Preconception Patient Information

Past Medical History

Medical Diseases

Diabetes
A woman can have diabetes before she gets pregnant (preexisting or pregestational diabetes) or it can develop during pregnancy (gestational diabetes). It is important for women of childbearing age with preexisting diabetes to carefully monitor their blood glucose levels. Uncontrolled diabetes, especially in the first few weeks of pregnancy, make the pregnancy at higher risk for birth defects. Gestational diabetes often develops later in pregnancy and poses some, but not as many, health risks.

For more information, go to:
http://www.marchofdimes.com/professionals/681_1197.asp

Hypertension
Hypertension, commonly known as high blood pressure, can be a complication during pregnancy. Hypertension can be present before pregnancy (called chronic hypertension) or develop during pregnancy (called gestational hypertension). Hypertension can create problems for the mother and baby, including preeclampsia. All women with hypertension should be monitored closely by her physician.

For more information please go to:
http://www.marchofdimes.com/professionals/681_1222.asp

Psychiatric Disorders
Mental health problems can be present before pregnancy or arise during pregnancy because of the many changes that occur in the pregnant woman’s body. These problems include depression and alcoholism. (For more information on alcoholism, please see the section on substance abuse.)

For more information about depression and pregnancy, go to:
http://www.marchofdimes.com/pnhec/188_15663.asp

Gum Disease/Oral Health
Periodontal disease, also known as periodontitis, is a bacterial infection of the gums and teeth and has been associated with preterm, low birth weight babies. In fact, women with periodontitis may be as much as seven times more likely to have a premature baby. These babies go on to have an increased risk for health problems such as mental retardation, blindness, chronic lung disease and cerebral palsy. It is very important to maintain proper oral hygiene before and during pregnancy, so make sure you see a dentist before and during pregnancy.

For more information please go to: http://www.marchofdimes.com/pnhec/159_15293.asp

Hepatitis B
Hepatitis B Virus, or HBV, is a sexually or blood transmitted disease that can cause scarring or cirrhosis of the liver. It is important to notify your doctor if you have a history of hepatitis because your baby is at risk of getting HBV. Treatment is available for the baby to prevent spreading of the disease.

For more information go to: http://www.cdc.gov/hepatitis

Human Papiloma Virus (HPV)
HPV infection, also known as genital warts, is the most commonly sexually transmitted infection in the United States. If you have genital warts make sure to tell your health care provider. Pregnant women who have HPV usually do not transmit it to their babies. Rarely, HPV can cause certain types of cancers.

For more information go to:
http://www.marchofdimes.com/pnhec/188_730.asp

HIV/AIDS
Human immunodeficiency virus or HIV is a virus that causes AIDS (acquired immunodeficiency syndrome). People who have AIDS cannot fight off diseases like people with a normally functioning immune system. Mothers who are pregnant and have HIV or AIDS can pass along the condition to her baby during pregnancy, delivery or breastfeeding.

For more information go to:
http://www.marchofdimes.com/pnhec/188_705.asp

Back Injury
It is very important to have a strong, flexible back before becoming pregnant. Back pain is very common during pregnancy but there are many simple things you can do to prevent or lessen the pain. Please consult your physician or physical therapist for these techniques. While some back pain is normal, intense pain could be a sign of more serious problems. If you have a fever or if the pain moves down your leg or you have tingling and numbness in your legs or feet, you should consult a doctor immediately.

For more information please go to:
http://www.marchofdimes.com/pnhec/159_15242.asp

Medication

Prescription and over-the-counter medications can have numerous effects on an unborn baby, including severe birth defects. Because of this, the United States Food and Drug Administration has assigned a risk category to every drug. When pregnant or planning a pregnancy, a woman should consult her doctor before beginning any new medication and also discuss the medications she is currently on, including the name, dose, and reason for taking it .

For more information about over-the-counter medications and pregnancy, visit
http://www.aafp.org/afp/20030615/2517.html

1) Psychiatric Medications
Many psychiatric medications cross the placenta and can have a variety of effects on an unborn baby. Traditionally, these medications have not been administered during pregnancy. However, recent studies suggest certain classes of psychiatric drugs, such as the commonly-prescribed SSRI’s, may be safe during pregnancy. In addition, untreated mental illness itself may have negative effects during pregnancy. A pregnant woman with concerns about her mental health should discuss with her doctor the benefits and risks of psychiatric medications during pregnancy.

For more information about psychiatric medications and pregnancy, visit
http://www.aafp.org/afp/20020815/629.html

2) Anti-seizure Medications
Anti-seizure medications taken during pregnancy may increase the risk of birth defects in an unborn baby. Women who take anti-seizure medication for any reason should discuss with their physician the benefits and risks of continuing the medication while pregnant.

For more information about anti-seizure medications and birth defects, visit
http://stronghealth.com/services/neurology/epilepsy/pregnancy.cfm

3) Aspirin
Aspirin may harm an unborn baby or cause complications during delivery. It is recommended that women who are pregnant avoid taking aspirin throughout pregnancy, and especially during the third trimester.

For more information about aspirin and other pain medications during pregnancy, visit http://www.marchofdimes.com/pnhec/159_529.asp

Immunizations

It is preferred that a woman have all her vaccinations up-to-date before she becomes pregnant. If this is not the case and a pregnant woman is in need of a vaccination, she should consult with her doctor about the benefits and possible risks of each vaccine. Most vaccines are proven to have higher benefits to the mother than risks to the baby.

Visit the National Immunization Program at http://www.cdc.gov/nip/publications/preg_guide.htm to download The Guide to Vaccinating Pregnant Women.

There is also a comprehensive table available at http://www.acog.org/from_home/publications/misc/bco282-1.cfm#table1

1) The Influenza Vaccine
When a pregnant woman comes down with the flu, she is more likely than a nonpregnant wom an to have severe symptoms or to contract a serious form of pneumonia. The influenza vaccine is considered to be a safe shot to receive during pregnancy. Therefore, if the second and third trimester of pregnancy fall within the flu season (October through February), it is recommended that the woman receive the flu shot. It is also recommended that every member in her household receive one as well.

2) Tetanus Toxoid
If a pregnant woman is infected with Tetanus, the disease can cause fetal death. The tetanus vaccine is safe to receive during pregnancy, and it is recommended for all pregnant women, especially if they have not been vaccinated against tetanus in the past 10 years.

3) Hepatitis B Vaccine
Hepatitis B is a viral infection that affects the liver and can cause many symptoms such as nausea, vomiting and jaundice. A pregnant woman can transmit Hepatitis B to her baby during labor and delivery. Therefore, it is recommended that all pregnant women who are health-care workers or in close contact with someone infected with hepatitis B receive the vaccine.

4) Hepatitis A Vaccine
Hepatitis A is a viral infection that is usually spread through contaminated food or water. Altough the illness does not usually affect an unborn baby, it is possible that the virus can contribute to premature labor and fetal death. The safety of the Hepatitis A vaccine during pregnancy has not been fully determined. Therefore, in general, this vaccine is not recommended for the majority of pregnant women. However, if a pregnant woman lives in or travels to an area where the virus is common, she should discuss the benefits and risks of this vaccine with her doctor.

5) Polio Vaccine
Most women in the United States have already been vaccinated against polio, and since this disease is extremely rare in America, most pregnant women do not need to receive another polio vaccine. However, pregnant women traveling to Southeast Asia, India or Africa may need to receive a polio booster shot. If this is the case, the inactivated form of the vaccine should be administered to minimize the risks to the baby.

6) Pneumonia Vaccine
It is recommended that pregnant women with a history of lung disease, such as asthma, discuss the need for the pneumonia vaccine with their doctors. This immunization is safe to receive during pregnancy.

7) MMR: Measles, Mumps, Rubella
The MMR vaccine is made from live virus components and may be harmful to an unborn baby. It is recommended that all women are up-to-date with their MMR immunizations prior to becoming pregnant. This vaccine should not be given at any time during pregnancy.

8) Varicella (Chickenpox) Vaccine
The Chickenpox vaccine is made from live virus components and may be harmful to an unborn baby. This vaccine should not be given at any time during pregnancy.

Travel

When women who are pregnant or are planning on becoming pregnant travel, they should take their health into special consideration. All women should be educated about vaccinations, fatigue, dehydration, and altitude and their effects on health. Women who are pregnant should be especially concerned about traveling to underdeveloped areas and the medical care available to them there as well as the infectious diseases that are prevalent in that area.

For more information, go to: http://www.cdc.gov/travel

Toxoplasmosis
Toxoplasmosis is a parasitic infection caused by one-celled parasites that a mother can get and pass on to her baby. One of the most common ways the infection is carried is by cats that have eaten an infected animal (such as a dead rodent in the backyard). Women can also get the infection by eating undercooked foods or spending time in unsanitary living conditions, which can occur when people travel outside the US. The symptoms of toxoplasmosis can resemble the flu or mononucleosis.

To learn more, go to http://www.marchofdimes.com/professionals/14332_1228.asp

Family History and Genetic Diseases

Family History

Your family history can be a valuable tool for your personal healthcare. Being aware of the medical diseases and conditions that run in your family can provide you with information about your own health and the conditions for which you must actively take care of yourself to avoid.

For more information, visit http://www.cdc.gov/genomics/public/famhistMain.htm

3 Generation Pedigree

The Surgeon General of the United States recently started a Family History Initiative and provides the American public with resources to create a 3 generation pedigree. It is a tool that helps patients and health care providers alike map out a family history and notice what diseases run in a person’s family.

For more information, visit the Surgeon General’s website at http://www.hhs.gov/familyhistory/

Ethnicity and Risk

Certain ethnic backgrounds put people at an increased risk of certain birth defects. With current technology, both members of a couple are able to be tested (with a simple blood test) to see if they are carriers for diseases at risk of being passed from parent to offspring.

Examples of genetic diseases in ethnic populations include:
a) Cystic Fibrosis in people of Northern European Caucasian ancestry
b) Tay-Sachs in people of Eastern European (Ashkenazy) Jewish or French
Canadian ancestry
c) Beta Thalassemia in people of Mediterranean, Southeast Asian, Pakistani, or
African ancestry
d) Alpha Thalassemia in people of Southeast Asian or African ancestry
e) Sickle Cell Anemia in people of African, Mediterranean, Mid-eastern,
Caribbean, Latin American, or Indian ancestry

To learn for about genetics and birth defects, visit http://www.marchofdimes.com/pnhec/4439_1126.asp

Environmental Factors

Chemical Exposures

There are many chemicals in the environment that may be harmful to pregnant women. Most of them have not been studied enough to know their true effect on the mother or the fetus. While pregnant, women should be careful of chemicals they come in contact with, especially in the home or workplace. Lead, mercury, and pesticides are some chemicals that should be avoided by pregnant women.

For more information, go to: http://www.marchofdimes.com/professionals/14332_9146.asp

Domestic Violence

Domestic abuse can have many forms. It can be physical, emotional, or sexual abuse. All forms of abuse can be harmful to a pregnant mother and her unborn baby. Women in abusive relationships need to tell someone about it and make a plan that will lead them to safety.

For information on the National Domestic Violence Hotline, go to www.ndvh.org. Or you can call 1-800-799-7223 (24 hours a day).

Wellness and Lifestyle

Nutrition

1) Folic acid
Folic Acid, a B vitamin, can prevent major birth defects if taken by a woman before she becomes pregnant. It is recommended that women of childbearing age and pregnant women take a folic acid supplement everyday. The current recommendation is 400 micrograms per day, but 1000 micrograms per day would be ideal. You can obtain folic acid in your diet through foods that are fortified by it or through a vitamin supplement.

For CDC and US Public Health Service guidelines, go to: http://www.cdc.gov/node.do/id/0900f3ec80010af9

2) Fish and Mercury
Fish are a healthy component of a balanced diet, containing omega-3 fatty acids and other nutrients. However, some fish contain traces of mercury that can be hazardous to the health of pregnant women. Because of this hazard, women of childbearing age should limit their exposure to fish and mercury.

For FDA and EPA guidelines on eating seafood, go to: http://www.cfsan.fda.gov/~dms/admehg3.html

3) Omega-3 Fatty Acids
Omega-3 fatty acids are polyunsaturated long chain fatty acids that are not produced by the body and must be obtained through the diet. They are found in fish and some poultry. Americans are often omega-3 fatty acid deficient because we don’t consume enough fish in our diets or take vitamins that contain it. Omega-3 fatty acids have been shown to prevent coronary heart disease and also improve pregnancy outcomes by benefiting the growth and development of the baby and preventing some pregnancy complications.

To learn about the FDA recommendations of Omega-3 fatty acids, go to:
http://www.fda.gov/bbs/topics/news/2004/NEW01115.html

4) Caffeine
Caffeine during pregnancy is a controversial topic. Some people think a small amount of caffeine during pregnancy is not harmful to the mother or fetus, while other people disagree. The one thing that most people believe, and that has been scientifically proven, is that large amounts of caffeine during pregnancy are harmful. So limit your consumption of caffeinated coffee and soda while pregnant.

To learn more, go to: http://www.marchofdimes.com/professionals/681_1148.asp

5) Calcium
Calcium is very important to a pregnant woman’s body. It plays a key role in the cardiovascular, musculoskeletal, and neurological body systems in addition to keeping your teeth healthy.

To learn more about the recommended dose of calcium, go to: http://www.marchofdimes.com/pnhec/159_9472.asp

6) Iron
Iron is very beneficial in pregnancy. It helps keep blood components at healthy levels so that you do not become anemic while pregnant or require a blood transfusion at the time of delivery. It is important for women who are pregnant or planning to become pregnant make sure they consume enough calcium each day, either from food in their diet or a nutritional supplement.

To learn more, visit: http://www.babycenter.com/refcap/pregnancy/pregcomplications/3073.html

7) Antioxidants
Antioxidants, such as vitamin E, may decrease the incidence of birth defects in pregnancies during which the pregnant mother abused alcohol. It may also benefit women at risk for pre-eclampsia.

For more information, go to: could not find a useful website!!

Exercise

Exercising at a moderate level during pregnancy can provide many benefits. Exercise can burn calories to prevent excess weight gain, help prevent gestational diabetes, as well as make you feel emotionally and physically better. Pregnant women need to be careful when choosing the frequency, intensity, duration and type of exercise. They also need to make sure they stay hydrated and that their heart rate remains within healthy limits. They must be sure to allow adequate time for warm-up and cool-down periods and check with their doctor before starting a new exercise routine.

Read more about exercise during pregnancy at http://www.marchofdimes.com/pnhec/159_515.asp

Sleep Disorder Breathing

During pregnancy a woman’s body goes through many physical and hormonal changes, some of which can lead to a change in breathing patterns (especially during sleep). If a pregnant woman begins to snore while sleeping, or snoring increases drastically, it may be an indication that she has either periods of no breathing (apnea) or periods of slowed breathing (hypopnea). If this occurs, the pregnant woman should consult with her doctor.

Reference: http://my.webmd.com/hw/health_guide_atoz/hw48302.asp (not the greatest website)

Stress

Pregnancy in itself is a stressful event for a mother-to-be. Morning sickness, doctor’s appointments and mood swings contribute to overall stress. Some stress is not bad, however, it becomes harmful if it interferes with eating a healthy diet and other daily functions at home or work. Excessive stress can cause the release of various hormones that can cause a preterm labor. Relaxation classes are available and a pregnant woman should try to have various support systems set-up before pregnancy, if possible.

For more information go to: http://www.marchofdimes.com/professionals/14332_1158.asp

Substance Abuse

1) Alcohol
Drinking any alcohol during pregnancy can harm the baby and stunt its growth. The most severe health hazard that results from alcohol use is fetal alcohol syndrome.

To learn more about alcohol and pregnancy, visit http://www.niaaa.nih.gov/publications/brochure.htm or
http://www.marchofdimes.com/professionals/681_1170.asp

2) Drugs
Women of childbearing age should not use illegal drugs (also called street drugs or recreational drugs). Drug use during pregnancy alters the blood flow across the placenta, affecting the baby’ s growth and development, and may lead to other risky, unhealthy activities such as needle-sharing and unprotected sex.

To learn more about drug use and pregnancy, go to http://www.marchofdimes.com/professionals/14332_1169.asp

Fertility

Infertility

Sometimes, couples have trouble conceiving a child. A couple is infertile if they try to have a baby for 12 months and do not conceive one. There can be various causes of infertility, including maternal age (infertility increases after age 35), sexually transmitted infections, and damage to the reproductive organs. If a couple believes that they are infertile they can consult a doctor for various options or a referral to a fertility center.

To learn more about infertility, go to http://www.marchofdimes.com/pnhec/173_14308.asp

Family Planning

It is important for women’s bodies to heal and for their families to adjust after a pregnancy. The current recommendation is that a woman waits approximately 24 months (2 years) between one delivery and another conception.

For more information, go to www.plannedparenthood.org or call 1-800-451-2229