Preconception counseling all women of childbearing years should

**Pre-conception counseling -all women of child-bearing years should be pre-screened for health and risk potentials before attempting to become pregnant.

This time allows a woman to better prepare her body for successful conception (fertilization) and pregnancy, and allows her to reduce any health risks which are within her control, , .

**What is involved in pre-conception counseling? -Pre-screening covers many body-system areas (not just the reproductive organs), as well as aspects of the woman's lifestyle and family history information.

Gynecological history When did your last menstrual period start? Are your periods regular? What kind of birth control are you using now, and what kinds have you used in the past? Have you ever tested for ovulation? Have you ever had an abnormal Pap smear? Have you or your partner ever been diagnosed with a sexually transmitted infection? Have you ever been diagnosed with pelvic inflammatory disease? Have you ever been tested for HIV? Have you ever been told you have uterine abnormalities? Do you have any history of ovarian cysts? Have you ever had any kind of gynecological surgery? Have you ever been treated for infertility?

Obstetric history NOTE: If you've had complications during a pregnancy, labor, or delivery that your practitioner is unaware of, bring the related medical records with you to your checkup. Have you ever been pregnant before? Have you ever had a miscarriage? If so, how many weeks pregnant were you? Did you have a D&C? Were there complications? Do you know the cause of the miscarriage? Have you ever had an ectopic pregnancy? If so, how many weeks pregnant were you? Did you have surgery? Have you ever had an abortion? If so, in which trimester? Were there any complications? For each child you've given birth to: What was the birth date? Place of birth? How many weeks gestation? Gender? Birth weight? What kind of delivery? Any labor or delivery complications? Have you ever had preterm labor or delivery? Have you ever had a cesarean section?

Medical history Have you ever had any serious medical problems? In particular, do you have diabetes, hypertension, epilepsy or other seizure disorders, kidney disease, hepatitis or other liver disease, heart disease, a clotting disorder, lung disease including asthma, thyroid disease, cancer, or a connective tissue disease such as lupus or rheumatoid arthritis?

Has anyone in your family ever had diabetes, hypertension, a stroke, epilepsy or other seizure disorders, kidney disease, hepatitis or other liver disease, heart disease, a clotting disorder, lung disease including asthma, thyroid disease, cancer, or a connective tissue disease such as lupus or rheumatoid arthritis?

Do you have any digestive problems? Have you ever been hospitalized? Have you ever had any operations? When and why? Have you ever had problems with anesthesia? Have you ever had a blood transfusion? Are you being treated for any conditions right now? What prescription or over-the-counter medications are you taking (including any herbs, vitamins, or supplements) and at what dose?

Are you taking prenatal vitamins? Are you allergic to any drugs? Any other allergies? Have you been exposed to any infectious diseases? Is there anyone in your household who has or had hepatitis? Tuberculosis?

Vaccination history NOTE: If you have a record of your immunizations, bring it with you to your appointment.

your childhood vaccinations for measles, mumps, and rubella? Have you ever been tested for rubella immunity? Have you ever been vaccinated against hepatitis B? When was your last tetanus booster?

Emotional and social history mental or emotional problems, including depression or an eating disorder? Have you ever been a victim of domestic violence?

Lifestyle questions Do you smoke or use tobacco products, or are you exposed to secondhand smoke? Do you use recreational drugs? Do you drink coffee or other caffeinated beverages? Do you see a dentist regularly? Do you exercise regularly? Do you have trouble maintaining a healthy weight? Do you follow any particular kind of diet or have any dietary restrictions?

Do you eat a lot of fish? Do you ever eat raw or undercooked meat, fish, or eggs? Do you have pets or do any gardening? Do you regularly use hot tubs or saunas? What do you do for a living? Do you work with small children? Do you or your partner live or work near any possible hazards, such as paints or solvents, pesticides, radiation (X-rays), lead, or mercury

Genetic screening Has anyone in your family or your partner's family ever had: Hemophilia or other bleeding disorders? Blood diseases such as sickle cell anemia or thalassemia? Sickle cell trait? Down syndrome or mental retardation? Other developmental delays? Premature menopause? Birth defects such as spina bifida or heart or kidney defects? Phenylketonuria (PKU)? Any genetic disorders or chromosomal abnormalities?

Blood work -Certain blood work may be ordered. This often includes a CBCwhich can show anemia. CBC includes WBC which can show the presence of infection. Anemia and infection, indicating problems with the woman's overall health at that moment, can both affect a woman's ability to become pregnant at that time as well as affect the stability of the pregnancy and health of the fetus. Fortunately

in the majority of cases both infection and anemia can be treated once the cause is identified. - Anemia may require ongoing evaluation and iron supplement. Urine analysis: -Urine sample or urinalysis can reveal the presence of proteinuria , a possible indicator of infection or kidney disease, or the presence of blood which can indicate a urinary tract infection. Urinalysis might also show the presence of glucose (glycosuria), but women of child bearing age are unlikely to have undiagnosed diabetes (this is separate from gestational diabetes that may occasionally develop during the course of a subsequent pregnancy). Using the assessment

folic acid supplement

-If you take folic acid tablets (supplements) in early pregnancy you reduce the risk of having a baby born with a spinal cord problem such as spina bifida. -This is because the early development of the baby's spinal cord requires a regular, good supply of folic acid. There is also evidence that folic acid also reduces the risk of having a baby born with a cleft lip and palate, a heart defect (congenital heart disease), and the risk of a premature (preterm or early) labor.

-Ideally, start taking folic acid tablets before becoming pregnant. The common advice is to start from the time you plan to become pregnant. - If the pregnancy is unplanned then start taking folic acid tablets as soon as you know that you are pregnant.

-Continue to take folic acid tablets for the first 12 weeks of pregnancy.

For most women the dose is 400 micrograms (0. 4 mg) a day. If your risk of having a child with a spinal cord problem is increased then the dose is higher (5 mg a day - you need a prescription for this higher dose). That is, if: you have had a previously affected pregnancy you or your partner have a spinal cord defect you are taking medication for epilepsy you have celiac disease, diabetes, sickle cell anemia, or thalassaemia.