Новые рекомендации по подготовке к беременности. CDC
 

Новые рекомендации по подготовке к беременности. CDC.
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J Am Board Fam Med. 2007;20:81-84.

Clinical Context
Preconception counseling offers an effective and efficient means to reduce complications of pregnancy for both the mother and baby. Primary care clinicians, particularly family physicians and family nurse practitioners, are in a privileged position to deliver preconception care. The current article recommends that family physicians inquire about conception plans annually among all women of childbearing age. Women should be made aware that specific preconception interventions may improve not only the outcomes of pregnancy, but their overall health as well.

The current article summarizes recommendations from the CDC for promoting preconception healthcare as well as specific interventions that have been demonstrated to improve pregnancy outcomes.

Study Highlights
Preconception health should be encouraged by public health measures and education, including encouragement of a reproductive life plan for all couples. These efforts should include improved health coverage for low-income women.
Preconception care may begin after a negative pregnancy outcome, but all couples planning a pregnancy should receive a clinician visit for counseling. At these visits, clinicians should focus on the most efficacious interventions for preconception health. Such interventions may include:
Folic acid supplementation: supplementation with folic acid can reduce the risk for neural tube defects by two thirds.
Rubella vaccination.
Diabetes management: improved control of diabetes can reduce the risk for birth defects 3-fold.
Hypothyroidism management: the requirement for thyroid replacement therapy increases during pregnancy, and early intervention promotes healthy neurologic development of children.
Hepatitis B vaccination for at risk women.
HIV screening and treatment.
Screening for Neisseria gonorrhoea and Chlamydia trachomatis. Elimination of these bacteria can reduce the risk for ectopic pregnancy and infertility as well as mental retardation and blindness of the newborn.
Maternal phenylalanine management among women with phenylketonuria. Elevated levels of maternal phenylalanine may promote mental retardation in childhood.
Oral anticoagulant use: warfarin is associated with an increased risk for birth defects and hemorrhage in pregnancy. If at all possible, women should stop treatment with warfarin prior to pregnancy.
Oral antiepileptic medication management: clinicians should attempt to minimize the teratogenic potential of these medications.
Cessation of treatment with isotretinoin.
Smoking cessation counseling: smoking is associated with preterm birth, low birth weight, and other negative perinatal outcomes.
Elimination of alcohol use.
Obesity control: a healthy weight prior to pregnancy reduces the risks for neural tube defects, preterm delivery, diabetes, Cesarean delivery, hypertension, and thromboembolic disease.
Pearls for Practice
Clinicians should inquire about plans for pregnancy in the next year among all women of childbearing age. Women should also be informed that preconception care can improve health outcomes for both mother and baby.
During preconception screening visits, clinicians should focus on issues such as folate supplementation, hypothyroidism management, obesity control, hepatitis B vaccination for at risk women, and rubella vaccination among previously unvaccinated women.

1. A 24-year-old woman presents as a new patient for an annual examination. She has 1 child and no history of complicated pregnancies. Which of the following statements is the best way for the clinician to introduce the subject of preconception counseling?
a) "Are you taking folate regularly?"
b)"Tell me about your last pregnancy."
c)"Are you considering becoming pregnant in the next year?"
d)"Should you become pregnant, several medications may be risky. Which medications are you taking?"


2. Which of the following actions is least appropriate during a preconception visit?
a)Vaccination against rubella
b)Closer monitoring of thyroid-stimulating hormone levels among a woman with hypothyroidism
c)Hepatitis B vaccination in a woman with a history of multiple sexual partners
d)Initiation of warfarin therapy for a woman with a history of deep venous thrombosis