The preconception office visit
- Joyce A Sackey, MD, FACP
Joyce A Sackey, MD, FACP
- Associate Professor of Medicine
- Dean for Multicultural Affairs and Global Health
- Tufts University School of Medicine
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).
PROVIDING PRECONCEPTION CARE
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 .
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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- PROVIDING PRECONCEPTION CARE
- RISK ASSESSMENT AT THE PRECONCEPTION OFFICE VISIT
- Medical history
- - Environmental exposures
- - Resources for information on potential teratogens
- Physical examination
- Laboratory assessment
- Core interventions
- Interventions for selected risks
- - Maternal medical problems
- - Heritable diseases
- - Psychosocial issues
- - Diet and supplements
- - Infertility, recurrent miscarriage, and adverse pregnancy outcome
- MEASURES OF SUCCESSFUL PRECONCEPTION CARE
- SUMMARY AND RECOMMENDATIONS