Pre-Pregnancy Counselling

All women planning a pregnancy are advised to consult with a view to: 1) detecting any clinical conditions that may be of relevance to the forthcoming pregnancy but are ideally managed prior to pregnancy 2) further assessment of any conditions of relevance and optimising any treatment with respect to the forthcoming pregnancy 3) obtaining general advice regarding personal health care in early pregnancy, in particular, medications, alcohol, X-rays etc Pre-pregnancy counselling should include: > Collection of relevant family history > Recommending periconceptional folic acid supplementation > Provision of information about screening and diagnostic tests during > Consideration of carrier tests for those from specific ethnic groups, eg thalassaemia, sickle cell screening and Tay-Sachs disease. > Assessment of drug and medication use and implications for pregnancy. > Discussion of lifestyle changes, eg alcohol and smoking cessation during pregnancy and changes to diet. > Provision of information about infectious diseases: Rubella vaccination status Varicella antibody status and immunization if non-immune Discussion about listeria infection and toxoplasmosis > Provision of information about pre-implantation genetic diagnosis (PGD), for couples who are known carriers of a genetic condition and/or couples undergoing IVF > Where couples are known carriers of a genetic condition, refer to Genetics Services

Clinical Assessment
Most important is a detailed medical history and clinical examination. Collecting the family history The family history of the woman and her partner should be collected regarding: > Inherited conditions, eg cystic fibrosis, fragile X syndrome, Duchenne muscular dystrophy > Down syndrome and other chromosomal abnormalities > Birth defects, eg spina bifida, cleft lip/palate, cardiac defects > Intellectual disability > Recurrent miscarriage > Unexplained perinatal deaths > Consanguinity (see Genetics in practice) > Ethnic background The following investigations are recommended: 1) rubella immunity status (if this is unknown) 2) varicella immunity status (if unknown and the patient does not give a clear history of varicella) 3) cervical smear (if clinically appropriate)

General Advice
All women planning pregnancy should receive advice with respect to:

1) potential teratogens in early embryogenesis (medications, alcohol, X-rays etc) 2) where and when to attend in early pregnancy 3) vitamin supplementation (particularly folic acid for 3 months preconception) Recommendations about folic acid in pregnancy Women at population risk for neural tube defects Women planning a pregnancy should take supplementary folic acid, 0.5mg [500g] folic acid tablet or multivitamin appropriate for use in pregnancy and containing at least 0.4 mg [400g] of folic acid) every day for at least one month prior to possible conception and continued for the first three months of pregnancy. As many pregnancies are unplanned, all women of reproductive age should consider taking supplementary folic acid or a folate-rich diet. Folic acid tablets and multivitamins containing at least 0.4mg [400g] folic acid are available from chemists, health food stores and some supermarkets. Women at increased risk for neural tube defects Women are at higher risk of having a baby with a neural tube defect if: > They have had a baby with spina bifida, anencephaly or other neural tube defects > They themselves have had a neural tube defect > They are on certain medications for epilepsy > They have a close relative who has had a neural tube defect. These women should take supplementary folic acid every day for at least one month prior to possible conception and continued for the first three months of pregnancy. The dose recommended is usually 5mg [5000g]. Important points about folic acid Women taking drugs to control epilepsy or seizures should ask their doctor whether they should increase the dose of folic acid to 5mg daily. However, specific evidence is limited in this area. Women planning to take multivitamins to provide folic acid supplementation should check with their pharmacist or doctor whether the multivitamin dose they are planning to use contains amounts of all the other vitamins/minerals that are safe for pregnancy, as well as providing the right amount of folic acid.

First Antenatal Visit in Pregnancy

All women should be advised to attend in early pregnancy with a view to: 1) confirming pregnancy and establishing an estimated date of confinement (albeit that may alter after subsequent ultrasound examinations) 2) a comprehensive clinical assessment in order to determine any clinical conditions that may be of relevance to the pregnancy 3) detailed assessment of any particular conditions or circumstances of relevance and optimising management for pregnancy 4) obtaining general advice regarding common issues of concern in early pregnancy and management of the pregnancy

Clinical Assessment
As always, of greatest importance is a careful medical history and thorough clinical examination.The
following investigations are recommended (in the absence of specific complications): 1)Full blood examination 2)Blood group and antibody screen 3)Rubella antibody status: 4)Syphilis serology 5) Midstream urine 6)HIV 7)Hepatitis B serology

8)Hepatitis C 9)Varicella 10)Cervical cytology Other tests that may be considered: 1) Screening for Haemoglobinopathies 2) Vitamin D

General Advice
All women in early pregnancy should be informed with respect to: 1) potential teratogens (medications, alcohol, X-rays etc 2) vitamin and mineral supplementation (see college statement) 3) model of care, expected visit frequency, place of booking for confinement, expected costs for both pregnancy and confinement

http://www.nhmrc.gov.au/_files_nhmrc/file/your_health/egenetics/practioners/gems/sections/03_ testing_and_pregnancy.pdf http://www.ranzcog.edu.au/womens-health/statements-a-guidelines/college-statements/283-prepregnancy-counselling-routine-antenatal-assessment-c-obs-3.html