Preconception care refers to interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management . Preconception evaluation and counseling provide an opportunity to inform women about fertility/pregnancy issues, identify some of the risks of pregnancy for the mother and fetus, educate them about these risks, and institute appropriate interventions, when possible, before conception [1,2].
Optimizing the health of the mother before conception is important for improving pregnancy outcome. This is particularly true for certain populations of women, such as those with medical disorders (eg, diabetes mellitus, phenylketonuria), nutritional deficiencies (eg, folate), and exposure to toxins or teratogens (eg, cigarettes, alcohol, warfarin, isotretinoin), in whom preconception care can reduce neonatal morbidity and mortality [3-6]. In particular, preconception care is more important than prenatal care for prevention of congenital anomalies since as many as 30 percent of pregnant women begin traditional prenatal care in the second trimester (>13 weeks of gestation), which is after the period of maximal organogenesis (between 3 and 10 weeks of gestation) (figure 1).
The Preconception Care Work Group of the Centers for Disease Control recommended that preconception care be an essential part of primary and preventive care, rather than an isolated visit [1,7,8]. Potential opportunities for preconception counseling occur during many nonemergency health care encounters, including:
- Premarital examination and testing
- Contraception counseling
- Evaluation for sexually transmitted disease or vaginal infection
- After a negative pregnancy test
- Anytime a woman of childbearing age presents for a periodic health examination
BARRIERS TO PRECONCEPTION COUNSELING
There are a number of barriers to preconception care and intervention: