MedTop College

1.0 Introduction

Providing quality preconception care is the responsibility of all primary care providers, not just those who provide maternity care or handle a high volume of women’s health. Innovative strategies that incorporate preconception care into routine primary care visits are needed. A comprehensive peri-natal program involves a coordinated approach to medical and psycho-social support that optimally begins before conception. Preconception care therefore should be an integral part of well women health care because it permits identification of those conditions or risk factors that could affect a future pregnancy or fetus, and promotes early intervention.

1.1 Definition

Pre-conception care is the provision of biomedical, behavioral and social health interventions to women and couples before conception occurs. (WHO, 2013)

1.2 Importance of pre-conception care

It improves pregnancy out come and women’s health in general through prevention of diseases and management of risk factors that affect pregnancy outcome and the health of future generations.

1.3 Components of Preconception Care

These components contains packages that addresses the following areas

1.3.1 Preconception Services for Women

Interventions

Care Considerations:

Reproductive Planning

Discuss reproductive goals and issues at each visit

When pregnancy is desired, discuss medications, health conditions, and activities that may affect fertility

Folic Acid Supplementation

All women of reproductive age should be advised to take folic acid and to consume a balanced, healthy diet of folate-rich foods. Women at high risk for NTDs should take higher levels of folic acid

Contraception Counseling

When pregnancy is not desired, discuss safe sex and effective contraceptive methods

Offer a full range of contraceptive methods and provide appropriate contraceptive counseling that is tailored to each patient’s preference

Counsel women on the importance of Healthy Timing and Spacing of Pregnancy

Family and Genetic History

Assess pregnancy risks on the basis of maternal age, maternal and paternal health, and obstetric history of past pregnancies / complications. Take a thorough family history to identify risk factors for genetic condition;

cystic fibrosis

Sickle cell,

Haemophilia etc.

Physical Assessment

To exclude;

Anaemia,

physical defects that may complicate pregnancy

Signs of physical violence

Healthy Body Weight

All women with a BMI greater than or equal to 30 kg/m2 or less than 18.5 kg/m2 should be counseled about infertility risk and risks during and after pregnancy.

Supplementing energy- and nutrient-dense food

Promoting exercise

Chronic Disease Management

Hypertension: Women of reproductive age should have blood pressure checks during routine care. If diagnosed with hypertension, they should be counseled on lifestyle changes and medications that are safe in pregnancy.

Diabetes: Women who have diabetes should be counseled about the importance of glycemzic control.

Depression/Anxiety Disorders: Women of reproductive age should be screened for depression and anxiety disorders and counseled about potential risks of untreated illness. Medications should be prescribed/adjusted prior to conception, if appropriate.

Assess for use of teratogenic medications and optimize risk profile of medications

Social and Behavioral History

Assess social history, lifestyle, and behavioral issues that may affect pregnancy

All women of childbearing age should be screened for alcohol consumption, tobacco use, and drug use at all clinical visits using “5 As” (ask, advise, assess, assist, arrange)

Advise Non-smokers about harm of second-hand smoke and harmful effects on pregnant women and unborn children

Immunizations

Immunization status should be reviewed annually and updated as indicated. Check record for – Rubella, HPV, TT/TD vaccine etc.

STIs/HIV prevention and Management

For all women of childbearing age and their partners, assess STI risk, provide counseling and immunizations as indicated to prevent acquisition of STIs, and provide indicated STI testing and treatment.

Physical/Sexual/Emotional abuse

All women of reproductive age should be screened for current, recent past, or childhood physical, sexual, or emotional interpersonal violence.

Identification and assistance for victims of current domestic violence

Psychological screening

Psychological screening for parenting readiness.

Assessing psychosocial problems

Providing educational and psychosocial counseling before and during pregnancy

Female Genital Mutilation

Discussing and discouraging the practice with the girl and her parents and/or partner

Screening women and girls for FGM to detect complications

Informing women and couples about complications of FGM and about access to treatment

Carrying out defibulation of infibulated or sealed girls and women before or early in pregnancy

Removing cysts and treating other complications

1.3.2 Preconception Care for Men

1.4 The Roles of CHEW’S in Pre-Conception Care

Health Education

Information, education and counseling on Lifestyle and behavior changes e.g. dangers of smoking, alcohol use and drugs abuse
Folic acid supplement as a standard care
Creating awareness and understanding of fertility and infertility and their preventable and unpreventable causes
Providing age-appropriate comprehensive sexuality education and services
Providing guidance and information on environmental hazards and prevention

Counselling

STI /HIV prevention and management
Importance of Family Planning /HTSP
Healthy body weight and adequate diet
Importance of personal hygiene/ oral hygiene
Avoidance of toxic substance and environment contaminant such as lead occupational exposure to toxins etc

Assessment

Physical assessment including physical examination
Taking a thorough family history to identify risk factors for genetic conditions
Screening for anaemia , diabetes, high blood pressure and other chronic diseases
Carrier screening - cystic fibrosis, sickle cell etc.
Immunization record – e.g. Rubella, HPV vaccine etc.
Complications with past pregnancies
Identification and assistance for victims of domestic violence
Psychological screening for parent readiness
Chronic diseases e.g. asthma, diabetes, heart disease, obesity etc.

Test item – Describe the various services that constitute preconception care

STUDENTS’ ACTIVITY

Topic: PRECONCEPTION CARE

Learning outcome: The student will be able to

Define pre-conception care
Mention the importance of pre-conception care
Describe the services that constitute pre-conception care
Identify the roles of community health extension workers in pre- preconception care

Task: In groups, brainstorm on how to involve the community members in ensuring effective preconception care

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