Table 2. Clinical pearls: planning pregnancy with certain medical conditions.

Medical condition	Preventative measures and supplementation	Contra-indications to pregnancy	Key points
Congenital heart disease	Rubella vaccination	WHO IV risk score	Needs comprehensive risk assessment before pregnancy
Rheumatic heart disease	Primary prevention of group A streptococcus with penicillin	WHO IV risk score	Needs comprehensive risk assessment before pregnancy
	Institute secondary prevention with penicillin after a diagnosis of ARF/RHD
Hypertension	Identify and treat secondary causes, treat sleep-disordered breathing, lifestyle changes	ACE inhibitors and ARBs	Normalise pre-pregnancy blood pressure
HIV	Treat co-morbidities	None	Avoid efavirenz if possible
			Optimise ART to maximal suppression of viral load
			Improved ART adherence
			Advise appropriate contraception
General	Screen for anaemia	As per examination	Information, education and counselling
	Food supplementation, iron and folate supplementation		Promote exercise and healthy diet
			Family planning and spacing
			Weight control
			Substance and tobacco control