Part 1: Preconception care

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Part 1: Preconception care

Chapter 9 – Preconception Care and Pregnancy

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Part 1: Preconception care
Part 2: Pregnancy and antenatal care
Part 3: Postnatal care
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Optimising the health of patients prior to conception is critical for the health of parents, babies and future generations. General Practitioners (GPs), nurses and midwives play a central role in the delivery of optimal preconception care.

Good preconception care addresses lifestyle risk factors, nutritional status, pre-existing medical co-morbidities and risk factors, vaccination status, medication and any substance use, and an assessment for possible familial genetic issues of the prospective parents (see Table 9.1 Preconception care checklist). The preconception period is a unique opportunity for intervention to optimise pregnancy outcomes.⁽¹^,²⁾

Since a significant number of pregnancies are unplanned, it is important that clinicians opportunistically offer information on preconception care to all patients of reproductive age. The concept of “One Key Question” is a strategy developed by the Oregon Foundation for Health and endorsed by the American Public Health Association.⁽¹^, ³⁾ The approach encourages clinicians to routinely ask patients of reproductive age during consultations the screening question “Would you like to become pregnant in the next year” with the answer either triggering provision of opportunistic preconception care, or provision of adequate contraception. Effective contraception until the time of desired pregnancy is a key strategy in preconception planning. Clinicians can ... Buy now

Diet, nutrition and body weight

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Nutritional supplementation

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Exercise

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Smoking, alcohol and substance use

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Optimising pre-existing medical conditions

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Reproductive and obstetric history

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Vaccination status and infectious disease advice

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Other pre-conception care

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Preconception genetic counselling and screening

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Dorney E, Black K. Preconception Care. Australian Journal of General Practice. 2018;47(7).

Stephenson J, Heslehurst N, Hall J, Schoenaker DA, Hutchinson J, Cade JE, et al. Preconception health 1: Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet. 2018;391:1830-41.

Bateson D, Black K. Preconception Care: An important yet underutilised preventative care strategy. MJA. 2018;209(9).

Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice. 9th ed. East Melbourne, Victoria: RACGP; 2018.

Barker M, Dombrowski SU, Colbourn T, Fall CH, Kriznik NM, Lawrence WT, et al. Intervention strategies to improve nutrition and health behaviours before conception Lancet. 2018;391(1853-64).

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement C-Obs 3(a): Pre-Pregnancy Counselling. [Internet]. RANZCOG; 1992 [updated 2017 July]. Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Pre-pregnancy-Counselling-(C-Obs-3a)-review-July-2017_1.pdf?ext=.pdf.

Schummers L, Hutcheon JA, Bodnar LM, Lieberman E, Himes KP. Risk of adverse pregnancy outcomes by pre-pregnancy body mass index: A population‑based study to inform pre-pregnancy weight loss counselling. Obstet Gynecol Clin North Am. 2015;125(1):133-43.

Kim S, Nisenblat B. Male fertility. Improving sperm health and chance of pregnancy. Medicine Today. 2019;20(1):55-7.

South Australia Maternal & Neonatal Clinical Network. South Australian Perinatal Practice Guidelines [internet]. South Australia: Government of South Australia; 2015 [updated 2018 Sept 30].

10.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement C-Obs 25: Vitamin and Mineral Supplementation and Pregnancy. [Internet]. RANZCOG; 2008 [updated 2015 May]. Available from: https://www.hps.com.au/wp-content/uploads/2019/04/Vitamin-and-mineral-supplementation-in-pregnancy-C-Obs-25-Review-Nov-2014-Amended-May-2015.pdf.

11.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement C-Obs 49: Management of Obesity in Pregnancy. [Internet]. RANZCOG; 2013 [updated 2017 March]. Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Management-of-obesity-(C-Obs-49)-Review-March-2017.pdf?ext=.pdf.

12.

Lumley J, Watson L, Watson M, Bower C. Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects. Cochrane Database Syst Rev. 2001;3(CD001056).

13.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement C-Obs 25: Vitamin and Mineral Supplementation and Pregnancy. [Internet]. RANZCOG; 2008 [updated 2019 November]. Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Vitamin-and-mineral-supplementation-in-pregnancy-(C-Obs-25).pdf?ext=.pdf.

14.

Department of Health. Alcohol. [Internet]. Australian Government; 2019. Available from: https://www.health.gov.au/resources/pregnancy-care-guidelines/part-c-lifestyle-considerations/alcohol.

15.

Perry M, Mulcahy H, De Franco EA. Influence of periconception smoking behaviour on birth defect risk. Am J Obstet Gynecol. 2019;220(6):588.

16.

Office of the Surgeon General (US), Office on Smoking and Health (US). The Health Consequences of Smoking: A Report of the Surgeon General. [Internet]. Atlanta, Georgia: Centres for Disease Control and Prevention; 2004. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44695/.

17.

Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum Reprod. 2011;17(589-604).

18.

Zhang K, Wang X. Maternal smoking and increased risk of sudden death syndrome: a meta-analysis. Leg Med (Tokyo). 2013;15:115-21.

19.

Hibbert E, Chalasani S, Kozan P, Myszka R, Park K, Black KI. Preconception care and contraceptive use among Australian women with diabetes mellitus. AJGP. 2018;47(12).

20.

Therapeutic Goods Administration. Pregnancy test kits. Department of Health, Australian Government [internet]. 2017. Available from: https://www.tga.gov.au/media-release/pregnancy-test-kits.

21.

Australian Immunisation Handbook [internet]. Department of Health, Australian Government; 2019. Vaccination for women who are planning pregnancy, pregnant or breast feeding [2019 Sept 20]. Available from: https://immunisationhandbook.health.gov.au/vaccination-for-special-risk-groups/vaccination-for-women-who-are-planning-pregnancy-pregnant-or.

22.

Australian Immunisation Handbook [internet]. Department of Health, Australian Government; 2018. Serological testing for immunity to rubella is only recommended before or after receiving rubella-containing vaccine in certain circumstances [updated 2018 June 7]. Available from: https://immunisationhandbook.health.gov.au/recommendations/serological-testing-for-immunity-to-rubella-is-only-recommended-before-or-after.

23.

Department of Health. Australian Technical Advisory Group on Immunisation (ATAGI). [Internet]. Australian Government; 2019. Available from: https://www.health.gov.au/committees-and-groups/australian-technical-advisory-group-on-immunisation-atagi.

24.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement C-Obs 64: Prevention of congenital cytomegalovirus (CMV) infection. [Internet]. RANZCOG; 2019 [updated 2019 Mar]. Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Prevention-of-congenital-cytomeglovirus(CMV)infection-(C-Obs-64)-New-Statement-March-2019-Amended.pdf?ext=.pdf.

25.

Centre for Disease Control and Prevention (CDC), National Centre for Emerging and Zoonotic Infectious Disease Control (NCEZID), Division of Vector-Borne Diseases (DVBD). Zika Virus [Internet]. 2019 [updated 2019 Jan 28]. Available from: https://www.cdc.gov/zika/hc-providers/preparing-for-zika/clinicalevaluationdisease.html.

26.

World Health Organization (WHO). Zika virus disease [Internet]. WHO; 2019 [updated 2019 July]. Available from: https://www.who.int/emergencies/diseases/zika/epidemiology-update/en/.

27.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement C-Obs 63: Genetic carrier screening. [Internet]. RANZCOG; 2019 [updated 2019 Mar]. Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Genetic-carrier-screening(C-Obs-63)New-March-2019_1.pdf?ext=.pdf.

28.

The Royal Women’s Hospital. Thalassaemia and Abnormal Haemoglobins in Pregnancy. [Internet]. The Royal Women’s Hospital: Victoria; 2018. Available from: https://thewomens.r.worldssl.net/images/uploads/downloadable-records/clinical-guidelines/thalassaemia-and-abnormal-haemoglobins-in-pregnancy-guideline_280720.pdf.

29.

Royal College of General Practitioners (RACGP). Genomics in general practice. 8^th East Melbourne, Victoria: RACGP; 2018. Available from: https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/Guidelines/Genomics-in-general-practice.pdf.

30.

Archibald A, Smith MJ, Burgess T, Scarff KL, Elliott J, Hunt CE, et al. Reproductive genetic carrier screening for cystic fibrosis X syndrome, and spinal muscular atrophy in Australia: outcomes of 12,000 tests. Genet Med. 2018;20(5):513-23.

31.

Delatycki M, Laing NG, Moore SJ, Emery J, Archibald AD, Massie J, et al. Preconception and antenatal carrier screening for genetic conditions: The critical role of general practitioners Australian Journal of General Practice. 2019;48(3).

32.

Clarke M, Boyle J. Antenatal care for Aboriginal and Torres Strait Islander women. Australian Family Physician. 2014;43(1-2).

33.

Department of Health. Part A: Optimising pregnancy care. [Internet]. Australian Government; 2018 [updated 2018 Nov 20. Available from: https://www.health.gov.au/resources/pregnancy-care-guidelines/part-a-optimising-pregnancy-care.

34.

Wilcox A, Baird DD, Dunson D. Natural limits of pregnancy testing in relation to the expected mestrual period. JAMA. 2001;286(14):1759-61.

35.

Department of Health. Gestational age. [Internet]. Australian Government; 2018 [updated 2018 Nov 20]. Available from: https://www.health.gov.au/resources/pregnancy-care-guidelines/part-d-clinical-assessments/gestational-age.

36.

Mendelsohn C, Gould GS, Oncken C. Management of smoking in pregnancy women. Australian Family Physician. 2014;43(1):46-51.

37.

Department of Health. Pregnancy Care Guidelines. [Internet]. Canberra, ACT: Australian Government; 2014 [updated 2018]. Available from: https://www.health.gov.au/resources/pregnancy-care-guidelines.

38.

Yildiz O, Aygen B, Esel D, Kayabas U, Alp E, Sumerkaan B, et al. Sepsis and Meningitis due to Listeria Monocytogenes. Yonsei Med J. 2007;48(3):433-9.

39.

Listeriosis fact sheet [internet]. NSW Health; 2018 [updated 2018 Oct 8]. Available from: https://www.health.nsw.gov.au/Infectious/factsheets/Pages/Listeriosis.aspx.

40.

Department of Primary Industries Food Authority. Food safety during pregnancy. [Internet]. NSW Government. Available from: https://www.foodauthority.nsw.gov.au/sites/default/files/_Documents/foodsafetyandyou/pregnancy_brochure.pdf.

41.

Munyame C, Vaithilingam N, Rahman Y, Vara R, Freeman A. Phenylketonuria in pregnancy. The Obstetrician and Gynaecologist. 2018;20(4).

42.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement C-Gyn 1: Female Genital Mutilation (FGM). [Internet]. RANZCOG; 1994 [updated 2017 Nov]. Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical%20-%20Gynaecology/Female-Genital-Mutilation-(C-Gyn-1)-Nov17.pdf?ext=.pdf.

43.

eTG Complete [internet]. Therapeutic Guidelines; 2019. Antibiotic.

44.

Nausea and vomiting of pregnancy [internet]. MotherSafe, The Royal Hospital for Women; 2016. Available from: https://www.seslhd.health.nsw.gov.au/sites/default/files/groups/Royal_Hospital_for_Women/Mothersafe/documents/NVPMothersafeFactsheet2016.pdf.

45.

Tan A, Foran T, Henry A. Management nausea and vomiting in pregnancy in a primary care setting. Perinatal care. 2016;45(8):564-8.

46.

Lowe S. Nausea and vomiting in pregnancy. O&G. 2007;9(4):23-5.

47.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement C-Obs 3b: Routine Antenatal Assessment in the Absence of Pregnancy Complications. [Internet]. RANZCOG; 1992 [updated 2019 Nov]. Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Routine-antenatal-assessment-in-the-absence-of-pregnancy-complications-(C-Obs-3b)_2.pdf?ext=.pdf.

48.

Department of Health. Syphilis. [Internet]. Australian Government; 2019 [updated 2019 June 4]. Available from: https://www.health.gov.au/resources/pregnancy-care-guidelines/part-f-routine-maternal-health-tests/syphilis.

49.

Department of Health. Infectious Syphilis Outbreak. [Internet]. Australian Government; 2019. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-infectious-syphilis-outbreak.htm.

50.

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51.

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52.

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53.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement C-Obs 46: Testing for hypothyroidism during pregnancy with serum TSH. [Internet]. RANZCOG; 2012 [updated 2015 July]. Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Testing-for-hypothyroidism-during-pregnancy-with-serum-TSH-(C-Obs-46)-Review-July-2015.pdf?ext=.pdf.

54.

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56.

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57.

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58.

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59.

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Reproductive and Sexual Health Handbook

Chapter 9 – Preconception Care and Pregnancy

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