Title: antenatal care 20 April 2023Learning question: What is antenatal care and why is it important?

Homework:

Aims from specification(d) outline the programme of antenatal care in the United Kingdom, with reference to pre-conceptual care (to include immune status with regard to rubella and the use of folic acid supplements) and routine post-conceptual care;

(e) state the dietary changes recommended during pregnancy with reference to DRV values for energy, protein, calcium, iron, vitamin A, vitamin C and folic acid and the reasons for the changes with respect to the role of these nutrients; (f) describe how human fetal growth can be measured using ultrasound to measure biparietal diameter of cranium and crown-rump length of back; (g) describe how alcohol and nicotine can affect the growth and development of the fetus (HSW6a, 6b, 7b, 7c); •

Care before conception

• Preconceptual care – the care that a mother should take before she is even pregnant

• Health of expectant mother is essential as the baby will live in the uterus for nine months!

Smoking• Giving up smoking before

pregnancy is important – can cause serious harm to developing fetus

• Men should also give up too – evidence shows sperm are healthier in non-smokers

• Passive smoking can have serious effects on baby also.

Effects of smoking on developing baby

• Lower the amount of oxygen available to you and your growing baby – carbon monoxide combines with haemoglobin, lowering O2 carrying capacity

• Nicotine causes vasoconstriction of arteries

• Increase your baby's heart rate

• Increase the chances of miscarriage and stillbirth

• Increase the risk that your baby is born prematurely and/or born with low birth weight

• Increase your baby's risk of developing respiratory (lung) problems

Drinking• Alcohol can cause serious

problems in developing baby

• Consuming more than two units of alcohol per day can lead to:– Language difficulty– Attention disorders– Hyperactivity disorders

• Best to give up altogether, but no more than 1-2 units per week are the guidelines

Foetal Alcohol Syndrome (FAS)• Children with FAS have distinct facial features including:

– small and narrow eyes– small head– smooth area between the nose and the lips and – thin upper lip. – Hearing and ear problems– Mouth, teeth and facial problems – Weak immune system– Epilepsy– Liver damage– Kidney and heart defects– Cerebral palsy and other muscular problems– Height and weight issues– Hormonal disorders

Immunity • Rubella (German measles) is a virus an expectant mother must be

immunised against

• Can cause problems in unborn baby such as: – hearing loss – brain damage– heart defects– cataracts

• Vaccinations contain the live virus, so pregnancy for 3 months after immunisation should be avoided

• Tests to check if you are immunised can be carried out by your GP and involves a blood test

Toxoplasmosis• A parasitic infection found in cats that

can spread to humans via cat faeces

• If caught during pregnancy, high risk of passing it on to baby, which is serious

• Can cause brain damage, hearing and eyesight problems, epilepsy and in extreme cases, still birth

• Can be avoided by taking care while gardening and avoiding cat litter trays

Food poisoning• Listeria - common in soft, unpasteurised cheeses and ready

meals

• Salmonella – present in raw, uncooked meat and eggs

• Cooking food thoroughly and only consuming pasteurised products helps to avoid these bacteria

• Fish such as shark and swordfish contain high levels of mercury and should be avoided also

• Tuna can be eaten in small doses

9 marks

Care after conception• Care received after a woman becomes pregnant is described as

antenatal care

• At 11-12 weeks, medical staff ask about general health and any history of pregnancy to decide if any special care is needed

• Advice on diet and exercise and services available are given

• Urine in screened for presence of glucose and protein – checks kidney function and signs of gestational diabetes

• Height, weight and blood pressure taken – a high BP is indicative of pre-eclampasia, which can cause maternal and infant deaths

Later appointments• After the 12 week mark, expectant mothers have check ups every 4

weeks, then every 2 weeks at 32 week mark

• Can take place at hospital, local clinic or even the woman’s own home

• Checks include:– Height, weight and BP (as before)– Abdomen check for baby growth rate (normal/abnormal)– Listen to baby’s heartbeat– Check baby’s movements– Mother’s emotional state– Check for swelling of arms, legs or face – signs of pre-eclampasia

Diet during pregnancy• Weight gain of 10-15kg is normal – NO dieting/weight gain

avoidance during this time

• Nutrients for developing baby are essential for normal development

• The following is recommended for daily consumption of pregnant women:– 4-6 portions of carbohydrates per day– 5 portions of fruit and vegetables– 3 portions of protein– 1 portion of dairy– 2 litres of fluid – gets rid of toxins and waste products and prevent

constipation

Diet during pregnancy

• Folic acid – reduces risk of problems with baby’s spine and brain, such as spina bifida

• Green leafy vegetables, bread and breakfast cereals contain lots of folic acid. These foods also contain lots of iron, which can help to prevent anaemia

Tests during pregnancy• Blood group – in case transfusion is required during pregnancy

• Mother’s Rhesus blood group – Rh- mothers need an injection after first baby’s birth to protect the second baby from a serious kind of anaemia if the baby is Rh+

• Check for the virus that causes hepatitis

• Check whether the mother has HIV, the virus that causes AIDS. Pregnant women can pass the virus to unborn baby, although medical treatment can reduce risk

• Check whether mother has syphilis

• Check whether the mother is immune to rubella

• Ultrasound carried out as well as tests to check for genetic defects