General

  • If confirmed not yet pregnant recommend for breast examination and CST
  • Perinatal outcomes are worse with interpregnancy intervals <18 months or >59 months; the outcomes affected are preterm birth, low birth weight and small size for gestational age
  • Record BMI and BP, check oral cavity in case dental work indicated
  • Recommend weight management and caution against being overweight or underweight
  • Regular moderate intensity exercise
  • Consider risk of nutrient deficiency
  • Optimise comorbidities

Substance use

  • Recommend complete cessation in pregnancy of
    • Alcohol
    • Tobacco
    • Illegal drug use

Immunisations

  • MMR
    • Women receiving MMR vaccine should be advised against becoming pregnant in following 28 days
  • Varicella – routine testing for varicella does not reliably provide evidence of vaccine induced immunity, but may show natural ammunity
  • Influenza immunisation
  • dTpa

Supplementations

  • Folic acid (0.4-0.5mg day) for 1 month prior to pregnancy and for next 3 months following conception
    • If increased risk NDT (taking anticonvulsants, pre pregnancy diabetes, previous history, BMI >30 or folate deficiency) 5mg should be used
  • Iodine supplements of 150mcg per day for all pregnant, breastfeeding or attempting conception

Healthy Environments

  • Avoid TORCH infections (Toxoplasmosis, Other (Syphillis, varicella, mumps, parvovirus, HIV, listeriosis), Rubella, Cytomegalovirus and Herpes simplex;
    • Toxoplasmosis; cat litter, garden soil, raw/undercooked meat and unpasteurised milk products, wash all fruit and vegetables
    • Cytomegalovirus, parvovirus B19 (fifth disease); recommend frequent hand washing, those who work with children or healthcare should wear gloves when changing nappies
    • Listeriosis; Avoid pate, soft cheeses (eg. feta, brie, blue vein), prepackaged salads, deli meats and chilled/smoked seafood. Wash all fruit and vegetables.