Friday, 17 April 2020

Vol 7, APRIL 2020 - PRE-CONCEPTION ADVICE & MANAGEMENT (NICE GUIDELINES)


PRE-CONCEPTION ADVICE AND MANAGEMENT (NICE GUIDELINES)



Advice for all women (16 years to 45 years Female)



1.           Of 100 couples (in which the woman is aged under 40years) having regular sexual intercourse without contraception:



o   About half of those who do not conceive in the first year will do so in the second year.



o   The remainder will take longer and some of these may need help for them to conceive.



2.           Sexual intercourse every 2 to 3 days optimises the chances of pregnancy. 



There is no need to plan intercourse to coincide with ovulation – this does not increase the chances of success and can cause stress for the couple.



3.           Women over 35 years have an increased risk of miscarriage, chromosomal abnormalities and obstetric complications compared to younger women.



4.           Advice on folic acid:



o   Normal risk of neural tube defect (NTD) should take the standard dose of 400 mcg

daily and once pregnant, to continue this until 12 weeks of pregnancy.



o   Women at high risk of NTD, or taking antiepileptic medication, should take 5 mg daily until the 12th week of pregnancy. 



o   Women with sickle cell disease, thalassaemia or thalassaemia trait, should take 5 mg daily throughout pregnancy.



o   Women with high BMI (30 kg/m²) should take folic acid 5 mg daily starting at least 1 month before conception and continue until 12 weeks.



5.           Advice on Diet:



o   Recommend a healthy, balanced diet.  Diet and nutrition before conception or during pregnancy are important as it can impact on pregnancy outcomes and the health  of the mother and her baby.





6.           Advice on weight management:



o   Women with a healthy weight (BMI 18.5 – 24.9 kg/m²) before becoming pregnant reduces the risk of pregnancy complications.

o   Women of high BMI (30 kg/m² or more ) have potential health risks including:



§  Reduced fertility

§  Reduced success rate from fertility treatment

§  Increased risk of miscarriage

§  Gestational diabetes

§  Gestational hypertension/pre-eclampsia

§  Big babies and should dystocia

§  Preterm delivery



7.           Women of low BMI (less than 18.5 kg/m²) have potential health risks of being underweight,

Including:



§  Reduced fertility

§  Miscarriage

§  Premature delivery

§  Low birth weight

§  Gastroschisis

                           

8.           Advice on smoking:



o   Smoking is associated with reduced fertility and reduced success rate from fertility treatment



o   Smoking is associated with growth restriction of the baby



o   Suggest referral to smoking cessation service.



9.           Advice on alcohol consumption



o   Avoid alcohol if trying to conceive and during pregnancy.



10.         Advice on illicit drug use:



o   Women planning pregnancy who use illicit drugs should stop, including so-called “legal highs”.  Those who are unable to stop should be referred to a specialist service.



11.         Advice on immunisation



o   Determine if a woman planning a pregnancy is protected against rubella.  For example documentation of having received two doses of rubella containing vaccine, or on a positive antibody test for rubella.



o   Refer to GP if not immune to rubella, for MMR vaccine.  Vaccine should not be given to immunocompromised or pregnant woman.  Women who are not pregnant should avoid pregnancy until one month after administration of vaccine.



12.         Advice on Cervical Screening



o   All women planning pregnancy who are due a cervical smear to have the test as soon as possible, before becoming pregnant.



13.         Multiple Pregnancies



o   Multiple pregnancies are associated with an increased risk of adverse outcomes in pregnancy such as miscarriages, bleeding, pre-term delivery, high blood pressure and diabetes.



o   Due to the increased risk mentioned above, we strongly advise the replacement of single embryo in IVF especially in women aged below 37 years.




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