pp5 prevention

8/14/2019 Pp5 Prevention

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reventing Recurrencefeural Tube BirthDefectsroduced by

eorgia Folic Acid Task Forceponsored by

eorgia Department of HumanResources


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Pre v e n tin g R e cu rre n ce

o f N T D s

R e vie w

Research

E d u ca tio n

G rie f


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Review of Neural Tube Birth Defects

NTDs

- Types

- . .NTDs in U Sand Georgia

- Risk factors

Folic acid

- Importance

- Sources

- Other benefits

- Spreading the word

- Target audiences


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hree Forms of Neural Tube Defects

pina bifida Encephalocelenencephaly


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nfant with spina bifida


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ow common are NTDs? ,Estimated 4 000 affected pregnancies

. .yearly in U S ,About 2 500 babies born yearly

,1 500 babies born with spina bifida ,1 000 babies born with anencephaly

,About 1 500 fetuses are miscarried orterminated after diagnosis

About 100 pregnancies annually inGeorgia


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actors that might increaseisk for NTDS

Previous pregnancy affected with NTD

( - :Certain medications Anti seizure Valproic/ , /acid Depakene Carbamazapine Tegratol

( -Certain medical conditions Insulin dependent,diabetes medically diagnosed

)obesity

Exposure to high temperatures early inpregnancy

/ (Race ethnic origin Hispanics at highest risk)


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:olic Acidn Answer for Many

-B vitamin necessary for cell growth andembryo development

%Prevents up to 70 of NTDs

. .U S Public Health Service recommendsthat all women capable of becoming

( .pregnant consume 400 micrograms 0 4)milligrams folic acid daily


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:olic Acid Every,oman Every Day

Any woman who can get pregnant can have!a baby with an NTD

% . .Over 50 of pregnancies in the U S are.unplanned

By the time a woman knows she is,pregnant the neural tube has formed.

400 micrograms of folic acid every day


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itaminSupplements

Multivitamins or singlefolic acid tablet

Absorbed and used by bodytwice as much as folate

Readily available instores

. .Most U S women ofchildbearing age do not

take a multivitamin

Requires sustainedbehavior change


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ortified Foods ,In 1998 folic acid added tomandatory list for enriched

.cereal and grain products

Wide reaching effect with no.behavior change necessary

Average daily intake of

folic acid increased by 100.mcg

May not be enough to fully.prevent all NTDs

Several breakfast cereals

.provide 400 mcg per serving


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-olate rich Foods Average daily

=intake 200 mcgfolate

Absorbed and usedby body half aswell as folic acid

Include lots of

-folate rich foods .for a healthy diet


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:olic Acid PotentialBenefits Prevention of other birth defects?

- /Cleft lip palate- Heart defects- Limb defects

Cardiovascular disease?- Reduction of homocysteine

Cancer prevention?

- Colon- Cervix


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preading the Word aboutolic Acid

Increase knowledge Change attitude Break down barriers

Change behavior

Use motivators


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ifferent Message Emphasis for TwoCategories Contemplators

Will do what it takes to have a healthybaby

:Timing emphasis Folic acid beforeconception

-on contemplators Preparing for pregnancy doesn t affect me

I m not getting pregnant any time soon

:Readiness emphasis Your body is readyeven if you re not


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Research on Recurrence

Risk

Reducing the risk

Recommendation

Special considerations

Medication use


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Did You Know?

-Risk for recurrence of NTD:affected pregnancy

- %2 3 Risk for NTD if one parent has

:spina bifida

- %1 5


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What We Do Know

, .olic acid 4 000 mcg or 4 0mg ( )10x the recommended amountreduces the risk of neural tubedefects for women who had aprevious child with an NTD up to

%.72


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*Recommendation

Who? - Women previous NTD affectedpregnancy

How much? , ( . )4 000 mcg 4 0 mg of folic acid(daily by prescription 10x the recommended

)amountWhen? -1 3 months before and continuing

through the first 3 months of pregnancy

* , , ,USPHS AAP ACOG Canadian Task Force


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Special considerations

Parents with spina bifida

Women with a family history of

NTDs

Women with diabetes mellitus


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Increased Risk

: Women taking certain medications - ( . .,Anti seizure e g valproic acid or

)carbamazepine drugs that interfere with folate

( . ., ,metabolism e g methotrexate, , )pyrimethamine trimethoprim phenytoin

Important to seek advice of physician!before taking folic acid


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Recurrence Prevention

- Women with previous NTD affected:pregnancy should be :Referred for counseling about

- Increased risk in later pregnancies

- Protective effect of folic acid :Advised to

- ( )Take folic acid 400 mcg daily when notplanning

- Consult HCP for future pregnancy planning- , ( . )Take 4 000 mcg 4 0 mg folic acid whenplanning


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Education

Counseling and education

Role of clinicians

Steps and strategies

-Ask- Advise- Answer- Assure


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Counseling and Education ,Emphasize need of prescription for 4 000

( . ) ( )mcg 4 0 mg folic acid 10x normal

,Reinforce that folic acid prevents most

not all NTDs Still recommend prenatal testing forNTDs

Explain methods for detecting NTDs


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The Vital Role ofClinicians

Firstcontact for

parents

Messenger of

recurrence information

Continuouscontact for-follow up

services


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Action Steps

Ask

Advise

Answer

Assure


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About pregnancy intentions

About multivitamin use

Ask


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Be clear

Personalize your message

Encourage taking folic acid daily

Remind patient to eat healthy

Advise


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Be prepared to answer questions

Plan ahead by reading this module!

Provide educational materials

Encourage a supportive staff

Answer


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Assure

Support behavioral change

Remind patients routinely

Provide prescription for folic acid


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he Grieving ProcessGrief is an emotional reaction to a

:traumatic situation Miscarriage Stillborn birth

Child born with disability Death of a child

Everyone grieves in a different way


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*Stages of Grief

Denial and Isolation Anger Bargaining Depression

AcceptancePeople progress and regress through thesestages in no specific time frame or order

* - ,Elisabeth Kubler Ross MD

.


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Sadness Anger

Disbelief Despair

Loneliness Personal Loss

Fear Withdrawal

Guilt Emptiness

Different FeelingsInvolved


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hat Do I Say?Couple educational messages with

,compassionate sensitive words

Educate about child s conditionDiscuss what they can expectOffer community resourcesGive educational and resourcematerials


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.Your child was born with spina bifidaThis is a type of birth defect that affects .the baby s spine There are many resources

,available for you in your community and Ican help you locate some that are right for.you

.Your child had anencephaly This is atype of birth defect that affects the baby s

.brain There are many support groups inyour area where you can meet other parents

who have experienced the same thing you.have I can help you locate some of those.groups if you would like

utting It Allogether


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ow Do I Say It? !Be honest

Learn to interpret body language

!Listen Be patient

Show you care


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Whats Next?

Refer and Follow-up: Services for Children Special Services

Medical Specialists

Childrens MedicalServices

Babies Cant Wait

Medicaid

Children 1st

Routine Health Careand Immunizations

Local health center Pediatrician/Primary

health careprovider


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Whats Next?

Refer and Follow-Up: Services for Parents

Special Services

Grief counselor

Genetic counselor

Parent-to-Parent Help with Medicaid,

PeachCareapplication

Support groups

Moms Dads

Couples

Kids

Speakers of

S i h

Routine Health Care

Local health center

Primary health care

provider Obstetrician/gynecologi

st

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