Introduction[edit | edit source]
The goals of preconception care are: health education and promotion; risk assessment; and intervention before pregnancy - to reduce the chances of poor perinatal outcomes.
- Nearly half of the 200 million pregnancies that occur annually are unplanned.
- Preconception counseling can play a major role in reducing poor perinatal outcomes.
Key Points[edit | edit source]
Preconception counselling targeted at the mother, father, and family can reduce maternal and infant morbidity and mortality.
- Every individual benefits from education about pregnancy readiness and the role of family and parenting with age-appropriate education.
- As children enter puberty, both boys and girls must be educated about the delay in sexuality, pregnancy prevention, and prevention of sexually transmitted infections (it is important to educate young males about their responsibilities in reproductive health).
- Every couple must have the opportunity to choose when they are ready to reproduce. Family planning and pregnancy prevention is key to pregnancy readiness.
- Unplanned and unintended pregnancy results in late prenatal care which can subsequently contribute to adverse events during pregnancy and poor perinatal outcomes.
Assessment[edit | edit source]
Both the woman and man must be assessed for risks and educated about the risks associated with poor perinatal outcomes. This risk assessment must include evaluation of overall well-being, medical history, surgical risks, social and behavioral risks, medication risks, occupational risks, education risks, and any other barriers that may pose an undue risk on fertility or pregnancy.
Recommendations to clinical practice[edit | edit source]
- infections as indicated.
- Update immunization with hepatitis B, rubella, varicella, Tdap, human papillomavirus, and influenza vaccines as needed.
- Assess the patient's risk of chromosomal or genetic disorders based on family history, ethnic background, and age; offer cystic fibrosis and other carrier screening as indicated.
- Assess the patient's anthropometric (i.e., body mass index), biochemical (e.g., anemia), clinical, and dietary risks.
- Counsel the patient about possible toxins and exposure to teratogenic agents (e.g., heavy metals, solvents, pesticides, endocrine disruptors, allergens) at home, in the neighborhood, and at work; review Material Safety Data Sheets and consult a local teratology information specialist as needed.
- Screen for depression, anxiety, domestic violence, and major psychosocial stressors.
- Laboratory testing should include a complete blood count; urinalysis; blood type and screen; screening for rubella, syphilis, hepatitis B, human immunodeficiency virus, gonorrhea, chlamydia, and diabetes; and cervical cytology as indicated. 
Risk assessment[edit | edit source]
Timing of pregnancy (Reproductive life plan):
Women and men should prepare for pregnancy before becoming sexually active — or at least three months before getting pregnant.
In couples having regular sexual intercourse every 2 or 3 days, and not using contraception, 84% will become pregnant within a year, and 92% within two years following use of the contraceptive injection, normal fertility may take up to a year to re-establish.The optimum biological age for pregnancy is between 20-35 years of age.
Review previous adverse pregnancy outcomes (e.g., infant death, fetal loss, birth defects, low birth weight, preterm birth) and assess ongoing biobehavioral risks that could lead to recurrence in a subsequent pregnancy.
If you are pregnant or thinking about becoming pregnant, talk with your doctor about any medications you are taking or thinking about taking. This includes prescription and over-the-counter medications, as well as dietary or herbal products. Less than 10% of medications approved by the U.S. Food and Drug Administration (FDA) since 1980 have enough information to determine their risk for birth defects.1
taking certain medications during pregnancy can cause serious birth defects. Examples are thalidomide (also known as Thalamid®) and isotretinoin (also known as Accutane®).
The effects depend on many factors, such as
- How much medication is taken (sometimes called the dose).
- When during the pregnancy the medication is taken.
- Other health conditions a woman might have.
Infections and immunization:
Screen for periodontal, urogenital, and sexually transmitted infections as indicated; update immunization with hepatitis B, rubella, varicella, Tdap, human papillomavirus, and influenza vaccines as needed; counsel the patient about preventing TORCH infections.
Genetic screening and family history:
Assess the patient's risk of chromosomal or genetic disorders based on family history, ethnic background, and age; offer cystic fibrosis and other carrier screening as indicated; discuss management of known genetic disorders (e.g., phenylketonuria, thrombophilia) before and during pregnancy
Assess the ABCDs of nutrition: anthropometric factors (e.g., BMI), biochemical factors (e.g., anemia), clinical factors, and dietary risks.
Substance abuse: Ask the patient about tobacco, alcohol, and drug use; use CAGE7 or T-ACE8questionnaires to screen for alcohol and substance abuse.
Toxins and teratogenic agents: Counsel the patient about possible toxins and exposure to teratogenic agents at home, in the neighborhood, and in the workplace (e.g., heavy metals, solvents, pesticides, endocrine disruptors, allergen.
Psychosocial concerns: Screen for depression, anxiety, domestic violence, and major psychosocial stressors.
Physical examination: Focus on periodontal, thyroid, heart, breast, and pelvic examinations
Laboratory testing: Testing should include a complete blood count; urinalysis; blood type and screen; and, when indicated, screening for rubella, syphilis, hepatitis B, human immunodeficiency virus, gonorrhea, chlamydia, and diabetes and cervical cytology; consider measuring thyroid-stimulating hormone levels .
Interventions[edit | edit source]
Supplementation with folic acid is one of the most significant preventative interventions available in the preconceptual /antenatal period. Daily use of vitamin supplements containing folic acid has been demonstrated to reduce the occurrence of neural tube defects by two thirds
All women should take at least 400 micrograms/day whilst trying to become pregnant and for at least the first three months of pregnancy to reduce the risk of neural tube defects (NTDs).Women at high risk of NTD should take a higher dose of 5 mg/day until 12 weeks of pregnancy.
- Reduce refined sugars and white flour (in the form of your usual suspects — cookies, doughnuts, Danish, cake, candy, and almost anything else you might grab from the vending machine, the coffee cart, the convenience store racks, the pastry shop.
- Relish the right stuff. Increase all the good things that your body (and your baby-to-be's body) needs: green leafy vegetables (those delicious salads), yummy yellows (apricots, carrots, papaya, mango), hearty whole grains (whole-wheat bread, brown rice, oatmeal), and low-fat dairy
- Stop being a meal skipper.
- Drink plenty of water
- Environmental toxins such as cigarette smoke, alcohol, and street drugs, and chemicals such as solvents and pesticides should be avoided.
- Avoid over heating - particularly saunas and spas. If exercising make sure you wear cool, comfortable clothing and drink plenty of water.
- If you do not exercise, try to start a reasonable and regular exercise routine - this has great benefits for pregnancy as well as your general health
- Avoid stress and practice relaxation
Summary[edit | edit source]
Women and men should prepare for pregnancy before becoming sexually active — or at least three months before getting pregnant. Some actions, such as quitting smoking, reaching a healthy weight, or adjusting medicines you are using, should start even earlier. The five most important things you can do for preconception health are:
- Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day if you are planning or capable of pregnancy to lower your risk of some birth defects of the brain and spine, including spina bifida. All women need folic acid every day. Talk to your doctor about your folic acid needs. Some doctors prescribe prenatal vitamins that contain higher amounts of folic acid.
- Stop smoking and drinking alcohol.
- If you have a medical condition, be sure it is under control. Some conditions that can affect pregnancy or be affected by it include asthma, diabetes, oral health, obesity, or epilepsy.
- Talk to your doctor about any over-the-counter and prescription medicines you are using. These include dietary or herbal supplements. Be sure your vaccinations are up to date.
- Avoid contact with toxic substances or materials that could cause infection at work and at home. Stay away from chemicals and cat or rodent feces
Reference:[edit | edit source]
- Fowler JR, Mahdy H, Jack BW. Preconception counseling.Available from: https://www.ncbi.nlm.nih.gov/books/NBK441880/ (accessed 18.10.21)
- Lu MC. Recommendations for preconception care. American Family Physician. 2007 Aug 1;76(3):397-400.
- UK and European Guidelines. Available from:http://www.patient.co.uk/doctor/pre-pregnancy-counselling (accessed 26 January2022)
- Jack BW, Atrash H, Coonrod DV, Moos MK, O'donnell J, Johnson K. The clinical content of preconception care: an overview and preparation of this supplement. American journal of obstetrics and gynecology. 2008 Dec 1;199(6):S266-79.
- Office on women health ,U.S. department of health. Available from:http://www.womenshealth.gov/pregnancy/before-you-get-pregnant/preconception-health.html (accessed 26 January 2022)
- Frey KA. Preconception care by the nonobstetrical provider. InMayo Clinic Proceedings 2002 May 1 (Vol. 77, No. 5, pp. 469-473). Elsevier.
- Center for disease control and prevention. Treating for two: Medicine and pregnancy. Available from: http://www.cdc.gov/pregnancy/meds/ (accessed 18 October 2021)
- Cheng D, Schwarz EB, Douglas E, Horon I. Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors. Contraception. 2009 Mar 1;79(3):194-8.
- American Diabetes Association. Preconception care of women with diabetes. Diabetes Care, 1998; 21(Supplement 1):S56-S59.
- Atrash HK, Johnson K, Adams MM, Cordero JF, Howse J. Preconception care for improving perinatal outcomes: the time to act. Maternal and child health journal. 2006 Sep 1;10(1):3-11.
- Willacy H. Pre-pregnancy counselling. 2020. Available from: http://www.patient.co.uk/doctor/pre-pregnancy-counselling (accessed 18 October 2021)
- Brundage SC. Preconception health care. American Family Physician. 2002 Jun;65(12):2507-2514. PMID: 12086240.