Preconception Period Fertile Couples Discussion

PRECONCEPTION PERIOD AND ITS IMPORTANCE

           The preconception period is mostly defined as a period of three months prior to conception, or a period of at least one year before the initiation of any unprotected sexual intercourse that could result in pregnancy. During this period, mothers can improve their health and behaviors pertaining to diet, exercise, body mass index (BMI), smoking, and drinking in preparation of a healthy pregnancy and baby, thus significantly reducing maternal, fetal, and neonatal morbidity and mortality (Stephenson et al., 2018).

FOLATE SUPPLEMENTATION

           Maternal folate supplementation is crucial for optimum development and function of the brain of the developing fetus, including prevention of neural tube defects (NTDs) and neurodevelopmental disorders, such as autism and schizophrenia. An adequate maternal folate status has also been associated with decreased risk of preterm birth, low birth weight, fetal growth retardation, and structural malformations (Naninck, Stijger, & Brouwer-Brolsma, n.d.). According to the United States Preventive Service Taskforce (USPSTF), all women planning on getting pregnant must consume 0.4 to 0.8 mg of folic acid daily (Bibbins-Domingo et al., 2017)

SOURCES OF FOLATE

         Cereals, leafy-green vegetables, milk and dairy products, meat and meat products, fish and shellfish, and legumes and pulses are the main dietary sources of folate (Partearroyo et al., 2017).

HIGHER NEED FOR FOLATE SUPPLEMENTATION

          Certain patient populations are predisposed to a higher risk of NTDs and thus require a higher dose of folate supplementation. These include pregnant women having an NTD themselves or in their partners, having a family history of NTDs, and having had a previous pregnancy affected by an NTD. Additionally, pregnant women having diabetes, and those taking anti-epileptic medication require a higher dose of folate.

EFFECTIVE HEALTH ASSESSMENT

          An effective health assessment must cover all physiological, psychological and social aspects of a patient’s life. Patients should be asked about their general health, activities of daily living, nutrition and eating patterns, physical activity, sexual health, sleep quality, stress, social and emotional health, and tobacco, alcohol and substance use (Agency for Health Care Research, n.d.).

FAMILY DEVELOPMENTAL STAGES

There are seven stages of family development:

Coupling – This is when two people get together to establish a joint household.

       Becoming Three – This phase is initiated by arrival of the first child.

       Entrances – This phase is initiated by the exit of the first child from the intra-family and entrance into the extra-family world, for example, starting school.

       Expansion – This phase is marked by the entrance of the last child of the family into the extra-family world.

       Exits – This phase is initiated when the family’s first child establishes an independent household of their own.

       Extension – This phase is marked by the establishment of an independent household by the last child of the family.

       Ending – This phase starts with the death of one spouse/partner and ends with the death of the other spouse/partner.

FAMILY STRUCTURE AND FUNCTION

            Traditionally, family structure involves two people in a sexual relationship that is sufficiently enduring to allow procreation and upbringing of children. There are different types of family structures, like nuclear, extended, childless, single-parent, and stepfamilies. Roles are assigned to each member of the family, for example, mother, father son, and daughter that signify the rights and responsibilities of each. Family structure is a major determinant in the healthcare provided to patients. A nurturing and stable family is associated with good physical and mental health of its members by virtue of the companionship, emotional support, and economic security it provides, and has been shown to decrease the risk of development of chronic disease, disability and mental handicap in individuals. Familial support ensures adequate and timely healthcare for its members in need and plays a central role in making health decisions and actions for their members. Stable families thus reduce the workload on healthcare while simultaneously ensuring a healthier community (van de Bovenkamp & Trappenburg, 2012).

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