PREPREGNANCY ASSESSMENT

AND COUNSELLING
 ASSESSMENT
• Timing of planned pregnancy.
• Folic acid.
• Smear history.
• Smoking history.
• Alcohol intake.
• Weight (overweight or obese?).
• Medication, including over-the-counter or herbal medication.
History of illicit drugs?
• Risks of exposure to hazardous substances or radiation.
• Rubella immune status.
• History of chickenpox or shingles.
• Risk of hepatitis B.
• History of miscarriage.
• Risk or concern regarding chromosomal abnormalities or inherited
genetic disorders
• Chronic health problems
 1. TIMING OF PREGNANCY
• In couples: 84% pregnant within a
year.
• 92% within two years.
• and some may need help or
intervention.
• The optimum biological age for
pregnancy is between 20-35 years of
age.
 2. FOLIC ACID
• All women should take at least 400 mcg/day
• Pregnant women: at least 3 months of
pregnancy

• Goals: to reduce risk of neural tube defect

(NTD)
• High risk women to get NTD should take 5mg
/day until 12 weeks of pregnancy
 3. CERVICAL SCREENING
- encourage women to have cervical screen
before becoming pregnant.
- because
• Smears are not routinely taken during
pregnancy, as pregnancy-related inflammatory
changes make them difficult to interpret.
• Many treatments cannot be carried out during
pregnancy should an abnormality be detected.
 4. Smoking

Intrauterine
Misscarrige
growth
and stillbirth
restriction

Prematured Placental
delivery problems
 5. Alcohol Use
• High level of alcohol use can cause fetal
alcohol syndrome (FAS)
• Growth restriction
• Intellectual impairment
• Facial anomalies
• Behavioral problems
• Can cause miscarriage
 6. Body Weight
• Advise women who are overweight (BMI 25-
29.9) or obese (BMI ≥30) to lose weight before
becoming pregnant.
• A healthy weight reduces the risk of NTD,
preterm delivery, gestational diabetes,
caesarean delivery, hypertension and
thromboembolic disease and is also more
likely to promote conception.
 7. Medication Review
• minimise exposure to all drugs, including
those bought over the counter.
• Avoid herbal preparations
• Advise not to exceed 10,000 IU of vitamin A
from vitamin supplements either prior to or
during pregnancy, as vitamin A is a potent
teratogen.
8. Risk From Environment
Pets, farm
animals,sheeps

Advise to wash
Avoid radiation hands after
gardening

Read product
Avoid hazardous
warning reg
substances
chemicals
 9. Diet
• advice on eating five portions of fruit and
vegetables per day and consuming dairy
products to raise stores of vitamins, iron and
calcium.
• Vitamin D deficiency causes impaired fetal
growth. All women should be informed about
the importance of maintaining adequate
vitamin D stores during pregnancy and breast-
feeding
 Diet to avoid
• Uncooked meat, fish and eggs
• Fish with high levels of mercury
• Unpasteurised milk
• Unripened soft cheeses, such as Brie,
Camembert or blue-veined cheese
• Unwashed fruit and vegetables
 10. Vaccination

Viral
hepatitis

Varicella
 11. Special Advice
• risk of miscarrige
Advanced • Complication of pregnancy
maternal age • Risk fetal chromosomal abnormalies

Women + h/o • Reassure for good chances for successful

pregnancy
miscarrige • Refer to gynecologist if >3consecutive miscarrige

Women + h/o • May have implication to fetal health

chroneic • Pregnancy and labour may worsen preexiting
maternal condition
diseas
 REFERENCE
• 1. Antenatal care; NICE Clinical Guideline (March 2008)
• 2. Inskip HM, Crozier SR, Godfrey KM, et al; Women's compliance
with nutrition and lifestyle recommendations before
• pregnancy: general population cohort study. BMJ. 2009 Feb
12;338:b481. doi: 10.1136/bmj.b481.
• 3. Bille C, Andersen AM; Preconception care. BMJ. 2009 Feb
12;338:b22. doi: 10.1136/bmj.b22.
• 4. Frey KA, Navarro SM, Kotelchuck M, et al; The clinical content of
preconception care: preconception care for men. Am J
• Obstet Gynecol. 2008 Dec;199(6 Suppl 2):S389-95. doi:
10.1016/j.ajog.2008.10.024.
• 5. Pre-conception - advice and management; NICE CKS, June 2012
Thank You