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Jung Yeol Han, June Seek Choi, Hyun Kyong Ahn, Jae Hyug Yang Mi Kyung Koong, Inn Soo Kang, Jae Uk Shim

Application of preconceptional care in Korea Jung Yeol Han, June Seek Choi, Hyun Kyong Ahn, Jae Hyug Yang Mi Kyung Koong, Inn Soo Kang, Jae Uk Shim The Korean Motherisk Program, Departments of Obstetrics and Gynecology ,

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Jung Yeol Han, June Seek Choi, Hyun Kyong Ahn, Jae Hyug Yang Mi Kyung Koong, Inn Soo Kang, Jae Uk Shim

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  1. Application of preconceptional care in Korea Jung Yeol Han, June Seek Choi, Hyun Kyong Ahn, Jae Hyug Yang Mi Kyung Koong, Inn Soo Kang, Jae Uk Shim The Korean Motherisk Program, Departments of Obstetrics and Gynecology , Samsung Cheil Hospital & Women’s Health-Care Center, Sungkyunkwan University School of Medicine, Seoul, Korea

  2. Introduction • Population in South Korea • Birth rate • Birth defect Monitoring • Intake of folic acid • Unintended pregnancy • Termination of pregnancy and teratogens

  3. Population in South Korea

  4. Birth rate in Korea 1.7 1.6 1.5 Firtlity rate 1.4 1.3 1.2 1.1 2002 1994 1993 1995 1997 1999 2001 2003 1996 2000 1998 YEAR Korea National Statistical office 2005

  5. Birth defect Monitoring in Korea • 10 medical centers around Seoul • May 1999 ~ October 2002 • All live birth, stillbirth,and spontaneous abortions after 16 weeks of gestation • 86,622 deliveries • Birth defects : 1,537 • Incidence of Birth defects : 1.8% J Korean med Sci 2004;19:509-13

  6. Incidence of 19 congenital anomalies by ICBDMS in Korea and other countries J Korean med Sci 2004 ICBDMS: International Clearinghouse for Birth Defects Monitoring System

  7. Intake of folic acid • Intake of folic acid at periconceptional period • 10.3%(131/1,277) • Assoicated risk factors : • Previous spontaneous abortion : RR 1.88 ( 95%CI 1.1 to 3.1 ) • Intended pregnancy : RR 5.2 ( 95%CI 3.0 to 9.3 ) Cross-sectional Survey at Maternity school 2005

  8. Unintended pregnancy in Korea • Rate of Unintended pregnancy 48%(657/1,354) • Assoicated risk factors : ≤ 24 years of age: RR 2.5 (95%CI 1.3-4.7) Lower household income: RR 1.3 (95%CI 1.0-1.6) Birth defects Research (Part A) 2005

  9. Unintended pregnancy Exposure to potential teratogens during the first trimester of pregnancy Total number of surveys= 1,354. Data are n (%) Birth defects Research (Part A) 2005

  10. T Termination of pregnancy among pregnant women exposed to potential teratogens In pressJ of Obstetrics and Gynecology 2005

  11. Applicationof preconceptional care in Korea

  12. Application of preconceptional care • Education • Clinic

  13. Education on preconceptional care Maternity school 2005

  14. Patients at Clinic • Setting : The korean Motherisk Program Samsung Cheil Hospital ( 2% of Korean birth) • December 2004 - May 2005 • 91 cases • Preconceptional counseling Laboratory tests & Questionnaire

  15. Description : • Characteristics of subjects • Reasons visited for preconceptional care • Positive rate of risk factors

  16. Characteristics of subjects

  17. Reasons visited for preconceptional care Familty history of genetic disease or mental retardation 2 (2.2%) Previous baby anomaly & problem 14(15.4%) No bad history Maternal disease 35(38.5%) 19(20.9%) 22(24.2%) N=91 Previous spontaneous abortion

  18. Reasons n Details Maternal disease 19 Psychotid disease(4) Diabetes(1) Systemic lupus erythematosus(1) Rheumatic arthritis(1) Asthma(1) Psoriasis(1) Hypothryroidism(1) Hypertension(1) Known ovarian tumor(1) Known uterine fibroids(2) Known uterine didelphysis(1) Known breast tumor(2) Antimalaria drug exposure(1) Methotrexate exposure(1) Previous congenital anomaly or adverse pregnancy outcome 14 Acrania(1) Cleft lip(1) Biliary tract agenesis(1) T-E fistula and TOF(1) Congenital heart anomaly(1) Combined anomaly(holoprosencephaly..)(1) Down syndrome(1) Edward syndrome(1) Anhydramnios(46,XX,add(22))(1) IUGR(1), Preterm birth(2) Abruptio placenta(1) Previous baby: learning disability(1) Family history of genetic disease or mental retard 2 Duchenne muscular dystrophy(1) Cerebral palsy(1) Details of Reasons for preconceptional care

  19. Laboratory tests Questionnaire Non immune hepatitis B (10) Hepatitis B surface Ag(+) (1) Non immune rubella (5) Ureaplasma (13) Mycoplasma (1) Chlamydia (1) Group B streptococcus (3) E-coli (3) CMV(-) (1) Varicella Zoster Virus Ab(-) (1) SGOT elevation (2) SGPT elevation (3) Abnormall TSH (5) Antimicrosomal Ab (2) Blood Irregular Ab(+) (1) Pap smear (3) Abnormal EKG (2) Abnormal mammogram (2) Diabetes (1) Spontaneous abortion (22) Matenral disease (19) Elderly(≥35yo) (16) Congenital anomaly (5) Preterm delivery (1) Abruptio placenta (1) PPROM (1) IUGR (1) Down syndrome (1) Edward syndrome (1) 46,XX,add(22) (1) 1st baby learning disability (1) Obese(BMI>23) (13) Low body weight(BMI<18.5) (5) Alcohol (32) Smoking (2) Nutritional problem (8) Herbal medicine (3) Lead exposure (1) Positive rate of risk factors Positive rate 85 91 (93%)

  20. Our preliminary data suggest that preconceptional care is absolutely necessary to all women who want a baby even though its evidence on improving pregnancy outcome is scarce yet in Korea.

  21. Thanks for attention !

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