preconception care summarize

Page 1

Pre-conception care

• Maternal and Newborn Health Nursing Department

Page 2

Outlines

• Introduction

• Definition of terms

• Objectives of PCC

• Who provides PCC

• Key Component of PCC

• Barriers to PCC

• Applications

Page 3

Introduction

• The Egyptian infant mortality rate is notably higher compared to many other countries.

• Although a higher percentage of women are accessing early prenatal care, the rates of preterm birth and low birth weight are on the rise.

Page 4

Reasons for Poor Outcomes

• Prenatal care often starts too late, hindering the prevention of many adverse pregnancy outcomes.

Page 5

Critical Periods of Development

• Key developmental milestones occur during gestation weeks 4 to 12:

  • Central Nervous System development

  • Formation of Heart, Arms, Eyes, Legs, Teeth, Palate, External genitalia, and Ears.

• Most susceptible time for major malformations occurs before mean entry into prenatal care.

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Definition of Preconception Care

• A preventative approach that identifies biomedical, behavioral, and psychosocial risk factors before or very early in pregnancy to optimize maternal and neonatal health outcomes.

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Preconception and Interconception Health

• Preconception health: Aiming for women to be as healthy as possible prior to pregnancy.

• Interconception health: Emphasizing the importance of health between pregnancies and the recommendation to wait at least 18 months before conceiving again.

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Timing for Preconception Care

• All women of childbearing age should be pre-screened for health and risk potentials before attempting pregnancy.

• Optimal timing: 3-6 months prior to conception to allow for:

  1. Successful conception and pregnancy

  2. Minimization of health risks.

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Preconception Well-woman Health

• Focus on achieving healthy outcomes for women.

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Objectives

• To ensure the health of women leads to:

  • Healthy women

  • Healthy mothers

  • Healthy babies

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Vision

• From healthy mothers to healthy babies.

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Concepts of Preconception Health

• Describes the health of women and men during their reproductive years.

• Good preconception health includes:

  1. Planning pregnancy: Enabling couples to decide about family planning.

  2. Fit for pregnancy: Acknowledging that many pre-pregnancy risk factors can be changed.

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Preconception Health Goals

• Health before pregnancy:

  • Improving outcomes for mothers and babies.

  • Fit for pregnancy involves healthy behaviors like:

    • Balanced diet

    • Folic acid supplementation

    • Regular exercise

    • Promoting emotional well-being

    • Ensuring health checks and vaccinations are up to date.

• Risk Factors:

  • Smoking, alcohol use, obesity, long-term health conditions, and previous pregnancy complications are significant risks.

• Wider Determinants:

  • Support systems, education, housing, and community stability impact health.

Page 14

Social Model of Health

• Adaptation of the model by Dahlgren & Whitehead [88], illustrating the influences on health.

Page 15

Women’s Health

• Focusing on aspects relevant to women's health and care.

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Target Demographics

• Preconception interventions target both women and their partners for a comprehensive approach.

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Goals of Preconception Care

• Promote the health of women of reproductive age to improve pregnancy-related outcomes.

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Additional Goals

1. Advising on pre-existing diseases and their treatment during pregnancy.

2. Understanding recurrence risks from past pregnancies.

Page 19

Preconception Pathway 1

• Addressing universal opportunities for preconception care.

• Focus on methods like:

  • Folic acid intake

  • Sexual health education

  • Establishing healthy adult lifestyles.

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Preconception Pathway 2

• Managing emerging risks through early interventions to improve reproductive health.

• Addressing issues like:

  • Obesity

  • Substance abuse

  • Maternal age risks.

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Preconception Pathway 3

• Planning and preparing for subsequent pregnancies improves future pregnancy outcomes.

• Early interventions during and after pregnancy give opportunities for health promotion.

Page 22

Providers of PCC

• Health Care Providers include:

  • OB-GYNs

  • Pediatricians

  • Family Physicians

  • Nurses and Nurse Practitioners

  • Midwives

  • Genetic Counselors

  • Health Educators

Page 23

Areas Addressed by the Preconception Care

• Various health conditions such as:

  • Mental health issues

  • Nutritional concerns

  • Infertility and subfertility

  • Psychological conditions

  • Domestic abuse and environmental health risks.

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Components of Preconception Care

1. Maternal Assessment

2. Vaccinations

3. Screening

4. Counseling

Page 25

Maternal Assessment Components

• Assess health aspects like:

  1. Family planning

  2. Medical history

  3. Substance use

  4. Nutritional status

  5. Domestic abuse history

  6. Immunization status

  7. Sexual health risk factors.

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Social Model of Health Continuation

• Continuing the insights from the Dahlgren & Whitehead model.

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Fetal Complications

• Common fetal complications include:

  • Spina Bifida

  • Anencephaly

  • Encephalocele.

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Vaccination

• Important vaccinations for women at risk:

  • Rubella

  • Hepatitis B.

Page 29

Screening Tests

• Key screenings include:

  • HIV screening

  • STD testing

  • Genetic disorder screenings based on history.

Page 30

Additional Screenings

• Screening includes:

  • Family history-based genetic disorders

  • Ethnicity-based disorders like sickle cell disease.

Page 31

Counseling Recommendations

• Counseling on:

  • Weight management pre-pregnancy

  • Avoidance of harmful substances

  • Importance of Folic Acid

  • Control of medical conditions.

Page 32

Checklist of Preconception Care Topics

• Addressing education and counseling on:

  • Substance abuse

  • Healthy weight management

  • Oral health importance

  • Genetic and environmental exposures.

Page 33

Health Assessment Components

• Evaluation should include:

  • Physical assessment

  • Immunization records

  • History of past pregnancy complications

  • Support for victims of domestic violence.

Page 34

Timing for Intervention

• Key life phases to consider timings:

  • Adulthood

  • Reproductive years

  • Infancy and preschool periods.

Page 35

Barriers to Preconception Care - Patient Aspects

1. High rates of unintended pregnancies.

2. Lack of knowledge on healthy habits before conception.

3. Limited access to health services.

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Barriers to Preconception Care - Provider Aspects

1. Providers may feel ill-informed on evidence-based practices.

2. Preconception care perceived as time-consuming.

3. Lack of awareness of integration opportunities into primary care.

Page 37

Genetic Counseling Timing

• Ideal before conception attempts, especially with:

  • Advanced maternal age

  • Previous pregnancy complications

  • Family history of genetic diseases.

Page 38

Case Example 1

• Mrs. A, a 40-year-old, smoking, and drinking woman with unclear family health history requires risk assessment for preconception counseling.

Page 39

Case Study: Obesity

• A 33-year-old woman with a history of gestational diabetes struggles with weight management and is seeking care for a missed period.

Page 40

Recommendations to Improve Preconception Health

1. Individual responsibility for reproductive health planning.

2. Raising consumer awareness on health behaviors.

3. Providing preventive visits and interventions for risks.

4. Improving public health programs integrating preconception care.

5. Enhancing health coverage for women with low incomes.

Page 41

Summary

• Preconception care serves as a preventive approach against maternal and fetal mortality and morbidity.

• Emphasize awareness and integrate services into primary health care systems.