Comprehensive Review: Assess previous pregnancy outcomes, chronic medical conditions, surgical history, and family history of genetic disorders.
Supplements
Folate:
Recommended dose: 400-500 mcg/day at least 1 month before conception and through the first 12 weeks of pregnancy.
Reduces the risk of neural tube defects.
higher dose of folic acid (5 mg daily) is recommended before conception and during pregnancy to reduce the risk of neural tube defects and other complications. The indications for 5 mg folic acid include:
Previous Pregnancy Affected by Neural Tube Defects/Downs Syndrome
Family History of Neural Tube Defects:
Diabetes
Obesity
Epilepsy: Women taking antiepileptic medications.
Malabsorption Syndromes: Conditions like coeliac disease, inflammatory bowel disease, or those who have had gastric surgery.
Certain Medications: Women taking medications known to interfere with folate metabolism, such as methotrexate or sulfasalazine.
Multiple Pregnancies: Women carrying twins or higher-order multiples.
Thalassemia Trait: Women with certain hemoglobinopathies like thalassemia trait.
High-Risk Ethnic Groups: Women from ethnic groups with a higher prevalence of neural tube defects, such as certain Aboriginal and Torres Strait Islander communities.
Iodine:
Recommended dose: 150 mcg/day during pregnancy and breastfeeding.
Supports fetal brain development and maternal thyroid function.
Nutrition and BMI Optimization
Optimize BMI:
Aim for a BMI within the normal range (18.5-24.9).
Set a realistic goal to lose 5-10% of body weight prior to conception if overweight or obese.
Referral: Refer to a dietitian for personalized nutritional guidance.
Immunizations and Screenings
Rubella Immunity:
Check immunity status.
Administer booster if necessary, advising against pregnancy within 28 days post-vaccination.
STI Screening:
Screen for common STIs (chlamydia, gonorrhoea, syphilis, HIV).
Thyroid Function:
Check TSH levels, especially if there is a history of thyroid disease or symptoms.
Vitamin D:
Assess levels and supplement if deficient.
Thalassemia Screening:
Perform if there is an abnormal FBC or the patient belongs to a high-risk group (e.g., Mediterranean, Asian, Middle Eastern descent).
Physical Examinations
Oral Health: Conduct a dental check-up to identify and treat any potential issues.
Breast Examination: Perform a clinical breast exam.
Thyroid Examination: Check for thyroid enlargement or nodules.
Cardiovascular Examination: assess for murmurs and other cardiovascular anomalies.
Cervical Screening: Ensure cervical screening is up to date according to Australian guidelines.
Lifestyle Modifications
Smoking Cessation: Offer resources and support for quitting smoking.
Alcohol and Illicit Drug Use: Counsel on the risks and encourage cessation.
Pre-conception Testing
Oral Glucose Tolerance Test (OGTT): Recommended for high-risk groups, including women with PCOS.
Genetic Testing: Offer pre-conception genetic testing for conditions such as cystic fibrosis, spinal muscular atrophy, and fragile X syndrome.
Cystic Fibrosis (CF) Screening – Mutations in the CFTR gene causing cystic fibrosis.
Spinal Muscular Atrophy (SMA) Screening – Mutations in the SMN1 gene causing spinal muscular atrophy.
Fragile X Syndrome Screening – Expansions in the FMR1 gene causing fragile X syndrome.
Expanded Carrier Screening Panels
Thalassemia and Hemoglobinopathies Screening =ethnic backgrounds (e.g., Mediterranean, Middle Eastern, Asian) or those with a family history of hemoglobin disorders.
sickle cell disease in individuals of African descent
Optimizing Health Before Conception
Chronic Disease Management: Ensure optimal control of chronic conditions such as diabetes, hypertension, and epilepsy.
TORCH Infections: Assess risk for Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes simplex virus.
Psychosocial Assessment: Screen for anxiety and depression, provide appropriate referrals and support.
Medication Review
Contraindicated Medications: Review and discontinue any medications that are contraindicated in pregnancy.
Advise against the use of NSAIDs like ibuprofen.
Counseling and Education
Exercise: Recommend at least 150 minutes of moderate-intensity exercise per week.
Healthy BMI – recommended weight gain 11-16kg
Antenatal Care: Discuss the importance of early and regular antenatal care to monitor the health of the mother and baby.
Interpregnancy Intervals
Optimal Timing:
Educate about the risks associated with interpregnancy intervals of less than 18 months or more than 59 months.
Emphasize that 2-5 years is the optimal interval to reduce the risk of pre-term birth, low birth weight, and small size for gestational age.