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If woman is positive for HIV, syphilis, hepatitis or other STIs,
please note this as POSITIVE SEROLOGY in the risk factor
section on the front of the antenatal record to maintain
patient condentiality.
Follow up post-natally:
Vitamin D
Vitamin D deciency in pregnant women is the single
greatest risk factor for vitamin D deciency in infants.
Vitamin D decient rickets is easily treated once recognised
but the potential for morbidity and mortality includes
hypocalcaemia seizures, failure to thrive, bone pain,
increased susceptibility to serious infection and potential for
chronic growth problems as well as the more well known
skeletal deformities.
Screening is recommended for all Kimberley women at the
rst antenatal visit.
Deciency = 25-OH-Vitamin D level of:
41-50 nmol/L = mild deciency
26-40 nmol/L = moderate
<26 nmol/L = severe
Treatment:
Folic Acid
All women should commence supplementation of folic acid
one month prior to conception and continue for the rst 3
months of pregnancy to aid in the prevention of neural tube
defects (NTD).
The recommended dose for most women is 0.5mg daily.
The combined iron/folic acid preparations do NOT contain a
sufcient dose of folic acid, however the combined iodine/
folic acid tablets DO.
Where there is an increased risk of NTD, then prescribe 5mg
daily until 14 weeks. This includes women:
with diabetes
Mild deciency:
Cholecalciferol (D3) 1000IU 1 tablet daily
Moderate to severe deciency:
Cholecalciferol (D3) 1000IU: 4000IU (4 tablets)
daily. Repeat level every 6 weeks until >50nmol/L,
then continue with 1000IU (1 tablet) daily1
Iron
Iron deciency during pregnancy affects maternal well
being, as well as being a strong predictor of iron deciency
in infants.
Iron rich foods include red meat, liver, sardines, enriched
breakfast cereals, beans.
Therefore:
(1) Screen all women with FBE and iron studies at the rst
antenatal visit, and again at the 28 and 36 week visits, and
treat if decient
(2) For all women, particularly those at increased risk of
iron deciency (multiple pregnancy and known history of
anaemia), provide routine supplementation with Ferro-tabs 1
tablet daily to prevent iron deciency
Follow-up post-natally:
Check FBE and iron levels at 6 week post-natal visit.
Parasites commonly causing infection in the Kimberley
include hookworm, strongyloides, and pinworm. These may
contribute to iron deciency.
Parasites
Routine screening for worms during pregnancy is not
recommended.
Medications used to treat parasites such as hookworm and
Kimberley Aboriginal Medical Services Council (KAMSC) and WA Country Health Service (WACHS) Kimberley
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ANTENATAL PROTOCOL
strongyloides, including mebendazole (category C) and
albendazole (Category D) may carry risks in pregnancy.
Pyrantel is the drug of choice for treatment of symptomatic
worm infections during pregnancy.
(eg hyperinfection with stronglyoides). Also consider
treatment of women with anaemia and eosinophilia.
Use 750mg if >45kg and 500mg if <45kg.
Iodine
Studies suggest that the Australian population is mildly
iodine decient. There are limited studies specic to the
iodine status of pregnant women in Australia, but those
available prior to iodine fortication of bread and salt
suggest it was inadequate.
The main health concern of mild iodine deciency during
pregnancy and breastfeeding is its negative effect on the
brain and nervous system of unborn children and infants.
Therefore, NHMRC recommends that women who are
pregnant, breastfeeding or considering pregnancy take
an iodine supplement of 150g each day. Supplements of
150g/d of iodine are safe and effective for pregnant and
breastfeeding women.
Iodine is currently available (in combination with folic acid)
as Blackmores I-Folic, which contains 250 g/d of iodine.
Pregnant women should be advised to use iodised salt and
eat plenty of dairy products, seafood, eggs and vegetables,
which are high in iodine.
If a pregnant woman has a pre-existing thyroid condition,
this should be discussed with a GP or Obstetrician prior to
taking a supplement.2
Medications in pregnancy
Exercise in pregnancy
Currently, most experts recommend that pregnant women
be encouraged to continue and maintain an active lifestyle
during their pregnancies, in the absence of medical and
obstetrical complications. Exercise may even improve some
pregnancy outcomes.
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