Preconception

Question 1

goals of preconception care

Answer 1

1. Improve the knowledge, attitudes and behaviors related to preconception health.
2. Ensure that all individuals of childbearing age in the US receive preconception care services enabling them to enter pregnancy in optimal health.
3. Reduce risks indicated by a previous adverse pregnancy outcomes through interventions during the inter-conception period.
4. Reduce health disparities in adverse pregnancy outcomes

Question 2

who, when why

Answer 2

All those planning to initiate a pregnancy should be counseled, including heterosexual, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and gender nonconforming individuals” (ACOG, 2019)
* Childbearing age
* Unintended pregnancies
* Think about health care disparities, social determinants of health and barriers to heath care specifically reproductive and preconception care

Question 3

transgender persons

Answer 3

• IMPORTANT TO ASK AND USE gender-affirming language, care, support
• Any transgender person with full reproductive organs engaging in sexual activity that could result in conception should be counseled.
• Gender affirming hormonal therapy is not contraception
• Counseling doesn’t change.
• Timing is important
• A positive preconception outlook can positively influence conjugal relationship, parenting, self-esteem, continued good health

Question 4

history

Answer 4

• Age
• PMH/PSHx –
• OBGYN & reproductive history
• DM, HTN, Obesity/Bariatric surgery, Thyroid disease, Mood disorders
• STI
• Vaccinations
• Medications – teratogenicity
• Family History – r/f aneuploidy
• Psychosocial History
• Environmental hazards/toxins (cats ?)
• IPV
• Health Habits – Diet, Etoh/Substance Use, lifestyle, safety
• SDOH – insurance, time off work, housing

Question 5

ROS/Objective

Answer 5

• SUBJECTIVE
• ROS – normal comprehensive appointment
• Consider focusing on s/sx associated with chronic health concerns and reproductive health
• OBJECTIVE
• VS – BP, HR, BMI (height, weight)
• PEX – well visit + pelvic exam
• Comprehensive based on PMH
• Consider normal pregnancy related changes that occur
• Dx/Labs:
• HIV (opt out)
• Cervical cancer screening (Pap smear) prn
• Blood type/Rh factor
• CBC
• UA
• STI screening
• Confirm immunity and give immunizations PRN,
• Genetic Screening PRN
• Chronic disease management