Access the full text.
Sign up today, get DeepDyve free for 14 days.
Abstract PRECONCEPTIONAL counseling is appropriate not only for women with medical complications but for any woman or couple contemplating pregnancy. The internist is in the unique position of seeing patients before conception. Carrier screening for genetic disorders may be offered to specific populations with an increased frequency for a particular disease. Commonly used drugs such as tobacco, alcohol, cocaine, and perhaps caffeine can adversely affect perinatal outcome. Women with medical illnesses such as diabetes mellitus and phenylketonuria have improved pregnancy outcomes with strict periconceptional metabolic control. Patients requiring chronic anticoagulation, seizure prophylaxis, antihypertensive pharmacotherapy, or control of manic-depressive illness may benefit from a change to a more appropriate medication for pregnancy. Periconceptional folic acid supplementation should be recommended for all patients considering pregnancy. The medical community has long recognized the importance of discussing the possibility of pregnancy with women of reproductive age with a variety of medical conditions. In certain References 1. Jones EF, Forrest JD, Henshaw SK, Silverman J, Torres A. Unintended pregnancy, contraceptive practice and family planning services in developed countries . Fam Plan Perspect . 1988;20:53-67.Crossref 2. Taskinen HK. Effects of parental occupational exposures on spontaneous abortion and congenital malformation . Scand J Work Environ Health . 1990;16:297-314.Crossref 3. Hemminki K, Muganen P, Saloniemi I, Niemi ML, Havinio H. Spontaneous abortions in hospital staff engaged in sterilizing instruments with chemical agents . BMJ . 1982;285:1461-1463.Crossref 4. McDonald AD, McDonald JC, Armstrong B, et al. Occupation and pregnancy outcome . Br J Indust Med. 1987;44:521-526. 5. Selevan SG, Lindbohm ML, Hornung RW, Hemminki K. A study of occupational exposure to antineoplastic drugs and fetal loss in nurses . N Engl J Med. 1985;313:1173-1178.Crossref 6. Axelsson G, Rylander R. Exposure to anaesthetic gases and spontaneous abortion: response bias in a postal questionnaire study . Int J Epidemiol. 1982;11:250-256.Crossref 7. Cohen EN, Bellville JW, Brown BW. Anesthesia, pregnancy, and miscarriage: a study of operating room nurses and anesthetists . Anesthesiology . 1971;35:343-347.Crossref 8. Krick JA, Remington J. Toxoplasmosis in the adult: an overview . N Engl J Med. 1978;298:550-553.Crossref 9. Granely JP, Comstock GW. Association of cats and toxoplasmosis . Am J Epidemiol. 1980;111: 238-246. 10. Clapp JF, Capeless EL. Neonatal morphometrics after endurance exercise during pregnancy . Am J Obstet Gynecol. 1990;63:1805-1811.Crossref 11. Exercise during pregnancy and the postpartum period . Am Coll Obstet Gynecol Tech Bull. 1994; 189:1-6. 12. Milunsky A, Ulcickas M, Rothman KJ, Willett W, Jick SS, Jick H. Maternal heat exposure and neural tube defects . JAMA . 1992;268:882-885.Crossref 13. Esposito TJ, Gens DR, Gerber-Smith L, Scorpio R, Buchman T. Trauma during pregnancy: a review of 79 cases . Arch Surg. 1991;126:1073-1078.Crossref 14. Pope SK, Whiteside L, Brooks-Gunn J, et al. Low-birth-weight infants born to adolescent mothers: effects of coresidency with grandmother on child development . JAMA . 1993;269:1396-1400.Crossref 15. Centers for Disease Control. Use of supplements containing high-dose vitamin A: New York State—1983-1984 . MMWR . 1987;36:30-86. 16. US Dept of Health and Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon General . Washington, DC: US Dept of Health and Human Services; 1990. Publication No. (CDC) 90-8416. 17. Centers for Disease Control. Cigarette smoking among reproductive-aged women: behavioral risk factor surveillance system—1989 . MMWR . 1991; 40:719-723. 18. Smoking and reproductive health . Am Coll Obstet Gynecol Tech Bull. 1993;180:1-5. 19. Committee on Susbstance Abuse and Committee on Children with Disabilities. Fetal alcohol syndrome and fetal alcohol effects . Pediatrics . 1993; 91:1004-1006. 20. Streissguth AP, Herman CS, Smith DW. Intelligence, behavior and dysmorphogenesis in the fetal alcohol syndrome: a report of 20 patients . Pediatrics . 1978;92:363-367.Crossref 21. Streissguth AP, Landesman-Dwyer S, Martin JC, Smith DW. Teratogenic effects of alcohol in humans and laboratory animals . Science . 1980; 209:353-361.Crossref 22. Kline J, Stein Z, Shrout P, Susser M, Warburton D. Drinking during pregnancy and spontaneous abortion . Lancet . 1980;2:176-180.Crossref 23. Harlap S, Shiono PH. Alcohol, smoking, and incidence of spontaneous abortions in the first and second trimester . Lancet . 1980;2:173-176.Crossref 24. Marbury MC, Linn S, Monson RR, et al. The association of alcohol consumption with outcome of pregnancy . Am J Public Health . 1983;73:1165-1168.Crossref 25. Cefalo RC, Moos MK. Preconceptional Health Promotion: A Practical Guide . 2nd ed. St Louis, Mo: Mosby—Year Book; 1995. 26. Mills JL, Holmes LB, Aarons JH, et al. Moderate caffeine use and the risk of spontaneous abortion and intrauterine growth retardation . JAMA . 1993;269:593-597.Crossref 27. Infante-Rivard C, Fernandez A, Gauthier R, David M, Rivard GE. Fetal loss associated with caffeine intake before and during pregnancy . JAMA . 1993;270:2940-2943.Crossref 28. Zuckerman B, Frank D, Hingson R, et al. Effects of maternal marijuana and cocaine use on fetal growth . N Engl J Med. 1989;320:762-768.Crossref 29. Chasnoff I, Burns W, Schnoll S, Burns K. Cocaine use in pregnancy . N Engl J Med. 1985; 313:666-669.Crossref 30. Slutsker L. Risks associated with cocaineuse during pregnancy . Obstet Gynecol. 1992;79:778-789. 31. Volpe JJ. Effect of cocaine use on the fetus . N Engl J Med. 1992;327:399-407.Crossref 32. Moore TR. Diabetes in pregnancy . In: Creasy RK, Resnik R, eds. Maternal-Fetal Medicine: Principles and Practice . 3rd ed. Philadelphia, Pa: WB Saunders Co; 1994:934-978. 33. Mills JL, Simpson JL, Driscoll SG, et al. Incidence of spontaneous abortion among normal women and insulin-dependent diabetic women whose pregnancies were identified within 21 days of conception . N Engl J Med. 1988;319:1614-1623.Crossref 34. Greene MF, Hare JV, Cloherty JP, Benacerraf BR, Soeldner JS. First-trimester hemoglobin A1 and risk for major malformation and spontaneous abortion in diabetic pregnancy . Teratology . 1989;39: 225-231.Crossref 35. Miodovnik M, Mimouni F, Siddiqui TA, Tsang RC. Periconceptional metabolic status and risk for spontaneous abortion in insulin-dependent diabetic pregnancies . Am J Perinatol. 1988;5:368-373.Crossref 36. Miodovnik M, Skillman C, Holroyde JC, Butler JB, Wendel JS, Siddiqui TA. Elevated maternal glycohemoglobin in early pregnancy and spontaneous abortion among insulin-dependent diabetic women . Am J Obstet Gynecol. 1985;153: 439-442.Crossref 37. Kitzmiller JL, Gavin LA, Gin GD, Jovanovic-Petterson L, Main EK, Zigrand WD. Preconception care of diabetes: glycemic control prevents congenital anomalies . JAMA . 1991;265:731-736.Crossref 38. Platt LD, Koch R, Azen C, et al. Maternal phenylketonuria collaborative study, obstetric aspects and outcome: the first 6 years . Am J Obstet Gynecol. 1992;166:1150-1162.Crossref 39. Lenke RR, Levy HL. Maternal phenylketonuria: results of dietary therapy . Am J Obstet Gynecol. 1982;142:548-553. 40. Cockburn F, Barwell BE, Brenton DP, et al. Recommendations on the dietary management of phenylketonuria . Arch Dis Child . 1993;63:426-430. 41. Jones KL. Smith's Recognizable Patterns of Human Malformations . 4th ed. Philadelphia, Pa: WB Saunders Co; 1988:504. 42. Hall JG, Pauli RM, Wilson KM. Maternal and fetal sequelae of anticoagulation during pregnancy . Am J Med. 1980;68:122-140.Crossref 43. Pauli RM, Lian JB, Mosher DF, Suttie JW. Association of congenital deficiency of multiple vitamin K—dependent coagulation factors and the phenotype of the warfarin embryopathy: clues to the mechanism of teratogenicity of coumarin derivatives . Am J Hum Genet. 1987;41:566-583. 44. Gillis S, Shushan A, Eldor A. Use of low molecular weight heparin for prophylaxis and treatment of thromboembolism in pregnancy . Int J Gynecol Obstet. 1992;39:297-301.Crossref 45. Delgado-Escueta AV, Janz D. Consensus guidelines: preconception counselling, management, and care of the pregnant women with epilepsy . Neurology . 1992;42( (suppl 5) ):149-160.Crossref 46. Lindhout D, Schmidt D. In utero exposure to valproate and neural tube defects . Lancet . 1986;2: 1932. 47. Jones KL, Johnson KA, Adams J, Lacro RV. Teratogenic effects of carbamazepine . N Engl J Med. 1989;321:1481-1484.Crossref 48. Rosa FW. Spina bifida in infants of women treated with carbamazepine during pregnancy . N Engl J Med. 1991;324:674-677.Crossref 49. Scolnik D, Nulman I, Rovet J, et al. Neurodevelopment of children exposed in utero to phenytoin and carbamazepine monotherapy . JAMA . 1994;271:767-770.Crossref 50. Buehler BA, Delimont D, Van Waes M, Finnell RH. Prenatal predication of risk for the fetal hydantoin syndrome . N Engl J Med. 1990;322: 1567-1572.Crossref 51. Jones KL, Lacro RV, Johnson KA, Adams J. Pattern of malformations in the children of women treated with carbamazepine during pregnancy . N Engl J Med. 1989;320:1661-1666.Crossref 52. Annegers JF, Elvebeck LR, Hauser WA, et al. Congenital malformations and seizure disorders in the offspring of parents with epilepsy . Int J Epidemiol. 1978;7:241-247.Crossref 53. Feldman G, Weaver D, Lorrien E. The fetal trimethadione syndrome: report of an additional family and further delineation of their syndrome . AJDC . 1977;131:1389-1392. 54. Barr M, Cohen MM. ACE inhibitor fetopathy and hypocalvaria: the kidney-skull connection . Teratology . 1991;44:485-495.Crossref 55. Hanssens M, Keirse MJNC, Vankelecom F, Van Assche FA. Fetal and neonatal effects of treatment with angiotensin-converting enzyme inhibitors in pregnancy . Obstet Gynecol. 1991;78: 128-135. 56. Scarpinato L, Mackenzie AH. Pregnancy and progressive systemic sclerosis: case report and review of the literature . Cleve Clin Q. 1985;52:207-211.Crossref 57. Bowden CL, Brugger AM, Swann AC, et al. Efficacy of divalproex vs lithium and placebo in the treatment of mania . JAMA . 1994;271:918-924.Crossref 58. Nora JJ, Nora AH, Toews WH. Lithium, Epstein's anomaly and other congenital heart defects . Lancet . 1974;1:594-595.Crossref 59. Cohen LS, Friedman JM, Jefferson JW, Johnson EM, Weiner ML. A reevaluation of risk of in utero exposure to lithium . JAMA . 1994;271:146-150.Crossref 60. Jacobson SJ, Jones K, Johnson X, et al. Prospective multicenter study of pregnancy outcome after lithium exposure during first trimester . Lancet . 1992;339:530-533.Crossref 61. Ferner RE, Smith JM. Lithium in pregnancy . Lancet . 1992;339:869.Crossref 62. Hibbard ED, Smithells RW. Folic acid metabolism and human embryopathy . Lancet . 1965;1: 1254.Crossref 63. Mulinare J, Cordero JF, Erickson JD, Berry BJ. Periconceptional use of multivitamins and the occurrence of neural tube defects . JAMA . 1988; 260:3141-3145.Crossref 64. Mills JL, Rhoads GG, Simpson JL, et al. The National Institute of Child Health and Human Development Neural Tube Defect Study Group: the absence of a relation between the periconceptional use of vitamins and neural tube defects . N Engl J Med. 1989;321:430-435.Crossref 65. Milunsky A, Jick H, Jick SS, et al. Multivitamin/ folic acid supplementation in early pregnancy reduces the prevalence of neural tube defects . JAMA . 1989;262:2847-2852.Crossref 66. Medical Research Council Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council vitamin study . Lancet . 1991;338:131-137.Crossref 67. Committee on Obstetrics. Maternal and fetal medicine: folic acid for the prevention of recurrent neural tube defects . Am Coll Obstet Gynecol. 1993; 120:1-3. 68. Recommendations for use of folic acid to reduce the number of spina bifida cases and other neural tube defects . JAMA . 1993;269:1233-1238.Crossref 69. Czeizel AE, Dudas I. Prevention of the first occurrence of neural tube defects by periconceptional vitamin supplementation . N Engl J Med. 1992;327:1832-1835.Crossref 70. Werler MM, Shapiro S, Mitchell AA. Periconceptional folic acid exposure and risk of occurrent neural tube defects . JAMA . 1993;269:1257-1261.Crossref
Archives of Internal Medicine – American Medical Association
Published: Oct 24, 1994
Access the full text.
Sign up today, get DeepDyve free for 14 days.