1. Healthy Before Pregnancy
March of Dimes
NC Preconception Health Campaign
These slides contain notes, speaking points, and other activities to enhance the lesson. Words written in Times are meant to be read aloud. All other notes are for your reference, and may be read aloud if desired.

2. Preventable factors that can lead to poor birth outcomes: Lesson Plan 4
We all wish that every baby could be born healthy, right? When an expectant moms get asked “Is it a boy or a girl” and she answers, “It doesn’t matter, I only want the baby to be healthy,” it’s really true.
Sometimes a baby dies or is born with a terrible birth defect or illness and there was nothing that could have been done differently to prevent it. In some cases though, some simple measures could have been taken that may be able to prevent such a tragedy.
The goal of this lesson plan is to teach all high school students in NC what they can do now and in the years ahead to help more babies be born healthy.

3. Causes of poor birth outcomes
Genetic birth defects
Maternal illness
Medication
Environment/Lifestyle
Age of mother
“Don’t know”
There are many causes or reasons why a baby dies or is born with a serious medical condition. Can you list some examples for each of these causes?
Notes:
Genetic birth defects: PKU, Fragile X, Down syndrome
Maternal illness: gestational diabetes, HIV, Rubella, infectious diseases with high fevers
Medication: Retinoids to treat acne (Accutane), seizure medications
Environment/Lifestyle: smoking, drugs, drinking
Age of mother: teen pregnancy or advanced maternal age—over 35 yrs

4. Genetic birth defects
Most birth defects are not preventable, but one type that may be prevented are neural tube defects (NTDs).
Studies show that if all women consumed the recommended amount of folic acid before and during early pregnancy, up to 70 percent of all NTDs could be prevented. Folic acid must be taken in the days and weeks before the spinal cord closes. This usually happens around 6-8 weeks of pregnancy. The spinal cord closes before most women even know they are pregnant.
Bottom line: All women of childbearing age should be in the habit of taking a daily multivitamin with 400 mcg “just in case.”
Note:
If you or someone in your family has a history of neural tube defects (NTDs), you need to take more folic acid when planning a pregnancy. Be sure to take the time to talk with your doctor about taking folic acid. Some women require a folic acid intake of 4,000 micrograms one month prior to becoming pregnant and during the first 14 weeks of pregnancy. 
Photo source: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention

5. Neural tube defects
Approximately 200 pregnancies are affected by a neural tube defect (NTD) each year in North Carolina
2,500-3,000 U.S. babies are born each year with NTDs
Another 1,500 are still born, spontaneously miscarried or terminated
North Carolina is in a region of the United States that has had historically high rates of NTDs, particularly in the mountains.

6. Neural tube defects Anencephaly Spina Bifida
The two types of NTDs are spina bifida and anencephaly.
Notes:
In the case of spina bifida the lower portion of the spinal cord and vertebrae fails to close completely. And as a result, the spinal cord and back bones don’t form as they should. A sac of fluid comes through an opening in the baby’s back. Much of the time, part of the spinal cord is in this sac is damaged.
Problems may include:
Not being able to move the lower parts of the body
Loss of bowel and/or bladder control
Fluid building up and putting pressure on the brain (hydrocephalus)
Learning disabilities
Allergy to latex
Current estimate of the financial cost to care for a child with spina bifida is between $636,000 and $1 million.
In the case of anencephaly, it is always fatal. The brain and skull bones do not form correctly. Part or all of the brain and skull might be missing. Often the baby is still born or dies shortly after birth.
Source: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities

7. Multivitamins: Take them for life!
Take a multivitamin and enjoy life as a smart, happy, healthy and physically active adolescent! They are beneficial to both females and males.
Many vitamins and minerals are essential for living and most people do not eat well enough to get them from food.
That’s where vitamins come in: they help fill in the nutrition gaps. Plus there are some specific nutrients like folic acid, vitamin D and vitamin C that are good for you. With so many vitamins needed, who wants to take several pills each day? Multivitamins solve this problem by combining all the vitamins you need into one easy pill.
Remember, eating smart is still important. Vitamins can’t fill in the gap of burgers, fries and soda!

8. Maternal illness
Examples include gestational diabetes, HIV, rubella, or infectious diseases with high fevers.
In many cases, illnesses can be prevented by making healthy lifestyle choices.
Bottom line: Keep up to date on vaccinations, eat healthy and stay fit, abstain from sex or limit sexual partners (always use condoms).

9. Maternal illness: Sexually transmitted infections (STIs)
Bacterial vaginosis
Chlamydia
Genital herpes
Genital warts
Gonorrhea
HIV/AIDS
Syphilis
Trichomoniasis
You can help protect yourself from STIs by abstaining from sex, limiting sexual partners, and using condoms. You can protect the health of a future baby by first avoiding getting STIs and secondly getting proper prenatal care from the start of a pregnancy.
STIs can hurt and some can even cause the death of a baby.
Bottom line: Having access to proper prenatal care is crucial for women who are at risk of STIs--it can literally save the life of a baby.
Notes:
Bacterial vaginosis: 16 out of 100 pregnancies are affected and it can be treated with antibiotics
Chlamydia: There are 3 million new cases each year. It can be treated with antibiotics, but if left untreated it can cause prematurity, pink eye, and breathing problems in a baby.
Genital herpes: 1 in 5 adults have this. It can be transmitted during a vaginal delivery and can be fatal to a baby.
Genital warts: It’s the most common STI and can be uncomfortable during pregnancy.
Gonorrhea: It can be treated with antibiotics, but if left untreated it can cause blindness, joint infections and life threatening blood infections in a baby.
HIV/AIDS: A virus that can be fatal to a baby, BUT proper medication before delivery can dramatically reduce the chances of transmission to a baby.
Syphilis: It can be treated with antibiotics but if left untreated it can cause blindness, brain damage and can even be fatal to a baby.
Trichomoniasis: There are 7 million U.S. cases a year and can be uncomfortable during pregnancy.

10. Maternal illness: Gestational diabetes
A baby can be born too large (over 10 lbs)
Birth defects
Stillborn
Newborn complications
Gestational diabetes is diabetes that develops during pregnancy. About 4 out of every 100 pregnant women develop gestational diabetes.
While gestational diabetes isn’t always preventable, the dangerous effects to a growing fetus can be prevented if it is detected during prenatal care and the woman makes necessary diet and lifestyle changes.
Pregnant women should be screened for gestational diabetes between 24 and 28 weeks of pregnancy.
Bottom line: Having proper prenatal care and having a healthy lifestyle that includes eating healthy and regular exercise prior to pregnancy are the best ways to avoid these health risks to a baby.
Notes:
When people have diabetes, the body doesn't produce enough insulin or it can't use insulin properly. Insulin is a hormone that is produced by the pancreas. It lets the body turn blood sugar into fat or energy.
Gestational diabetes can often be controlled with diet and exercise. If not, insulin injections and blood sugar level monitoring at home may be necessary. A weight loss and exercise program started after delivery can help reduce the risk of developing diabetes in future pregnancies and later in life.

11. Medication
All pregnant females should consult their health care provider before taking over-the-counter or prescription medications. Certain prescription medications are particularly dangerous to the health of a fetus if taken while a female is pregnant.
Has anyone heard of using prescription drugs to treat acne?
Women taking these drugs, known as Retinoids, are advised to take a monthly pregnancy test and to use dual method contraception if sexually active. If taken while pregnant it can cause serious birth defects to the baby.
Notes:
Accutane (isotretinoin) is the most well-known prescription medication used to treat acne, however it was discontinued in Other brands of isotretinoin (Amnesteem, Claravis, Sotret) are still available by prescription.
Isotretinoin is a member of a family of drugs called retinoids, which are related to vitamin A. When taken during pregnancy, isotretinoin and other retinoids can cause miscarriage or very serious birth defects.
Thalidomide is one of the most powerful human teratogens (drugs or other agents that cause abnormal development in the embryo or fetus). Taking even a single dose of thalidomide during early pregnancy may cause major birth defects. Women should never take thalidomide if they could become pregnant or if they are pregnant.
Other prescription drugs can also cause birth defects. A female taking any of the following prescription drugs should talk to her provider before getting pregnant. She may need to switch to a safer drug for pregnancy:
ACE inhibitors (enalapril or captopril)
Androgens and testosterone by-products
Anticancer drugs
Antifolic acid drugs, like methotrexate or aminopterin
Carbamazepine
Levothyroxine
Lithium
Phenytoin
Streptomycin and kanamycin
Tetracycline
Trimethadione and paramethadione
Valproic acid
Warfarin and other coumarin by-products
If a female is pregnant and taking any of the following drugs, she should stop taking the medicine immediately and call her health care provider:
Acccutane, Amnesteem, Claravis, Sotret (isotretinoin) and other retinoids
Soriatane (acitretin)
Thalomid (thalidomide)
Revlimid (lenalidomide)

12. Environment/Lifestyle
Can you think of any things in the environment of a pregnant female that could impact the health of a developing fetus?
Answers:
Smoking
Alcohol Use
Illicit drug Use
Exposure to some toxins
Experience high levels of stress
Experiencing violence
Smoking is the most common environmental risk factor. It can contribute to premature birth, low birthweight, sudden infant death syndrome (SIDS), and pregnancy problems, such as placenta problems.

13. Would you give a baby a cigarette?
Pregnancy and smoking don’t mix
Babies of women who smoke have an increased risk of birth defects, prematurity and low birthweight
One of the best things you can do for your own health and the health of your children is to never start smoking. If you are a smoker already, now is the best time for you to quit. Waiting to quit until you or your partner is pregnant is not an ideal plan.
Women who smoke during pregnancy have a higher risk of having a baby with cleft lip or palate. They also have a higher risk of having a baby born too soon (premature) and/or born too small (low birthweight). Prematurity and low birthweight put babies at higher risk of serious health problems, such as cerebral palsy, mental retardation or learning difficulties.

14. Would you give a baby lead, arsenic or carbon monoxide?
Do you think it’s a good idea for a baby to be breathing in smoke-filled air? Of course not, but it happens all the time.
What is secondhand smoke?
It is the smoke given off by the burning end of a cigarette, pipe or cigar or the smoke exhaled by the smoker.
Secondhand smoke is also called passive or involuntary smoking. It contains over 250 harmful chemicals; about 50 of these can cause cancer. 
While a mom is pregnant, if she is breathing in secondhand smoke, then her baby is at a higher risk of being born too small (low birthweight).
When a baby is born and is exposed to secondhand smoke, then he or she is at a higher risk of having asthma, bronchitis, pneumonia, ear infections, and respiratory problems such as slow lung growth.
Breastfeeding is one of the best ways to give a baby a healthy start in life. But a smoking mother can pass dangerous chemical on to her baby through breast milk.

15. Third-hand smoke is dangerous too
Tobacco use is so dangerous to babies and young children that even third-hand smoke is detrimental.
What is third-hand smoke?
It is breathing in the toxic gases and particles left behind from cigarette or cigar smoke.
These gases and particles cling to clothes, hair, couches, carpets, and the interior of cars well after the smoke has cleared from the room.

16. Why weight really does matter
A woman’s weight before pregnancy may affect her health during pregnancy, as well as influence the health of her baby.
You may have known that gaining the proper amount of weight during pregnancy is important to have a healthy baby but did you know that being at a healthy weight long before becoming pregnant (or getting a partner pregnant) is just as important?
Many poor birth outcomes can often times be traced back to overweight/obesity.
Bottom line: For women, being at a healthy weight BEFORE pregnancy helps prevent these difficulties.

17. Babies born to obese pregnant women…
Are at a higher risk of:
Birth defects
Stillbirth
Dying in the first 28 days of life
High birthweight (>9.9 lbs)
Developing obesity, high blood pressure and the inability to process glucose
Low infant reflex scores 1 and 5 minutes after birth
Not being breastfed
The connection between overweight and obesity and difficulties for the pregnant mom are only the beginning. The effects on baby are also very serious.
Notes:
Birth defects: particularly neural tube defects, birth defects of the brain and spine (see Lesson 2: Multivtamins: Take Them For Life for more about neural tube defects)
Neonatal death: when a baby dies in the first 28 days of life (four weeks)
Metabolic syndrome: obesity, hypertension, dyslipidemia and glucose intolerance
Infant reflex scores are called Apgar scores and are taken at 1 and 5 minutes after birth. Babies with low scores may need extra care. The tests measure: activity, muscle tone; pulse rate; grimace; reflex (measured by placing a bulb syringe in the baby’s nose and seeing his response); appearance: skin color; and respiration
Breastmilk is the best food for most babies during the first year of life. Studies show that children who are breastfed have fewer ear infections, lower respiratory infections, and urinary tract infections than children who receive formula. Breastfed babies are also less likely to develop childhood obesity.

18. Weight connections We know that NC adolescents are getting heavier
We know that there is a connection between a woman’s weight before pregnancy and the health of the baby
We know that most births in NC are to women over the age of 18
Note:
We know that more African-American and Hispanic adolescents are getting heavier compared to white adolescents.

19. myeatsmartmovemore.com See yourself here Move more
Breastfeed your baby
See yourself where you want to be and commit to getting there—you’ll be glad you did. Many of us want to be more active. We feel good after activity but sometimes struggle to find the time. Finding the time may not be as difficult as you think. A good way to fit activity in is to: (1) Set a weekly physical activity goal; (2) Make a commitment; and (3) Plan the time.
Move more, like parking further away from stores and taking the stairs, instead of the elevator.
Different activities bring different benefits. Adults need to be active 30 minutes a day on most days—at least 150 minutes a week. Adolescents, like you, need 60 minutes or more per day. These activities should be hard enough to get your heart pumping and make you breathe faster. Don’t forget to add in some activities that strengthen your muscles at least twice a week.
Breastfeed when the time comes. Mother's milk provides the best food to grow on. Breastfed babies do not get sick as often and have fewer allergies. Mother's milk is very easy for baby to digest. Breastfeeding helps you get your shape back sooner.  

20. Age of mother Teen mothers have:
Increased risk of premature and low birthweight babies
Higher rates of infant mortality
Higher rates of smoking
Less likely to access prenatal care
Higher risk of premature labor, anemia and high blood pressure
Less education and higher rates of living in poverty
Age really does matter. It at least can make a difference.
Note:
Advanced maternal age (older than 35 years) is also associated with higher risks for various poor birth outcomes.

21. Goal: all babies are intended
Don’t resign yourself to the idea of “if it happens, it happens”
Take control over your own reproductive lives today, tomorrow and in years to come
Note:
Intended can also mean planned.

22. Have a Reproductive Life Plan
Part of an overall LIFE plan
Determining when (and if) having children fits into your life plan
Taking steps to achieve optimal physical health, emotional well-being and financial independence and stability PRIOR to starting a family
Make a plan! Do you want children someday? If yes, how many do you want? How old will you be when you have your first? How far will they be spaced apart? What is your strategy to prevent pregnancy until you are ready? Abstinence, birth control? What life goals do you want in place before starting a family? Education, job, income level, life experiences?
Revisit your plan from time to time.
Bottom line: Take control of your own life and if/when you will become a parent.

23. Take care of yourself
The health and lifestyle choices you make today can affect the health of your future family
Revisit your reproductive life plan at least once a year
Advocate for yourself, your body and your life goals
What are health issues you can avoid or lifestyle choices that you make that could help you have a healthier baby in the future?
Answers:
Avoid risky behaviors that lead to STIs
Avoid drugs, alcohol, and smoking—these can be habit forming, and if used while pregnant there can be negative outcomes
Weight—being at a healthy weight now and through young adulthood helps your chances of being at a healthy weight during pregnancy
Abuse—having healthy non-abusive relationships now helps you form the foundation and relationship skills to have a healthy partnership in the future.

24. Healthy Before Pregnancy
Remember, being in the best physical, emotional and financial position BEFORE pregnancy is best
Make sure your future pregnancies are planned and intended
Proper prenatal care is a must for when you do become pregnant
Bottom line for female students: How you take care of your body now can impact the health of your future babies.
Bottom line for male students: How you treat your own body can influence how female friends and partners take care of theirs.
Everyone deserves to feel safe and be treated with respect. Healthy friendships and relationships are a must!