{"id":105,"date":"2020-08-12T19:55:30","date_gmt":"2020-08-12T19:55:30","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=105"},"modified":"2021-05-05T22:48:54","modified_gmt":"2021-05-05T22:48:54","slug":"9-preconception-care","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/9-preconception-care\/","title":{"rendered":"9. Preconception Care"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/k9GJEvPnmlQ\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>Duration = 8:16<\/p>\n<input type='hidden' bg_collapse_expand='69e9b554e9a2d3058903550' value='69e9b554e9a2d3058903550'><input type='hidden' id='bg-show-more-text-69e9b554e9a2d3058903550' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b554e9a2d3058903550' value='Hide Transcript'><button id='bg-showmore-action-69e9b554e9a2d3058903550' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b554e9a2d3058903550' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number nine<br \/>\n00:02<br \/>\npreconception care meet our patient<br \/>\n00:04<br \/>\nyoung reproductive aged she is a common<br \/>\n00:07<br \/>\npatient in all medical and surgical<br \/>\n00:09<br \/>\nscenarios it is always important to<br \/>\n00:11<br \/>\nconsider the likelihood of pregnancy in<br \/>\n00:13<br \/>\nall of our reproductive aged patients<br \/>\n00:15<br \/>\nthe objectives of this video are to<br \/>\n00:17<br \/>\ndescribe how certain medical conditions<br \/>\n00:19<br \/>\naffect pregnancy to describe how<br \/>\n00:21<br \/>\npregnancy affects certain medical<br \/>\n00:22<br \/>\nconditions to assess a patient&#8217;s genetic<br \/>\n00:24<br \/>\nrisk as well as a father&#8217;s genetic risk<br \/>\n00:26<br \/>\nwith regards to pregnancy to describe<br \/>\n00:28<br \/>\ngenetic screening options in pregnancy<br \/>\n00:30<br \/>\nto recognize a patient&#8217;s risk of<br \/>\n00:32<br \/>\nsubstance abuse and intimate partner<br \/>\n00:34<br \/>\nviolence and explain how this would be<br \/>\n00:35<br \/>\naddressed for the patient to appraise a<br \/>\n00:37<br \/>\npatient&#8217;s nutritional status and make<br \/>\n00:39<br \/>\nrecommendations to the patient on<br \/>\n00:40<br \/>\nnutrition and exercise to assess a<br \/>\n00:42<br \/>\npatient&#8217;s medications immunizations and<br \/>\n00:45<br \/>\nenvironmental hazards in pregnancy to<br \/>\n00:47<br \/>\nidentify appropriate folic acid intake<br \/>\n00:49<br \/>\nand to identify ethical issues<br \/>\n00:51<br \/>\nassociated with prenatal genetic<br \/>\n00:52<br \/>\nscreening and diagnostic tests many of<br \/>\n00:55<br \/>\nour patients see their obstetrician<br \/>\n00:56<br \/>\ngynecologist when they are already<br \/>\n00:57<br \/>\npregnant in a perfect world miss young<br \/>\n01:00<br \/>\nwould come in for a preconception<br \/>\n01:01<br \/>\ncounseling visit before she became<br \/>\n01:03<br \/>\npregnant especially if she has<br \/>\n01:04<br \/>\npre-existing medical conditions such as<br \/>\n01:06<br \/>\ndiabetes why is this important let&#8217;s<br \/>\n01:09<br \/>\nlook at fetal malformation rates and<br \/>\n01:11<br \/>\ntheir relationship to maternal<br \/>\n01:12<br \/>\nhemoglobin a1c levels at a hemoglobin<br \/>\n01:15<br \/>\na1c level of less than 7 the fetal<br \/>\n01:17<br \/>\nmalformation rate is the same as<br \/>\n01:18<br \/>\nbaseline at seven point two to nine<br \/>\n01:21<br \/>\npoint one there is a 14% rate at nine<br \/>\n01:23<br \/>\npoint two to eleven point one there&#8217;s a<br \/>\n01:25<br \/>\ntwenty three percent rate and if the<br \/>\n01:27<br \/>\nhemoglobin a1c is greater than eleven<br \/>\n01:29<br \/>\npoint two there&#8217;s a 25% fetal<br \/>\n01:31<br \/>\nmalformation rate of the diabetic<br \/>\n01:33<br \/>\nrelated fetal malformations cardio<br \/>\n01:35<br \/>\nvascular malformations are the most<br \/>\n01:37<br \/>\ncommon followed by central nervous<br \/>\n01:38<br \/>\nsystem than gastrointestinal<br \/>\n01:40<br \/>\ngenitourinary and skeletal malformations<br \/>\n01:43<br \/>\nin addition if a diabetic woman&#8217;s<br \/>\n01:46<br \/>\nhemoglobin a1c level is 11 there is a<br \/>\n01:48<br \/>\n44% miscarriage rate remember that organ<br \/>\n01:52<br \/>\nformation occurs at approximately 3 to<br \/>\n01:54<br \/>\n10 weeks estimated gestational age and<br \/>\n01:56<br \/>\nfewer than 30% of diabetic women seek<br \/>\n01:59<br \/>\npreconception counseling a savvy<br \/>\n02:01<br \/>\nendocrinologist or primary care doctor<br \/>\n02:04<br \/>\nshould therefore always talk to their<br \/>\n02:05<br \/>\nyoung reproductive age women about<br \/>\n02:07<br \/>\ncontraception and risk of pregnancy<br \/>\n02:08<br \/>\nespecially if glucose control as an<br \/>\n02:10<br \/>\nissue if young came in for a<br \/>\n02:12<br \/>\npreconception counts<br \/>\n02:13<br \/>\nvisit what should we address if she has<br \/>\n02:15<br \/>\nmedical issues we need to talk about<br \/>\n02:17<br \/>\noptimizing control of the disease<br \/>\n02:19<br \/>\nprocesses let&#8217;s start by discussing<br \/>\n02:21<br \/>\nsystemic lupus erythematosus SLE ideally<br \/>\n02:25<br \/>\npregnancy should occur during a period<br \/>\n02:26<br \/>\nof disease quiescence for at least six<br \/>\n02:29<br \/>\nmonths prior to conception if her SLE is<br \/>\n02:32<br \/>\nactive at the time of conception this is<br \/>\n02:34<br \/>\na strong predictor of adverse maternal<br \/>\n02:36<br \/>\nand obstetric of complications all of<br \/>\n02:38<br \/>\nher SLE medications need to be reviewed<br \/>\n02:40<br \/>\nand adjusted prior to conception with<br \/>\n02:43<br \/>\nthe goal of maintaining disease control<br \/>\n02:44<br \/>\nwhile maximizing safety profiles<br \/>\n02:46<br \/>\npreconception counseling with SLE is<br \/>\n02:48<br \/>\nthus especially important next let us<br \/>\n02:51<br \/>\ndiscuss if young had hypertension there<br \/>\n02:54<br \/>\nare several key issues pertaining to<br \/>\n02:55<br \/>\nhypertension and pregnancy planning<br \/>\n02:57<br \/>\nfirst blood pressure classifications we<br \/>\n02:59<br \/>\nclassify hypertensive pregnant women<br \/>\n03:01<br \/>\ninto three classes normal with blood<br \/>\n03:03<br \/>\npressures less than 140 over 90 mild to<br \/>\n03:06<br \/>\nmoderate hypertension with systolic&#8217;s of<br \/>\n03:08<br \/>\n140 to 159 over a diastolic of 90 over<br \/>\n03:11<br \/>\n109 and severe hypertension is greater<br \/>\n03:14<br \/>\nthan a systolic of 160 and a diastolic<br \/>\n03:16<br \/>\nof 90 we know that treating severe<br \/>\n03:19<br \/>\nhypertension leads to a reduction in<br \/>\n03:20<br \/>\nstroke risk there is an unclear benefit<br \/>\n03:23<br \/>\nof treating mild to moderate<br \/>\n03:24<br \/>\nhypertension for there needs to be a<br \/>\n03:26<br \/>\nbalance for lowering maternal blood<br \/>\n03:27<br \/>\npressure too much reduces placental<br \/>\n03:29<br \/>\nperfusion the medication classifications<br \/>\n03:32<br \/>\nof ACE inhibitors angiotensin ii<br \/>\n03:34<br \/>\nreceptor blockers and direct renin<br \/>\n03:36<br \/>\ninhibitors are contraindicated during<br \/>\n03:38<br \/>\nall stages of pregnancy methyl dopa and<br \/>\n03:41<br \/>\nlabetalol are safe and commonly used<br \/>\n03:43<br \/>\nduring pregnancy pre pregnancy<br \/>\n03:45<br \/>\nhypertension otherwise known as chronic<br \/>\n03:47<br \/>\nhypertension is associated with greater<br \/>\n03:48<br \/>\nrisks during pregnancy of superimposed<br \/>\n03:51<br \/>\npreeclampsia placental abruption and<br \/>\n03:53<br \/>\nfetal growth restriction if young has<br \/>\n03:56<br \/>\ndiabetes in addition to the fetal issues<br \/>\n03:58<br \/>\nwe discussed earlier in this video<br \/>\n04:00<br \/>\npregnancy has been associated with<br \/>\n04:01<br \/>\nexacerbation of many disease related<br \/>\n04:03<br \/>\ncomplications poorly controlled pre<br \/>\n04:06<br \/>\ngestational diabetes can lead to serious<br \/>\n04:08<br \/>\nand organ damage that could become<br \/>\n04:09<br \/>\neventually life-threatening for example<br \/>\n04:11<br \/>\ndiabetic nephropathy diabetic<br \/>\n04:13<br \/>\nretinopathy and chronic hypertension the<br \/>\n04:16<br \/>\ngood news is that perinatal mortality<br \/>\n04:18<br \/>\nhas decreased markedly in recent years<br \/>\n04:20<br \/>\nbecause of the ability to achieve<br \/>\n04:22<br \/>\nglucose control with medical therapy<br \/>\n04:24<br \/>\neither with insulin or oral hypoglycemic<br \/>\n04:27<br \/>\nagents<br \/>\n04:27<br \/>\ngoing back to our preconception<br \/>\n04:29<br \/>\ncounseling checklist we have discussed<br \/>\n04:31<br \/>\nsome key medical issues that should be<br \/>\n04:32<br \/>\ndiscussed what else should we talk about<br \/>\n04:34<br \/>\ninfectious disease issues vaccines live<br \/>\n04:38<br \/>\nvaccines cannot be administered during<br \/>\n04:39<br \/>\npregnancy so the preconception<br \/>\n04:41<br \/>\ncounseling visit is an ideal time to<br \/>\n04:43<br \/>\noffer vaccinations for a rare Acela and<br \/>\n04:45<br \/>\nour rubella if a woman is not immune in<br \/>\n04:47<br \/>\naddition consider the pertussis and<br \/>\n04:49<br \/>\nhepatitis B vaccines additional<br \/>\n04:52<br \/>\nscreening issues to consider would be<br \/>\n04:54<br \/>\nHIV all pregnant women and women<br \/>\n04:56<br \/>\nplanning a pregnancy should be counseled<br \/>\n04:58<br \/>\nabout being tested for HIV<br \/>\n04:59<br \/>\nin addition screen for other sexually<br \/>\n05:01<br \/>\ntransmitted diseases also a woman who<br \/>\n05:04<br \/>\nare trying to conceive should minimize<br \/>\n05:05<br \/>\nexposure to outdoor cat feces secondary<br \/>\n05:07<br \/>\nto the risk of exposure to toxic<br \/>\n05:09<br \/>\nplasmosis<br \/>\n05:09<br \/>\nduring the preconception counseling<br \/>\n05:11<br \/>\nvisit we should also discuss genetic<br \/>\n05:13<br \/>\nscreening the genetic disorders are<br \/>\n05:15<br \/>\nbased on the ethnic and racial<br \/>\n05:17<br \/>\nbackground of our patients sickle<br \/>\n05:19<br \/>\nhemoglobin appa these are more common in<br \/>\n05:20<br \/>\nAfrican descent beta thalassemia is a<br \/>\n05:22<br \/>\nmore common and Mediterranean Southeast<br \/>\n05:24<br \/>\nAsian and African descent and alpha<br \/>\n05:26<br \/>\nthalassemias are more common in<br \/>\n05:28<br \/>\nSoutheast Asian Mediterranean and<br \/>\n05:30<br \/>\nAfrican descent tay-sachs disease is<br \/>\n05:32<br \/>\nmore common in Ashkenazi Jewish French<br \/>\n05:34<br \/>\nCanadians and Cajun descent Canavan<br \/>\n05:37<br \/>\ndisease and familial dysautonomia are<br \/>\n05:39<br \/>\nmore common in Ashkenazi Jewish descent<br \/>\n05:41<br \/>\nand cystic fibrosis is more common in<br \/>\n05:43<br \/>\nCaucasians of European and Ashkenazi<br \/>\n05:46<br \/>\ndescent let&#8217;s discuss what would happen<br \/>\n05:48<br \/>\nif young tested positive for one of<br \/>\n05:50<br \/>\nthese genetic disorders for example<br \/>\n05:51<br \/>\ncystic fibrosis<br \/>\n05:53<br \/>\nsince cystic fibrosis is an autosomal<br \/>\n05:56<br \/>\nrecessive disorder and we find that she<br \/>\n05:58<br \/>\nis a carrier denoted here with a capital<br \/>\n06:00<br \/>\nC lowercase C then the next step is to<br \/>\n06:02<br \/>\ntest the father and the baby for cystic<br \/>\n06:04<br \/>\nfibrosis<br \/>\n06:04<br \/>\nif young is already pregnant it is<br \/>\n06:06<br \/>\nimportant to have a private conversation<br \/>\n06:08<br \/>\nwith her to confirm the paternity of the<br \/>\n06:10<br \/>\npregnancy if the father of the baby also<br \/>\n06:12<br \/>\ntests positive as a carrier for cystic<br \/>\n06:14<br \/>\nfibrosis so both parents are carriers<br \/>\n06:16<br \/>\nbig C little C then 1\/4 of their future<br \/>\n06:19<br \/>\npregnancies would have a chance of<br \/>\n06:21<br \/>\ninheriting both genes little C little C<br \/>\n06:23<br \/>\nand would thus be affected with cystic<br \/>\n06:25<br \/>\nfibrosis<br \/>\n06:26<br \/>\nif preconception testing reveals that<br \/>\n06:28<br \/>\nyoung and her partner are both carriers<br \/>\n06:29<br \/>\nthen one of their options is<br \/>\n06:31<br \/>\npre-implantation genetic diagnosis this<br \/>\n06:34<br \/>\nis a process by which in vitro<br \/>\n06:35<br \/>\nfertilization is used to create an<br \/>\n06:37<br \/>\nembryo and then this embryo can be<br \/>\n06:39<br \/>\ntested for cystic fibrosis prior<br \/>\n06:41<br \/>\nto being implanted alternatively young<br \/>\n06:43<br \/>\nhonor partner can conceive naturally and<br \/>\n06:45<br \/>\nthe fetus can be tested for cystic<br \/>\n06:47<br \/>\nfibrosis with a chorionic villus<br \/>\n06:49<br \/>\nsampling or amniocentesis procedure this<br \/>\n06:52<br \/>\ncan lead to very wrenching decisions for<br \/>\n06:54<br \/>\nparents about whether to carry or<br \/>\n06:55<br \/>\nterminate a pregnancy if the fetus is<br \/>\n06:57<br \/>\nfound to be affected continuing to move<br \/>\n07:00<br \/>\ndown our preconception counseling visit<br \/>\n07:02<br \/>\nchecklist folic acid supplementation all<br \/>\n07:04<br \/>\npregnant women and women trying to<br \/>\n07:06<br \/>\nconceive should take at least 0.4<br \/>\n07:08<br \/>\nmilligrams of folic acid daily and women<br \/>\n07:11<br \/>\nshould take 4 grams daily if they have<br \/>\n07:13<br \/>\nhad a prior neural tube defect affected<br \/>\n07:15<br \/>\npregnancy let&#8217;s now discuss the<br \/>\n07:17<br \/>\nimportance of intimate partner violence<br \/>\n07:18<br \/>\nscreening intimate partner violence is<br \/>\n07:21<br \/>\nestimated to affect as many as 324,000<br \/>\n07:24<br \/>\npregnant women per year there is a<br \/>\n07:26<br \/>\ngrowing body of research on the<br \/>\n07:28<br \/>\nconnection between relationship violence<br \/>\n07:29<br \/>\nand poor reproductive health care<br \/>\n07:31<br \/>\noutcomes for women before and during a<br \/>\n07:34<br \/>\npregnancy are opportunities for the<br \/>\n07:35<br \/>\npatient to begin developing trust with a<br \/>\n07:37<br \/>\nhealth care provider lastly we will<br \/>\n07:40<br \/>\nconclude the discussion about<br \/>\n07:41<br \/>\npreconception counseling with the topics<br \/>\n07:43<br \/>\nof nutrition and obesity counseling<br \/>\n07:45<br \/>\nwomen about the importance of exercise<br \/>\n07:47<br \/>\nand balanced nutrition and the<br \/>\n07:49<br \/>\npreconception time can lead to healthier<br \/>\n07:51<br \/>\nhabits that can be more easily adapted<br \/>\n07:52<br \/>\nduring pregnancy and the postpartum time<br \/>\n07:54<br \/>\nthis concludes the aapko video on<br \/>\n07:57<br \/>\npreconception care we have reviewed many<br \/>\n07:59<br \/>\naspects of preconception counseling and<br \/>\n08:01<br \/>\nthe importance are trying to optimize a<br \/>\n08:02<br \/>\nwoman&#8217;s health for pregnancy and beyond<\/p>\n<p><\/div>\n<hr>\n","protected":false},"excerpt":{"rendered":"<p>\ufeff Duration = 8:16<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":9,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-105","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/105","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=105"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/105\/revisions"}],"predecessor-version":[{"id":2766,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/105\/revisions\/2766"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=105"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}