Preconception and Interconception Health

1. Preconception andInterconception Health Every Child Deserves a Healthy Start Patricia A. Brownlee, B.S.N., A.R.N.P. Hendry / Glades County Health Department

2. Public Health Perspective • Preconceptual and Interconceptional Education and Counseling for women of childbearing age has the potential to favorably impact rates of: • Infant mortality and morbidity • Maternal mortality and morbidity • Moms and Babies survive and do well.

3. Goals • To increase awareness of the optimal health status needed by any sexually active woman to improve the birth outcome of a potential pregnancy. • To identify reversible risks to a woman’s health or pregnancy outcome, emphasizing those factors which must be acted on before conception.

4. Strategies • Risk Identification, Reduction, and Elimination • Appropriate intervention, treatment and/or referral • Ongoing education, counseling and support • Prevention of Unplanned Pregnancy

5. Unplanned Pregnancy • Incidence of unplanned pregnancy is 50%. • Usual entry into prenatal care is in the 3rd month after the Last Menstrual Period. • Preconception counseling needs to be provided to all reproductive age individuals.

6. Baby Spacing • A short pregnancy interval may be associated with: • Birth of a Small For Gestational Age (SGA) infant in a subsequent pregnancy (Lieberman 1989, Zhu 1999) • Preterm birth in a subsequent pregnancy (Basso 1998, Zhu 1999)

7. Health Care Provider • Review medical history and immunizations • Review family history for genetic disorders (such as Tay-Sachs, Thalassemia, Cystic Fibrosis, Sickle Cell disease) • Laboratory testing and screening for infectious diseases • Medical assessment and management • Lifestyle assessment/intervention • Recommend Folic Acid, immunize and counsel • Review contraceptive options

8. Diabetes Hypertension Cardiac Conditions Seizure Disorder Thyroid Disorder Thrombo-embolic disease Hemoglobin disorders STDs/HIV Infection Depression Eating Disorders Alcohol, tobacco and other drug use Domestic Violence Poor nutrition Common Conditions Amenable to Preconception Care

9. Conditions that Need Time to Correct Prior to Conception • Optimal Weight • Dental Health • Choice and Use of Medications • Substance Use and Abuse: ~Illicit Drugs ~Alcohol ~Tobacco

10. Nutritional Risks • UNDERWEIGHT: Increased risk for low birth weight, fetal death and mental retardation. • OVERWEIGHT AND OBESE: Increased risk for diabetes, hypertension, thrombo-embolic disease, birth trauma, abnormal labor, cesarean delivery.

11. Nutritional Alerts • Over supplementation of Vitamins A (limit to 3,000 IU /day) & D (limit to 400 IU/day) - Associated with an increase in congenital anomalies • Pica - Associated with iron deficiency and lead poisoning • Iron Deficiency – Associated with increased risk of preterm delivery and low birth weight • Milk Intolerance or Calcium Deficiency

12. Physical Activity and Nutrition • Exercise at least 30 minutes 3 times / week. • Eat a balanced meal from the Food Pyramid. • Don’t eat uncooked or undercooked meats or fish. • Limit or eliminate caffeine intake from coffee, tea, sodas, medications and chocolates.

13. Dental Health • Research suggests that the bacteria that cause inflammation in the gums can actually get into the bloodstream and target the fetus, potentially leading to premature labor and low birth weight babies. (Offenbacher 1996) • Women who have gum disease are more than twice as likely as other women to give birth to a premature baby. (Jeffcoat 2000) • Encourage routine dental health care.

14. Medications • Not all medications are safe while trying to conceive and during pregnancy. • Over-the-Counter • Prescription • Vitamins and Supplements • Pregnancy Risk Categories for Meds • Review all medications with a health care provider.

15. Substance Use / Abuse • Birth Defects and Learning Defects • Safety Issues impacting the ability to properly care for an infant • Family Dysfunction • Financial Stress • Potential for Law Enforcement Involvement • Pregnancy may be a strong motivator for change. • Refer for Substance Abuse Evaluation/Counseling

16. Alcohol Intake • Fetal Alcohol Syndrome is a leading cause of preventable mental retardation. • No level of alcohol is considered “safe”. • Advise to abstain when attempting to conceive and during pregnancy. • Refer for evaluation and treatment.

17. Tobacco Exposure • Smoking in pregnancy is associated with preterm delivery and low birth weight infants. • Smoking in the household is associated with Sudden Infant Death Syndrome, childhood respiratory illness, asthma, and otitis media. • Promote Smoking Cessation.

18. Environmental Hazards • Chemical: Lead, Mercury, Herbicides & Pesticides • Physical: Hyperthermia • Radiation: X-Ray • Infectious: Live Vaccines, STD’s, Toxoplasmosis, Cytomegalovirus, Parvovirus B19 (Fifth Disease) • Exposures at home, workplace and environment • Cultural considerations

19. Environmental Counseling • Avoid hot tubs, saunas, and x-rays. • Stay away from toxic chemicals like insecticides, solvents, mercury and lead. • Avoid cat litter, garden soil and raw meat. • Frequent hand washing • Universal Precautions for child care and health care • Cultural Practices

20. Life Cycle Issues • Psychological Concerns • Social Concerns • Screen for Domestic Violence • Readiness for parenthood • Financial readiness • Life Plans (Education or Career) • Stress • Teens

21. Neural Tube Defects • Anacephaly - born without brain • Spina Bifida -exposure of tube along spine • Encephalocele - hernia of the brain • Estimated 4000 affected pregnancies /year in U.S. • NTD form in the first 28 days of pregnancy

22. Increased Risk of NTD • Ethnicity (Hispanic mothers) • Maternal Conditions • Medications taken during pregnancy • Previous NTD • Low socio-economic status • Genetics/environment

23. What is Folic Acid? • Water soluble B vitamin also known as folate, folacin or pteroylmonoglutamic acid. • Helps to synthesize DNA required for all rapidly growing cells. • The need for folate rises whenever cells are multiplying. • Only about half of dietary folate is available for use in the body

24. Folic Acid • Modifies risk of neural tube defects (NTD) • Supplementation for all women of childbearing potential • No history of NTD: 0.4 mg daily • Prior infant with NTD: 4.0 mg daily • Woman with NTD: 4.0 mg daily • Nutritional sources often inadequate

25. Orange Juice and Oranges Bananas Spinach Dried Navy Beans Peanuts Broccoli Asparagus Peas and lentils Food with added Folic Acid: Flour Rice Spaghetti Bread Cereals Check food label for folate Food High in Folic Acid

26. Ongoing Support and Involvement • Lifestyle Choices • Community Resources • Promote routine women’s health care versus increased attention and care of women while pregnant. • Personalize the message

27. www.healthystartflorida.com www.marchofdimes.com “Funded by a Community Grant from the March of Dimes. “This material is for information purposes only and does not constitute medical advice.. The opinions expressed in this material are those of the author(s) and do not necessarily reflect the views of the March of Dimes.”