Preconception and

Interconception Health

Every Child Deserves a Healthy

StartPatricia A. Brownlee, B.S.N., A.R.N.P.Hendry / Glades County Health Department

Public Health Perspective Preconceptual and Interconceptional Preconceptual and Interconceptional

Education and Counseling for women of Education and Counseling for women of childbearing age has the potential to childbearing age has the potential to favorably impact rates of:favorably impact rates of:

Infant mortality and morbidity Infant mortality and morbidity Maternal mortality and morbidityMaternal mortality and morbidity Moms and Babies survive and do well.Moms and Babies survive and do well.

Goals To increase awareness of the optimal health To increase awareness of the optimal health

status needed by any sexually active woman status needed by any sexually active woman to improve the birth outcome of a potential to improve the birth outcome of a potential pregnancy.pregnancy.

To identify reversible risks to a woman’s To identify reversible risks to a woman’s health or pregnancy outcome, emphasizing health or pregnancy outcome, emphasizing those factors which must be acted on before those factors which must be acted on before conception.conception.

Strategies Risk Identification, Reduction, and Risk Identification, Reduction, and

EliminationElimination Appropriate intervention, treatment and/or Appropriate intervention, treatment and/or

referralreferral Ongoing education, counseling and supportOngoing education, counseling and support Prevention of Unplanned PregnancyPrevention of Unplanned Pregnancy

Unplanned Pregnancy Incidence of unplanned pregnancy is 50%.Incidence of unplanned pregnancy is 50%. Usual entry into prenatal care is in the 3Usual entry into prenatal care is in the 3 rdrd

month after the Last Menstrual Period.month after the Last Menstrual Period. Preconception counseling needs to be Preconception counseling needs to be

provided to provided to allall reproductive age individuals. reproductive age individuals.

Baby Spacing A short pregnancy interval may be A short pregnancy interval may be

associated with:associated with: Birth of a Small For Gestational Age (SGA) Birth of a Small For Gestational Age (SGA)

infant in a subsequent pregnancy infant in a subsequent pregnancy (Lieberman 1989, (Lieberman 1989,

Zhu 1999)Zhu 1999)

Preterm birth in a subsequent pregnancy Preterm birth in a subsequent pregnancy (Basso (Basso

1998, Zhu 1999)1998, Zhu 1999)

Health Care Provider Review medical history and immunizationsReview medical history and immunizations Review family history for genetic disorders (such as Tay-Sachs, Thalassemia, Cystic Review family history for genetic disorders (such as Tay-Sachs, Thalassemia, Cystic

Fibrosis, Sickle Cell disease)Fibrosis, Sickle Cell disease) Laboratory testing and screening for infectious diseasesLaboratory testing and screening for infectious diseases Medical assessment and managementMedical assessment and management Lifestyle assessment/interventionLifestyle assessment/intervention Recommend Folic Acid, immunize and counselRecommend Folic Acid, immunize and counsel Review contraceptive optionsReview contraceptive options

Common Conditions Amenable to Preconception Care DiabetesDiabetes HypertensionHypertension Cardiac ConditionsCardiac Conditions Seizure DisorderSeizure Disorder Thyroid DisorderThyroid Disorder Thrombo-embolic Thrombo-embolic

diseasedisease Hemoglobin disordersHemoglobin disorders

STDs/HIV InfectionSTDs/HIV Infection DepressionDepression Eating DisordersEating Disorders Alcohol, tobacco and Alcohol, tobacco and

other drug useother drug use Domestic ViolenceDomestic Violence Poor nutritionPoor nutrition

Conditions that Need Time to Correct Prior to Conception Optimal WeightOptimal Weight Dental HealthDental Health Choice and Use of MedicationsChoice and Use of Medications Substance Use and Abuse:Substance Use and Abuse:

~Illicit Drugs~Illicit Drugs~Alcohol~Alcohol~Tobacco~Tobacco

Nutritional Risks UNDERWEIGHT:UNDERWEIGHT: Increased risk for low Increased risk for low

birth weight, fetal death and mental birth weight, fetal death and mental retardation.retardation.

OVERWEIGHT AND OBESE:OVERWEIGHT AND OBESE: Increased Increased risk for diabetes, hypertension, thrombo-risk for diabetes, hypertension, thrombo-embolic disease, birth trauma, abnormal embolic disease, birth trauma, abnormal labor, cesarean delivery.labor, cesarean delivery.

Nutritional Alerts Over supplementation of Vitamins A Over supplementation of Vitamins A (limit to (limit to

3,000 IU /day)3,000 IU /day) & D & D (limit to 400 IU/day)(limit to 400 IU/day) - Associated - Associated with an increase in congenital anomalieswith an increase in congenital anomalies

Pica - Associated with iron deficiency and Pica - Associated with iron deficiency and lead poisoninglead poisoning

Iron Deficiency – Associated with increased Iron Deficiency – Associated with increased risk of preterm delivery and low birth risk of preterm delivery and low birth weightweight

Milk Intolerance or Calcium DeficiencyMilk Intolerance or Calcium Deficiency

Physical Activity and Nutrition

Exercise at least 30 minutes 3 times / week.Exercise at least 30 minutes 3 times / week. Eat a balanced meal from the Food Eat a balanced meal from the Food

Pyramid.Pyramid. Don’t eat uncooked or undercooked meats Don’t eat uncooked or undercooked meats

or fish.or fish. Limit or eliminate caffeine intake from Limit or eliminate caffeine intake from

coffee, tea, sodas, medications and coffee, tea, sodas, medications and chocolates.chocolates.

Dental Health Research suggests that the bacteria that Research suggests that the bacteria that

cause inflammation in the gums can cause inflammation in the gums can actually get into the bloodstream and target actually get into the bloodstream and target the fetus, potentially leading to premature the fetus, potentially leading to premature labor and low birth weight babies. labor and low birth weight babies. (Offenbacher (Offenbacher 1996)1996)

Women who have gum disease are more Women who have gum disease are more than twice as likely as other women to give than twice as likely as other women to give birth to a premature baby.birth to a premature baby. (Jeffcoat 2000) (Jeffcoat 2000)

Encourage routine dental health care.Encourage routine dental health care.

Medications Not all medications are safe while trying to Not all medications are safe while trying to

conceive and during pregnancy.conceive and during pregnancy. Over-the-CounterOver-the-Counter PrescriptionPrescription Vitamins and SupplementsVitamins and Supplements Pregnancy Risk Categories for MedsPregnancy Risk Categories for Meds Review all medications with a health care Review all medications with a health care

provider.provider.

Substance Use / Abuse Birth Defects and Learning DefectsBirth Defects and Learning Defects Safety Issues impacting the ability to properly care Safety Issues impacting the ability to properly care

for an infantfor an infant Family DysfunctionFamily Dysfunction Financial StressFinancial Stress Potential for Law Enforcement InvolvementPotential for Law Enforcement Involvement Pregnancy may be a strong motivator for change.Pregnancy may be a strong motivator for change. Refer for Substance Abuse Evaluation/CounselingRefer for Substance Abuse Evaluation/Counseling

Alcohol Intake Fetal Alcohol Syndrome is a leading cause Fetal Alcohol Syndrome is a leading cause

of preventable mental retardation.of preventable mental retardation. No level of alcohol is considered “safe”.No level of alcohol is considered “safe”. Advise to abstain when attempting to Advise to abstain when attempting to

conceive and during pregnancy.conceive and during pregnancy. Refer for evaluation and treatment.Refer for evaluation and treatment.

Tobacco Exposure Smoking in pregnancy is associated with Smoking in pregnancy is associated with

preterm delivery and low birth weight preterm delivery and low birth weight infants.infants.

Smoking in the household is associated Smoking in the household is associated with Sudden Infant Death Syndrome, with Sudden Infant Death Syndrome, childhood respiratory illness, asthma, and childhood respiratory illness, asthma, and otitis media.otitis media.

Promote Smoking Cessation.Promote Smoking Cessation.

Environmental Hazards Chemical: Lead, Mercury, Herbicides & Chemical: Lead, Mercury, Herbicides &

Pesticides Pesticides Physical: HyperthermiaPhysical: Hyperthermia Radiation: X-RayRadiation: X-Ray Infectious: Live Vaccines, STD’s, Toxoplasmosis, Infectious: Live Vaccines, STD’s, Toxoplasmosis,

Cytomegalovirus, Parvovirus B19 (Fifth Disease)Cytomegalovirus, Parvovirus B19 (Fifth Disease) Exposures at home, workplace and environmentExposures at home, workplace and environment Cultural considerationsCultural considerations

Environmental Counseling Avoid hot tubs, saunas, and x-rays.Avoid hot tubs, saunas, and x-rays. Stay away from toxic chemicals like Stay away from toxic chemicals like

insecticides, solvents, mercury and lead.insecticides, solvents, mercury and lead. Avoid cat litter, garden soil and raw meat.Avoid cat litter, garden soil and raw meat. Frequent hand washingFrequent hand washing Universal Precautions for child care and Universal Precautions for child care and

health carehealth care Cultural PracticesCultural Practices

Life Cycle Issues Psychological ConcernsPsychological Concerns Social ConcernsSocial Concerns Screen for Domestic ViolenceScreen for Domestic Violence Readiness for parenthoodReadiness for parenthood Financial readinessFinancial readiness Life Plans (Education or Career)Life Plans (Education or Career) StressStress TeensTeens

Neural Tube Defects Anacephaly - born without brainAnacephaly - born without brain Spina Bifida -exposure of tube along Spina Bifida -exposure of tube along

spinespine Encephalocele - hernia of the brainEncephalocele - hernia of the brain Estimated 4000 affected pregnancies Estimated 4000 affected pregnancies

/year in U.S./year in U.S. NTD form in the first 28 days of NTD form in the first 28 days of

pregnancypregnancy

Increased Risk of NTD Ethnicity (Hispanic mothers)Ethnicity (Hispanic mothers) Maternal ConditionsMaternal Conditions Medications taken during pregnancyMedications taken during pregnancy Previous NTDPrevious NTD Low socio-economic statusLow socio-economic status Genetics/environment Genetics/environment

What is Folic Acid? Water soluble B vitamin also known as Water soluble B vitamin also known as

folate, folacin or pteroylmonoglutamic acid.folate, folacin or pteroylmonoglutamic acid. Helps to synthesize DNA required for all Helps to synthesize DNA required for all

rapidly growing cells.rapidly growing cells. The need for folate rises whenever cells are The need for folate rises whenever cells are

multiplying.multiplying. Only about half of dietary folate is available Only about half of dietary folate is available

for use in the bodyfor use in the body

Folic Acid Modifies risk of neural tube defects (NTD)Modifies risk of neural tube defects (NTD) Supplementation for all women of Supplementation for all women of

childbearing potentialchildbearing potential No history of NTD: 0.4 mg dailyNo history of NTD: 0.4 mg daily Prior infant with NTD: 4.0 mg dailyPrior infant with NTD: 4.0 mg daily Woman with NTD: 4.0 mg dailyWoman with NTD: 4.0 mg daily Nutritional sources often inadequateNutritional sources often inadequate

Food High in Folic Acid Orange Juice and Orange Juice and

OrangesOranges BananasBananas SpinachSpinach Dried Navy BeansDried Navy Beans PeanutsPeanuts BroccoliBroccoli AsparagusAsparagus Peas and lentilsPeas and lentils

Food with added Folic Food with added Folic Acid:Acid:

FlourFlour RiceRice SpaghettiSpaghetti BreadBread CerealsCereals Check food label for Check food label for

folatefolate

Ongoing Support and Involvement Lifestyle ChoicesLifestyle Choices Community ResourcesCommunity Resources Promote routine women’s health care Promote routine women’s health care

versus increased attention and care of versus increased attention and care of women while pregnant.women while pregnant.

Personalize the messagePersonalize the message

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“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.”