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The preconception office visit

Joyce A Sackey, MD, FACP
Section Editor
Louise Wilkins-Haug, MD, PhD
Deputy Editor
Vanessa A Barss, MD, FACOG


Preconception care is a broad term that refers to the process of identifying social, behavioral, environmental, and biomedical risks to a woman's fertility and pregnancy outcome and then reducing these risks through education, counseling, and appropriate intervention, when possible, before conception [1,2]. Preconception intervention is more important than prenatal intervention 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 primary period of organogenesis (between 3 and 10 weeks of gestation) (figure 1).


Preconception care should be an essential part of primary and preventive care for all women of childbearing age who present for a periodic health examination [1,3,4]. Routinely addressing preconception issues in women of childbearing potential is important because, although many women intend to obtain preconception evaluation and counseling before attempting pregnancy, almost 50 percent of pregnancies in the United States are unintended [5].

Ideally, the patient and her provider will create a reproductive health plan, which will be reviewed and revised, as needed, at each visit. As part of that plan, women should be asked about their intention to become pregnant and offered contraception that meets their current contraceptive needs while taking into account the timing of a planned pregnancy. Contraception should continue to be addressed during all medical visits of reproductive age women.

In addition to the periodic health evaluation, potential opportunities for preconception care occur during many nonemergency healthcare encounters, including:

Premarital examination and testing


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Literature review current through: Feb 2017. | This topic last updated: Dec 22, 2016.
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  1. Johnson K, Posner SF, Biermann J, et al. Recommendations to improve preconception health and health care--United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm Rep 2006; 55:1.
  2. American College of Obstetricians and Gynecologists. Preconceptional care. ACOG technical bulletin 205. American College of Obstetricians and Gynecologists, Washington, DC 1995.
  3. American College of Obstetricians and Gynecologists. ACOG Committee Opinion number 313, September 2005. The importance of preconception care in the continuum of women's health care. Obstet Gynecol 2005; 106:665.
  4. Moos MK, Dunlop AL, Jack BW, et al. Healthier women, healthier reproductive outcomes: recommendations for the routine care of all women of reproductive age. Am J Obstet Gynecol 2008; 199:S280.
  5. Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011; 84:478.
  6. Moser R Jr, McCance KL, Smith KR. Results of a national survey of physicians' knowledge and application of prevention capabilities. Am J Prev Med 1991; 7:384.
  7. Conway T, Mason E, Hu TC. Attitudes, knowledge, and skills of internal medicine residents regarding pre-conception care. Acad Med 1994; 69:389.
  8. Conway T, Hu TC, Mason E, Mueller C. Are primary care residents adequately prepared to care for women of reproductive age? Fam Plann Perspect 1995; 27:66.
  9. Mazza D, Chapman A, Michie S. Barriers to the implementation of preconception care guidelines as perceived by general practitioners: a qualitative study. BMC Health Serv Res 2013; 13:36.
  10. Moos MK, Bangdiwala SI, Meibohm AR, Cefalo RC. The impact of a preconceptional health promotion program on intendedness of pregnancy. Am J Perinatol 1996; 13:103.
  11. Jack BW, Culpepper L, Babcock J, et al. Addressing preconception risks identified at the time of a negative pregnancy test. A randomized trial. J Fam Pract 1998; 47:33.
  12. Bernstein PS, Sanghvi T, Merkatz IR. Improving preconception care. J Reprod Med 2000; 45:546.
  13. Leuzzi RA, Scoles KS. Preconception counseling for the primary care physician. Med Clin North Am 1996; 80:337.
  14. Ray JG, O'Brien TE, Chan WS. Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis. QJM 2001; 94:435.
  15. Cox M, Whittle MJ, Byrne A, et al. Prepregnancy counselling: experience from 1,075 cases. Br J Obstet Gynaecol 1992; 99:873.
  16. Kitzmiller JL, Gavin LA, Gin GD, et al. Preconception care of diabetes. Glycemic control prevents congenital anomalies. JAMA 1991; 265:731.
  17. Waisbren SE, Hanley W, Levy HL, et al. Outcome at age 4 years in offspring of women with maternal phenylketonuria: the Maternal PKU Collaborative Study. JAMA 2000; 283:756.
  18. Hayslett JP. The effect of systemic lupus erythematosus on pregnancy and pregnancy outcome. Am J Reprod Immunol 1992; 28:199.
  19. Spronsen FJ, Smit GP, Erwich JJ. Inherited metabolic diseases and pregnancy. BJOG 2005; 112:2.
  20. Korenbrot CC, Steinberg A, Bender C, Newberry S. Preconception care: a systematic review. Matern Child Health J 2002; 6:75.
  21. Stubblefield PG, Coonrod DV, Reddy UM, et al. The clinical content of preconception care: reproductive history. Am J Obstet Gynecol 2008; 199:S373.
  22. McDiarmid MA, Gardiner PM, Jack BW. The clinical content of preconception care: environmental exposures. Am J Obstet Gynecol 2008; 199:S357.
  23. Sathyanarayana S, Focareta J, Dailey T, Buchanan S. Environmental exposures: how to counsel preconception and prenatal patients in the clinical setting. Am J Obstet Gynecol 2012; 207:463.
  24. Shaw GM. Adverse human reproductive outcomes and electromagnetic fields: a brief summary of the epidemiologic literature. Bioelectromagnetics 2001; Suppl 5:S5.
  25. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: Summary recommendations of the Advisory Committee on Immunization Practices (ACIP) http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm#Tab3 (Accessed on November 07, 2013).
  26. Solomon BD, Jack BW, Feero WG. The clinical content of preconception care: genetics and genomics. Am J Obstet Gynecol 2008; 199:S340.
  27. Williams L, Zapata LB, D'Angelo DV, et al. Associations between preconception counseling and maternal behaviors before and during pregnancy. Matern Child Health J 2012; 16:1854.
  28. Elsinga J, de Jong-Potjer LC, van der Pal-de Bruin KM, et al. The effect of preconception counselling on lifestyle and other behaviour before and during pregnancy. Womens Health Issues 2008; 18:S117.
  29. Floyd RL, Sobell M, Velasquez MM, et al. Preventing alcohol-exposed pregnancies: a randomized controlled trial. Am J Prev Med 2007; 32:1.
  30. Hood KK. Preconception counseling for adolescent females with type 1 diabetes: the READY-Girls Program. Curr Diab Rep 2010; 10:393.
  31. Temple RC, Aldridge VJ, Murphy HR. Prepregnancy care and pregnancy outcomes in women with type 1 diabetes. Diabetes Care 2006; 29:1744.
  32. Tripathi A, Rankin J, Aarvold J, et al. Preconception counseling in women with diabetes: a population-based study in the north of England. Diabetes Care 2010; 33:586.
  33. de Weerd S, Thomas CM, Cikot RJ, Steegers EA. Maternal smoking cessation intervention: targeting women and their partners before pregnancy. Am J Public Health 2001; 91:1733.
  34. Beckmann MM, Widmer T, Bolton E. Does preconception care work? Aust N Z J Obstet Gynaecol 2014; 54:510.
  35. Winterbottom J, Smyth R, Jacoby A, Baker G. The effectiveness of preconception counseling to reduce adverse pregnancy outcome in women with epilepsy: what's the evidence? Epilepsy Behav 2009; 14:273.
  36. Drogari E, Smith I, Beasley M, Lloyd JK. Timing of strict diet in relation to fetal damage in maternal phenylketonuria. An international collaborative study by the MRC/DHSS Phenylketonuria Register. Lancet 1987; 2:927.
  37. Lum KJ, Sundaram R, Buck Louis GM. Women's lifestyle behaviors while trying to become pregnant: evidence supporting preconception guidance. Am J Obstet Gynecol 2011; 205:203.e1.
  38. Oza-Frank R, Kachoria R, Keim SA, Klebanoff MA. Provision of specific preconception care messages and associated maternal health behaviors before and during pregnancy. Am J Obstet Gynecol 2015; 212:372.e1.
  39. Chandranipapongse W, Koren G. Preconception counseling for preventable risks. Can Fam Physician 2013; 59:737.
  40. Shannon GD, Alberg C, Nacul L, Pashayan N. Preconception health care and congenital disorders: mathematical modelling of the impact of a preconception care programme on congenital disorders. BJOG 2013; 120:555.
  41. American Diabetes Association. 13. Management of Diabetes in Pregnancy. Diabetes Care 2017; 40:S114.
  42. Committee opinion no: 636: Management of women with phenylketonuria. Obstet Gynecol 2015; 125:1548.
  43. Tabet M, Flick LH, Tuuli MG, et al. Prepregnancy body mass index in a first uncomplicated pregnancy and outcomes of a second pregnancy. Am J Obstet Gynecol 2015; 213:548.e1.
  44. Dunlop AL, Jack BW, Bottalico JN, et al. The clinical content of preconception care: women with chronic medical conditions. Am J Obstet Gynecol 2008; 199:S310.
  45. Klerman LV, Jack BW, Coonrod DV, et al. The clinical content of preconception care: care of psychosocial stressors. Am J Obstet Gynecol 2008; 199:S362.
  46. Frieder A, Dunlop AL, Culpepper L, Bernstein PS. The clinical content of preconception care: women with psychiatric conditions. Am J Obstet Gynecol 2008; 199:S328.
  47. Yonkers KA, Wisner KL, Stewart DE, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet Gynecol 2009; 114:703.
  48. U.S. Preventive Services Task Force. Folic acid for the prevention of neural tube defects: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2009; 150:626.
  49. National Health Service. Vitamins and nutrition in pregnancy. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/vitamins-minerals-supplements-pregnant.aspx (Accessed on November 05, 2012).
  50. Goh YI, Bollano E, Einarson TR, Koren G. Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis. J Obstet Gynaecol Can 2006; 28:680.
  51. Nilsen RM, Vollset SE, Rasmussen SA, et al. Folic acid and multivitamin supplement use and risk of placental abruption: a population-based registry study. Am J Epidemiol 2008; 167:867.
  52. Ray JG, Laskin CA. Folic acid and homocyst(e)ine metabolic defects and the risk of placental abruption, pre-eclampsia and spontaneous pregnancy loss: A systematic review. Placenta 1999; 20:519.
  53. Oakley GP Jr, Erickson JD. Vitamin A and birth defects. Continuing caution is needed. N Engl J Med 1995; 333:1414.
  54. Rothman KJ, Moore LL, Singer MR, et al. Teratogenicity of high vitamin A intake. N Engl J Med 1995; 333:1369.
  55. Frayne DJ, Verbiest S, Chelmow D, et al. Health Care System Measures to Advance Preconception Wellness: Consensus Recommendations of the Clinical Workgroup of the National Preconception Health and Health Care Initiative. Obstet Gynecol 2016; 127:863.