3 Preconception Counseling Points

JULY 11, 2017
Pharmacists can play an important role in preconception counseling. Since approximately half of all US pregnancies are unplanned, education is extremely important.Keep in mind that women may not know they are pregnant until 17-56 days after conception, which is when the fetus is most at risk for developing certain birth defects.2 Pharmacists are considered one of the most trusted health care professionals, and you will therefore receive many questions regarding preconception health. Check out these 3 preconception counseling points.  

Patients should have the appropriate amount of folic acid and iron.
The US Preventive Services Task Force recommends that women who are planning or capable of becoming pregnant take a daily supplement containing 0.4 to 0.8 mg of folic acid to prevent neural tube defects (NTDs).3 The most common NTDs are anencephaly (underdeveloped brain and incomplete skull) and spina bifida (incomplete closing of the spinal cord).1 Women planning to become pregnant should begin taking a prenatal vitamin that contains at least 27 mg of iron.4 Iron helps to supply oxygen to the developing fetus. 

Most prescription prenatal vitamins contain 1 mg of folic acid.  Evidence suggests that women who have previously had a NTD affected pregnancy should consume 4 mg of folic acid one month prior to trying to become pregnant and for the first 3 months of pregnancy.1

Educate couples to limit caffeine consumption.
Evidence suggests that high caffeine consumption prior to conception may increase the risk of miscarriage. According to a recent study, there is an increased risk of miscarriage when a woman and her partner consume more than 2 caffeinated beverages a day during the weeks leading up to conception.5 Counsel couples trying to conceive to limit their caffeine consumption to less than 3 beverages per day. The American College of Obstetricians and Gynecologists recommends that pregnant women not consume more than 200 mg a day of caffeine, which is equivalent to one 12 ounce cup of coffee.4 

Counsel patients regarding Zika virus infection prevention strategies.6
Educate women and men trying to conceive to avoid traveling to areas with risk of Zika virus infection. The CDC recommends the following for women and men who have been diagnosed with Zika virus or had an exposure to an area with a CDC Zika travel notice:
  • If a woman is exposed, then the couple should wait at least 8 weeks after the symptoms started or the last possible exposure before trying to conceive.
  • If a man is exposed, then the couple should wait at least 6 months after the symptoms started or the last possible exposure before trying to conceive.
  • If a woman and man are both exposed through travel, then the couple should wait at least 6 months after the symptoms started or the last possible exposure before trying to conceive.
  • Counsel couples to correctly and consistency use condoms during sex through the waiting periods.
References
  1. Folic acid.  CDC website.  https://www.cdc.gov/ncbddd/folicacid/recommendations.html.  Accessed July 5, 2017.
  2. Preconception health and care.  CDC website.  https://www.cdc.gov/preconception/hcp/index.html.  Accessed July 5, 2017.
  3. Folic acid for the prevention of neural tube defects: preventive medicine.  U.S. Preventive Services Task Force website.  https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/folic-acid-for-the-prevention-of-neural-tube-defects-preventive-medication?ds=1&s=folic%20acid.  Accessed July 5, 2017.
  4. Nutrition during pregnancy.  ACOG website.  https://www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy.  Accessed July 5, 2017.
  5. Louis GM, Sapra KJ, Schisterman EF, et al.  Lifestyle and pregnancy loss in a contemporary cohort of women recruited before conception: The LIFE Study.  Fertil Steril.  2016; 106:180-188.
  6. People planning to conceive.  CDC website.  https://www.cdc.gov/zika/hc-providers/reproductive-age/patient-counseling.html.  Accessed July 5, 2017.


Jennifer Gershman, PharmD, CPh
Jennifer Gershman, PharmD, CPh
Jennifer Gershman, PharmD, CPh, received her PharmD degree from Nova Southeastern University (NSU) College of Pharmacy in 2006 and completed a 2-year drug information residency. She served as a pharmacy professor at NSU’s College of Pharmacy for 6 years, managed the drug information center, and conducted medication therapy management reviews. Dr. Gershman has published research on prescription drug abuse, regulatory issues, and drug information in various scholarly journals. Additionally, she received the Sheriff’s Special Recognition Award for her collaboration with the Broward, Florida Sheriff’s Office to prevent prescription drug abuse through a drug disposal program. She has also presented at pharmacist and physician continuing education programs on topics that include medication errors, prescription drug abuse, and legal and regulatory issues. Dr. Gershman can be followed on Twitter @jgershman2
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