Preconception & Early Prenatal Care

What chronic disease should be addressed during prenatal care?

Diabetes, HTN, Epilepsy, Thyroid, Disease, Obesity

Which medications should be stopped or avoided during preconception/prenatal care?

- ACE inhibitors / ARBs

- Statins

- Isotretinoin

- Methotrexate

- Warfarin

What types of medications should be reviewed during prenatal care?

Antiepileptics and psychiatric medications

What is the reccomended dose of folic acid?

400-800 mcg daily (0.4 mg) started >1 month before conception and continued through pregnancy

When are higher doses of folic acid indicated?

4mg indicated for prior neural tube defect and certain anticonvulsants

What are the maternal factors of pregnancy risk?

age, comorbid disease, BMI, prior obesteric history

What are the pregnancy factors of pregnancy risk?

multiple gestation, assisted reproduction, and fetal concerns

What risks are associated with adolescent pregnancy?

preterm birth, low birth weight, anemia, and social challenges

What risks are associated with advanced maternal age (35+)?

aneuploidy, pregnancy loss, HTN disorders (preeclampsia), and gestational diabetes

What risks are associated with multiple gestation pregnancies?

preterm delivery, growth restriction, HTN disorders, gestational diabetes

What are the goals of the first prenatal visit?

1) confirm pregnancy

2) establish gestational age

3) identify risk factors

4) create care plan

What family history conditions should be assessed for in prenatal care?

Hemoglobinopathies and Cystic Fibrosis

What does GTPAL stand for?

1. Gravidity (number of pregnancies including present one

2. Term births (longer than 37 weeks)

3. Preterm births (before 37 weeks)

4. Abortions or miscarriages

5. Living children

What are included in the prenatal physical exam?

Blood pressure, Weight/BMI, General, Thyroid, Cardiac, Pulmonary, Pelvic Exam

What labs are included for maternal health?

CBC, Blood type/Rh, Antibody screen

What labs are included for infection screening?

HIV, Syphilis, Hep B

What labs are included for immunity screening?

Rubella

What is the gestational age?

starts from LMP

What is conceptional age?

~ 2 weeks less

Naegele's Rule

LMP + 1 year - 3 months + 7 days

What is the most accurate method for dating pregnancy?

First trimester ultrasound

What is the approximate prenatal visit schedule?

- Every 4 weeks until 28 weeks

- Every 2 weeks until 28-36 weeks

- Weekly until 36 weeks-delivery

What clinical symptoms are seen during early pregnancy and where do they come from?

↑ hCG - nausea

↑ Progesterone - constipation

↑ Blood volume - mild tach

Breast changes - tenderness

Increased renal blood flow - urinary frequency

What are the concerning symptoms during pregnancy?

severe vomiting, dehydration, syncope, chest pain, dysuria, and heavy bleeding