Review Note
Last Update: 05/29/2024 06:06 PM
Current Deck: SLS Cards::5. Prenatal care
New Card (Unpublished)Currently Published Content
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Pending Suggestions
Field Change Suggestions:
Front
Commit #103719
What pre-pregnancy prevention/ screening procedures should be done from a chronic medical condition perspective?
Back
Commit #103719
Asthma? --> delay conception until good control achieved
Cancer? --> potential effects of treatment, e.g. chemo, on fertility and informed of alternatives to preserve fertility
Diabetes? -->
HTN?
Cancer? --> potential effects of treatment, e.g. chemo, on fertility and informed of alternatives to preserve fertility
Diabetes? -->
- Increased risk of birth defects if no good glycemic control
- Folic acid 5 mg daily pre-conception (at least 3 weeks) and at least 12 weeks after conception
- ACEi and statins contraindicated --> STOP
- Avoid estrogen-containing contraception if DM > 20 years OR end-organ damage
HTN?
- Increased risk of adverse fetal and maternal outcomes
- Asses for end-organ damage
- Alternatives to ACEi in women of reproductive age
- Avoid estrogen-containing contraception if uncontrolled/ severe
- Active episodes --> increased risk of miscarriage, premature delivery, still birth, low birth weight
- Delay conception until disease in remission
- Encourage maintenance of low phenylalanine level during repro years and esp prior to conception
- Encourage optimal control prior to conception (e.g. normal BP)
- Use alternative to ACEi
- Seizure and seizure medications pose increased risk of adverse outcome
- Folic acid 4-5 mg daily prior to conception and for 12 weeks after conception
- Lowest dose of single medication recommended (e.g. lamotrigine or levetiracetam (Keppra))
- Valproic acid, lithium, and topiramate contraindicated
- Many antiepileptic medications inferfere with hormonal contraceptive methods
- Delay conception until good control
- Natural history during/ after pregnancy
- Cyclophosphamide, methotrexate, leflunomide contraindicated
- Avoid estrogen-containing contraception if SLE and positive/ unknown antiphospholipid antibody syndrome
- Risk for VTE during pregnancy and postpartum increased
- Requires anticoagulation
- Coumadin contraindicated
- Avoid estrogen-containing contraceptives
- Achieve euthyroid prior to conception
- If hypothyroid --> increase levothyroxine dose by 30% as soon as pregnant
- Radioactive iodine contraindicated
- Screen for CBC and TSH prior to conception