• Female – cervical smear, high vaginal swab (HVS)



General health and fertility



Body weight


Fertility and obesity are closely linked, with subfertility-related problems occurring in women below and above the desirable range of body weight.



image The Quetelet or body mass index (BMI) is calculated by dividing the weight in kilograms by the height in metres squared.


image The desirable or healthy range is between 18.5 and 24.9.


Substantial evidence is accumulating that corroborates the relationship between an increased risk of pregnancy complications/adverse pregnancy outcomes and excess weight and obesity in women. Overweight women should be encouraged to lose weight before conception; however, some caution is required, as consuming an energy-deficient diet immediately prior to conception may result in nutritional deficiencies that could disadvantage the fetus. Dietary changes and weight loss should occur at least 3–4 months before attempting conception.



Principles of a healthy diet


A simple and easy guide is to advise women to eat:



image more starchy foods, such as cereals and bread


image at least five portions of fruit and vegetables daily


image fewer fatty foods.



Folate, folic acid and neural tube defects


Folic acid is a water-soluble vitamin belonging to the B complex.



image The term ‘folates’ is used to describe the folic acid derivatives that are found naturally in food.


image The term ‘folic acid’ is used to refer to the synthetic form found in vitamin supplements and fortified foods.


The main sources of folate in the UK diet are listed in Box 6.2.



Box 6.2 Principal sources of dietary folate




• Dark green vegetables


• Potatoes


• Fruit and fruit juices


• Beans


• Yeast extract


Folates are vulnerable to heat and readily dissolve in water; therefore considerable losses can occur as a result of cooking or prolonged storage. Folic acid is more stable and better absorbed than folate and is added to many brands of bread and breakfast cereal in the UK.



image To reduce the risk of first occurrence of neural tube defects (NTDs), all women should increase their daily folate and folic acid intake by an additional 400 μg prior to conception and during the first 12 weeks of pregnancy.


image Women with a history of a previous child with NTD should take a daily dose of 5 mg of folic acid to reduce the risk of recurrence.


image This dose is also recommended in women with diabetes, those taking antiepileptic medication, and those who have malabsorption syndrome.

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Related posts:

  1. The Placenta
  2. Trauma During Birth, Haemorrhage and Convulsions
  3. Obstetric Emergencies
  4. Problems of Pregnancy

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Jul 11, 2016 | Posted by in MIDWIFERY | Comments Off on Preparing for Pregnancy

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