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Estella is a 32-year-old Hispanic woman, married, mutually monogamous with her husband, a G4/T1P1A2L2, and has a BMI of 30. She had gestational diabetes with two of her previous pregnancies that resulted in live births. She is constantly struggling to control her weight and does not feel that she has time to exercise. Her first baby was born at 34 weeks due to preterm labor and her second baby was delivered at term; but she had to have cesarean section delivery due to cephalopelvic disproportion (CPD) and a large for gestational age (LGA) infant. Her past obstetric history is positive for one elective abortion at 14 weeks and one spontaneous abortion (SAB) at 6 weeks gestation. Both of her children are healthy. Estella would like to have another baby. However, she and her husband cannot afford a third baby just yet. She has a history of irregular menses and has been using condoms and withdrawal for birth control.
Answer the followings:
1. If Estella were to become pregnant, which health conditions will she and/or her baby be at risk to develop?
2. What strategies would help to reduce her preconception health risks?
3. What strategies would reduce Estella’s risks for having a baby with a neural tube defect (NTD)?
4. How often should Estella have a pap test and mammogram done?