Preconception Care

Dr.Abdikarim Awale
Doctor at Neonatal Unit Hargeisa Group Hospital

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 Objectives
• To identify reversible health risks to
pregnancy outcome
• To emphasize factors that must be acted
on before conception to achieve optimal
pregnancy outcomes.
• To educate women on risk prevention
before pregnancy.

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 Preconception Care

• Definition: Preconception care is care

received by mothers before they get
pregnant. 
• Conception: the action of conceiving a child
or of a child being conceived.
• A good preconception care and antenatal
care are a prerequisite for a good neonatal
care.
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 Preconception Care
Preconception
care
Antenatal
care
Neonatal
care

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 Preconception Care Importance

1. Provides Women & Families Information

And Opportunities To Modify Unhealthy
Behaviors And Thus Potentially Improve
The Quality Of Their Lives and babies
2. Increase Reproductive Choices, Possibly
Decreased Unintended & Unwanted
Pregnancies.

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 Preconception Care Importance

3. Improve Pregnancy Outcome By

Decreasing Infant Mortality & Morbidity
4. Reduces The Probability Of Damage
During Organogenesis

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 Preconception Care focus
1. History, physical examination and relevant labs to
find out any problems that might affect mother and
her baby later, like diabetes, high blood pressure
or infections.
2. Increasing the amount of folic acid to
prevent neural tube defects
3. Getting up to date on vaccines
4. Avoiding smoking, drinking alcohol, or taking drugs
5. Trying to reach a healthy weight

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Controllable Risks before conception

• Smoking
• Alcohol
• Drugs
• Weight
• Diabetes
• Infections

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 SMOKING

• All mothers should Stop All tobacco before

attempting to conceive and during
Pregnancy.

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 Smoking

• Tobacco and Reproductive Outcomes:

– One of the leading preventable causes
of infant mortality
– Preventable cause of low birth weight
and prematurity
– Associated with placental
abnormalities
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 Smoking
• Obstetric Risks
• Ectopic pregnancy
• Placenta previa
• Abruptio placenta
• Preterm delivery
• Perinatal mortality
• Low birth weight – 2 times greater in smokers
• Intrauterine growth retardation

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 Smoking
• Infant Risks
• Low birth weight
• Sudden Infant Death Syndrome (SIDS)
• Respiratory illnesses Pulmonary and
Asthma
• School problems Lower scores on spelling &
reading tests Decreased attentionRisk for
hyperactive behavior
• Increased Hospitalizations

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 Smoking

• If smoking during pregnancy

eliminated, estimated There is :
– 10% reduction in perinatal mortality
– 11% reduction in the incidence of
low birth weight

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 SMOKING: Evidence based
counseling
• Ask every patient about tobacco use
• Advise them to quit
• Assess willingness to quit
• Assist them in quitting
• Arrange follow up

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 Alcohol

• All mothers should Stop Alcohol

before attempting To conceive and
during Pregnancy.
• “No amount of alcohol consumption
can be considered safe during
pregnancy.

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 Alcohol
• Alcohol consumed during pregnancy
increases the risk of alcohol-related birth
defects, including:
• Growth Deficiencies
• Facial Abnormalities
• Central Nervous System Impairment
• Impaired Intellectual Development.

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Alcohol-Related Birth Defects Include:

• Fetal Alcohol Syndrome (FAS)

which is characterized by:
1. Central Nervous System Problems
2. Low Birth Weight And Height

3. Typical Facial Features

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12/25/2021 NORMAL Dr.Abdikarim Awale FAS 18
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 Drugs
• Medications
– Association With Some Medications With
Some Birth Defects
– Some Women On Anti-seizure Medications
For Years of Seizure free Might Be Able To
Discontinue.
– Lowest Possible Effective Dose
– Single Drug instead of Multiple Drugs

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 Weight
• Risks of underweight
• If Mothers BMI is less than 18.5 before she
became pregnant, she may be advised to
gain more weight than someone who is in
the normal range.
•  Being underweight can bring a small
increased risk of pregnancy problems such
as premature birth (before 37 weeks) or
having a baby that is underweight.
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 Weight

• Obesity (Mother with BMI>30) and

Pregnancy :There is increased risk of :
– Glucose intolerance of pregnancy
– Pregnancy induced hypertension
– Thrombophlebitis
– Neural tube defects
– Prematurity
– Higher rates of difficult births
– Fetal injury from birth difficulty
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 Diabetes
• General Population
– 2-3% Risk Of Severe Birth Defects
• Diabetics Prior To Pregnancy
– POORLY CONTROLLED [ Hgb A1c>7]
– Risk Increases To 6-9%
– Heart Disease, Spina Bifida, Others
– Well Controlled Preconceptionally
• Back To Baseline Rate In The General Population!

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 Diabetes
• Risks of infant with Diabeteic Mother
• Respiratory distress
• Macrosomia or SGA
• Hypocalcemia or hypomagnesemia
• Polycythemia, jaundice
• Hypertrophic cardiomyopathy
• Hypoglycemia
• Malformations
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 Macrosomia

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 Malformations;
myelomeningocele, Anencephaly and Caudal Regression Syndrome

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 DIABETES :MATERNAL
COUNCELLING
• Pre-conception care and good glucose control
before and during pregnancy can reduce
these risks. (HbA1c level below(6.5%).
• Women with diabetes who are planning to
become pregnant should take 5 mg folic acid
daily until 12 weeks of gestation, to reduce
the risk of neural tube defects.
• Good antenatal care
• Timing of delivery <38 weeks.
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 DIABETES :MATERNAL COUNCELLING

• All other hypoglycaemic agents should

be discontinued before pregnancy, and
insulin substituted.
• Offer pregnant women with diabetes
ultrasound monitoring of fetal growth and
amniotic fluid volume every four weeks
from 28-36 weeks.

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 DIABETES :MATERNAL
COUNCELLING

• Importance of Preconception and post-

conception supplementation of folic
acid:
• Decreases rate of spina bifida by 50-70%
• Decreases rate of cleft lip
• Decreases rate of heart disease

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 INFECTIONS
• HEPATITIS B
– 90% Chronic Carriers Are Without Symptoms
– Pregnancy Doesn’t Alter Course Of Disease
– Identify Neonates For Full Vaccination And
Prophylaxis
– High Risk Women Who Are HBV-neg Can Be
Vaccinated

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 HIV
• Disclosure of HIV diagnosis
• Partner testing
• Screening other STI
Contraception, as needed, to delay
pregnancy while health issues are
addressed

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 HIV
• Risk factors for
MTCT and strategies
to reduce those risks
– ARV medications
– C-section
– Avoidance of
Breastfeeding

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 HIV
• Perform clinical staging, CD4 testing and viral
load as indicated
• Assess and treat opportunistic infections
• Assess need for prophylaxis against
Opportunistic Infections
• Optimize treatment/control of other chronic
diseases
• Review all medications for safety in pregnancy

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 OTHER INFECTIONS
• STD’S
– LABORATORY SCREANING
– APROPRIATE TREATMENT
• VARICELLA AND RUBELLA:
– IF NEGATIVE ANTIBODY, CAN IMMUNIZE
– WAIT THREE MONTHS PRIOR TO CONCEPTION
• TOXOPLASMA PRECONCEPTION TESTING
-APROPRIATE TREATMENT

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 Antenatal Care
• Importance of Antenatal Care:
 To ensure that the pregnant woman and her
fetus are in the best possible health.
 To detect early and treat properly
complications
 Offering education for parenthood
 To prepare the woman for labor, lactation and
care of her infant
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