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Prescribing for pregnancy: general prepregnancy care
  1. Joanna Girling
  1. Dept Obstetrics and Gynaecology, West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Joanna.Girling{at}chelwest.nhs.uk

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Introduction

Outcomes for mother and baby are better when the pregnancy has been planned. Supporting women to use contraception effectively when they do not wish to be pregnant, and helping them to prepare for pregnancy before they do conceive are both important. National data show that over 20% of all pregnancies ended as a legal termination in 2016, ranging from 6% in women in stable relationships in their 20s and 30s to more than 50% in single women aged under 18 years.1 Among women who had term pregnancies, only 66% were described as planned.2

This article covers some of the key issues that should be considered for all women as part of prepregnancy care.

Background

Ideally, women should be in the best physical and mental health before they conceive and be aware of lifestyle and medical adjustments required before and during pregnancy. Healthcare professionals should opportunistically enquire about pregnancy knowledge, use of contraception and plans to conceive; this might include at new patient, family planning, cervical smear, sexual health, medication review and vaccination appointments. For women with long-term medical disorders, routine consultations are also an important chance to discuss prepregnancy care.

Long-term conditions

Women with long-term conditions such as diabetes, epilepsy, hypertension, rheumatological disorders and mental health diagnoses need targeted preconception guidance about the impact of their health on pregnancy outcome, the potential impact of pregnancy on their medical or mental health disorder and use of their medication in pregnancy and breastfeeding. Some of these conditions will be covered in future articles in this series. For women with pre-existing medical conditions, the use of effective non-pharmacological options should be maximised, and the smallest number of the safest medicines at the lowest effective doses should be used while preparing for pregnancy and during pregnancy. In particular, it is important that consideration is given …

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