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Chapter 69. Pregnancy and Lactation: Therapeutic Considerations

SB is a 30-year-old woman who wants to start vitamins before she becomes pregnant. She wants to try to become pregnant sometime this year. She takes acetaminophen for headaches, her vaccines are current, and she consumes about 600 mg of caffeine per day.

Which component of a multivitamin is most important for SB to decrease the risk of NTDs?

a. Calcium

b. Iron

c. Vitamin D

d. Folic acid

Answer d is correct. Adequate intake of folic acid decreases the incidence of NTDs by 50% to 70%. Neural tube defects can occur in the first 4 weeks of development. It is important that all women of childbearing age take 400 mcg of folic acid daily. Some women with a higher risk of a pregnancy affected by NTDs may require 4 mg daily.

Answer a is incorrect. Calcium plays an important role in bone health. A fetus will require 30 grams of calcium for a full term pregnancy. Recommended daily calcium intake is 1300 mg for ages 14 to 18 years and 1000 mg for women 19 to 50 years.

Answer b is incorrect. Iron is important to support the increase in red cell mass, expanded plasma volume, and the growth of the fetal-placental unit. The CDC recommends 27 to 30 mg of elemental iron daily.

Answer c is incorrect. Adequate vitamin D is important for maintaining the proper amount of calcium and phosphorus for healthy bones and teeth.

SB is a 30-year-old woman who wants to start vitamins before she becomes pregnant. She wants to try to become pregnant sometime this year. She takes acetaminophen for headaches, her vaccines are current, and she consumes about 600 mg of caffeine per day.

If SB does become pregnant, which vaccines are safe to administer during pregnancy?

a. Varicella and MMR

b. Influenza (inactivated) and Tdap

c. Tdap and HPV

d. Influenza (inactivated) and MMR

Answer b is correct. Influenza is associated with a high morbidity and mortality. The vaccine is available as inactivated virus and has no reports of harm to the fetus. The CDC recommends pregnant women receive the vaccine in any trimester. Tdap is recommended with each pregnancy and is safe to administer. During pregnancy it is best to administer between 27 and 36 weeks gestation to reduce the transmission of pertussis which can result in death.

Answer a ...

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