ObstetricsTier 2Topic

Counselling women regarding healthy behaviour both before and during pregnancy

Overview

Preconception and antenatal counselling on modifiable factors affecting pregnancy outcome - diet, gestational weight gain, physical activity, substance use, medication safety, and supplementation
Modifiable lifestyle factors contribute substantially to preventable adverse outcomes (fetal growth restriction, macrosomia, neural tube defects, fetal alcohol spectrum disorder)

Folate deficiency periconceptionally -> neural tube defects; alcohol -> fetal alcohol spectrum disorder (no safe threshold established); smoking -> growth restriction, placental abruption, preterm birth; excess/inadequate gestational weight gain -> macrosomia/growth restriction respectively

Booking visit: assess baseline BMI, diet, substance use, medication review, immunisation status

Folic acid 0.4-0.5mg/day from >=1 month preconception to 12 weeks (5mg/day if high risk - anticonvulsants, diabetes, obesity, previous neural tube defect)
Iodine 150 micrograms/day for all pregnant, breastfeeding, or planning women in Australia/NZ
Vitamin D if deficient; routine multivitamin otherwise not required if diet is adequate
Alcohol - no safe amount, abstinence recommended; smoking cessation support; caffeine <200mg/day
Gestational weight gain targets by pre-pregnancy BMI (Institute of Medicine): underweight 12.5-18kg, normal 11.5-16kg, overweight 7-11.5kg, obese 5-9kg
Moderate exercise encouraged unless contraindicated (e.g. placenta praevia, significant cardiac/respiratory disease)
Medication review - stop/switch teratogenic drugs preconception where possible

Neural tube defects (folate), fetal alcohol spectrum disorder, iodine deficiency disorders (neurodevelopmental impact)

Interventions are most effective preconception or in early first trimester - the neural tube closes by ~day 28, often before pregnancy is recognised, which is why folate is recommended before conception

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