Preconception Care Essay Example

is at least 400 mcg, beginning at least one month before conception and continuing through the first three months of pregnancy. In women with diabetes mellitus and epilepsy, a dosage of 1mg per day is recommended (Brundage, 2002). Also, for mothers who have given birth to children with neural tube defects previously, it is recommended to take 4 mg of folic acid per day for subsequent pregnancies (Brundage, 2002).

Congenital Infections with Viruses Preconception testing for human immunodeficiency virus (HIV) is important and beneficial. Women with HIV positive status should be advised against getting pregnant to prevent mother-to-child transmission. Pregnant women with HIV infection may prevent infecting their child with HIV by antiretrovirus therapy during pregnancy, delivery and in the new-born period. Early screening and treatment of syphilis reduces the risk of congenital infection to the baby. Preconception, women should be immunized against hepatitis B, rubella and varicella.

Rubella and varicella are live-virus vaccines should be given at least one month before conception (Brundage, 2002). Other diseases which need to be screened for preconception are cytomegalovirus, toxoplasmosis and herpes. The viral diseases can affect the fetus and lead to multiple complications in the child. Toxoplasma can cause hydrocephalus with diffuse intracranial calcifications and chorioretinitis. Syphilis affects the skeletal system and leads to osteochondritis (metaphyseal plates), periostitis, symmetric osteomyelitic lesions of the humerus and tibia and saber shins (Laartz, 2006).

It also causes hemolytic anemia in the baby. Infection with cytomegalovirus leads to microcephaly with periventricular calcifications, thrombocytopenia and purpura, hepatitis, interstitial pneumonitis and late and progressive hearing loss (Laartz, 2006). Rubella causes cataracts, glaucoma, chorioretinitis and patent ductus arteriosus (Laartz, 2006). Herpes

simplex virus can lead to hepatitis, chorioretinitis, pneumonitis and fever (Laartz, 2006). Varicella infection during pregnancy can lead to skin scarring and limb trophy (Laartz, 2006).

Another important infection that needs to be prevented during pregnancy is Parvo virus B19 which can cause hydrops fetalis and anemia (Laartz, 2006). Environmental Factors Affecting Pregnancy Environmental toxins affect fetus during organogenesis and cause defects in the baby. It has been estimated that drug or chemical exposure causes 3 to 6 percent of anomalies (Brundage, 2002). The severity of anomaly depends on the amount of exposure, the duration of exposure and also the timing of the exposure. Exposure to certain toxins before 17 days of conception can lead to fetal death (Brundage, 2002).

Exposure from days 17 to 56 a toxin can cause a structural anomaly, and after day 56, a functional impairment (Brundage, 2002). Some of the drugs which should be avoided during pregnancy and in the preconception period are, analgesics like aspirin and ibuprofen, antibiotics, anticoagulants, antidepressants, antifungals, anticonvulsants, antivirals, etc. Those at work should identify and determine hazardous substances and avoid them before and during pregnancy. Pregnant women should avoid prolonged exposure to pesticides and to solvents such as paint thinners and strippers at home and work place.

Ionizing radiation (radiography and radioactive materials) can cause genetic damage in the embryo. Smoking can cause miscarriage, low birth weight and attention-deficit disorder in the child. It can increase perinatal mortality (Brundage, 2002). Women should also avoid consuming alcohol because it can lead to mental retardation, malformation, growth retardation, miscarriage, and behavioral disorders in infants (Brundage, 2002). Use of illicit drugs like cocaine, marijuana

and heroin should be stopped before conception. Cocaine causes miscarriage, prematurity, growth retardation, and congenital defects in the fetus.

Marijuana can cause prematurity and jitteriness in the neonate. Consumption of heroin during pregnancy may lead to intrauterine growth restriction, hyperactivity, and severe neonatal withdrawal syndrome (Brundage, 2002). Effect of Chronic Illnesses Studies have shown that poorly controlled diabetes mellitus during pregnancy can lead to spontaneous abortion and several congenital anomalies in the fetus which include patent ductus arteriosus and macrosomia. Hence it is important to manage diabetes intensively before conception. Insulin is the drug of choice for women with type 1 and type 2 diabetes mellitus during pregnancy (Brundage, 2002).

Those with chronic hypertension are more prone to preeclampsia, renal insufficiency, and fetal growth retardation. The drugs useful for managing hypertension during pregnancy are methyldopa and calcium channel blockers. Angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists and thiazide diuretics are associated with congenital defects and should be avoided during pregnancy (Brundage, 2002). Children born to epileptic mothers have an increased risk of developing congenital anomalies either due to genetic background or due to the anticonvulsant medication.

Preconception counseling in these patients includes optimizing seizure control, prescribing folic acid supplements with a dosage of about 1 to 4 mg per day, and genetic counseling (Brundage, 2002). It is important to reduce the number of drugs as much as possible during pregnancy. Women with personal or family history of venous thromboembolism should be tested for thrombophilia before pregnancy, because there is good chance for deep vein thrombosis to occur during pregnancy (Brundage, 2002). Since warfarin is teratogenic, the patient should be started on heparin.