INVESTIGATIONS & DIAGNOSIS, TREATMENT PLAN

INVESTIGATIONS & DIAGNOSIS

• Review immunisation status (rubella, varicella)
• Cervical screening if due
• Hepatitis B, C and HIV screening for IV drug users
• Genetic risk assessment based on personal/family history and ethnicity
• Thyroid function tests for those with thyroid conditions
• HbA1c for diabetics
• Renal function tests for diabetics (eGFR, ACR)
• Prolactin levels if on antipsychotics (esp. amisulpride, risperidone)

TREATMENT PLAN

Conservative measures:

• Timing: inter-pregnancy interval 18-59 months Sexual intercourse 2-3 times/week
• Folic acid supplementation:
• Normal risk: 400 mcg daily until 12 weeks of gestation
• High risk: 5mg daily until 12 weeks of gestation
• Continuous for sickle cell anaemia, thalassemia, thalassemia trait
• Aim for a BMI of 18.45-24.9
• Smoking cessation (consider NRT if needed)
• Alcohol cessation
• Illicit drug cessation
• Avoid herbal/OTC medications
• MMR vaccine if seronegative (wait 1 month before conception)
• Varicella vaccine if eligible and seronegative (wait 1 month before conception)
• Avoid Zika virus-prone areas; if exposed, delay conception 2-3 months

Medical management:

• Adjust the levothyroxine dose if hypothyroid
• Diabetes management:
• Aim HbA1c <48 mmol/mol (6.5%)
• Capillary glucose targets: 5-7 mmol/L fasting, 4-7 mmol/L pre-meals
• Continue antiepileptic medications
• Switch from warfarin to low molecular weight heparin if indicated

Referrals:

• Diabetes team for pre-pregnancy counselling and management
• Genetic counselling, if indicated