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Preconception advice

Preconception advice. Charlotte Porter GP Update NUHSHS, March 2019. R educing risk in pregnancy. A lcohol S moking D rugs F amily/pregnancy spacing M edical/obstetric history Medication. P re pregnancy: positive interventions. F olate * V itamin d

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Preconception advice

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  1. Preconception advice Charlotte Porter GP Update NUHSHS, March 2019

  2. Reducing risk in pregnancy • Alcohol • Smoking • Drugs • Family/pregnancy spacing • Medical/obstetric history • Medication

  3. Pre pregnancy: positive interventions • Folate * • Vitamin d • Weight optimisation (pcos, miscarriage, obesity* and stillbirth) • Stop smoking • Listeria/brucella avoidance • Iron supplements • Mood assessment/ domestic violence • STI/ cervical cytology/ hep b/c • FGM

  4. Pre pregnancy planning • Epilepsy* • Diabetes* • Thyroid disease • Hypertension • Cardiac disease • Renal disease • Asthma • Previous/FH VTE • Rheumatological conditions/ connective tissue disorders • Inflammatory bowel* • Haemaglobinopathy* • depression

  5. Other questions? • Travel plans (Zika, malaria) • Risk of genetic disorder (age, FH, consanguinity) • Rubella and chickenpox vaccination • Drug use, OTC, prescribed and illegal • Work related risk

  6. Obstetric history • Nullip? • Previous termination of pregnancy • Previous miscarriage • Previous caesarean section • Previous pregnancy complications • Reduced maternal and perinatal mortality and morbidity with 18-59 month interpregancy interval

  7. Prescribing in pregnancy- general principles • Avoid teratogenesis (1st trimester week 3-11) • Avoid fetal effects- eg on growth, brain development, renal function • Avoid effects on labour, eg uterine relaxation • Avoid effects on neonate (eg respiratory supression) • Remember altered physiology, and necessity for altered doses/schedules related to cardiovascular/renal and hepatic changes

  8. Prescribing in pregnancy • Less than 10% of commonly prescribed medications have enough known about them to truly determine risk in pregnancy • Most women avoid medication • Sometimes the risk of stopping medication has to be balanced against the risk to the fetus • Treating for two! (or three)

  9. Prescribing in pregnancy • But up to 90% of women will use OTC medication during pregnancy, and 70% will have prescribed medication (Am J O&G 2008) • There are large gaps in the evidence base • BUMPS website • UK national teratology database • Valproate, retinoids, carbimazole

  10. Epigenetics? • Heritable changes in gene expression (DNA methylation, histone modification) • Alteration in phenotype without change in genotype • Age of parents • Lifestyle • Environmental exposure • Fertility treatments War babies/ famine in pregnancy increases risk of cvd and schizophrenia in offspring Pollution exposure and asthma

  11. Thank you

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