Title: antenatal care 30 October 2015 Learning 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 O 2 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 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