Preconception Care

Basics

Description

  • Given that women often become pregnant without intending to, preconception care should be a critical aspect of primary care for all women of reproductive age.
  • Preconception care should be tailored to meet the needs of the individual woman. Plans for conception should be addressed with the woman at her annual wellness visit. If pregnancy is not desired, contraception options should be discussed and implemented (see “Contraception”).
  • Counseling should not be limited to women because there are contraception options for men as well as health optimization opportunities to reduce risks for conception (i.e., treatment of chronic disease and STIs, updating immunizations).
  • With regard to pregnancy ambivalence, it is important for the provider to help clarify feelings about pregnancy, which can empower both women and men to actively participate in reproductive decision-making or more consistent contraception use.
  • For women who desire pregnancy, a general approach to preconception care includes optimization of chronic disease state (if applicable), ensuring immunizations are up-to-date, reviewing medications for teratogenic effects, improving diet, assuring folic acid, and encouraging exercise (1).
  • It is important to deliver preconception services in a culturally competent manner while addressing the needs of adolescents, lesbian, gay, bisexual, transgender, or those questioning their sexual identity.

Epidemiology

  • According to the CDC, 49% of pregnancies are unintended.
  • A large number of young adults express pregnancy ambivalence, so good health habits should be encouraged for everyone who may become pregnant.
  • Risk factors for poor pregnancy outcome often are present before the start of prenatal care:
    • Unintended conception
    • Chronic disease
    • Teratogenic exposures
    • Short interpregnancy interval

Etiology and Pathophysiology

  • Approximately 10% of birth defects are caused by exposure to teratogens in the environment. These include maternal illness, infectious agents, physical agents, and drugs and chemical agents.
  • The embryo is most vulnerable to teratogenic insults because organ development occurs at this time (end of the 10th week of gestation, 8th week postconception).
  • Most congenital anomalies result from an interplay of the embryo’s genetic predisposition and environmental insults during embryogenesis.

General Prevention

  • Providers should have ongoing, patient-centered discussions with their patients about desire to conceive. By asking women the “one key question”—“Would you like to become pregnant in the next year?” can best initiate discussion regarding women’s reproductive health desires. Some would rephrase “Do you plan to have a child in the coming year?” to include other means of having children.
  • For women not desiring pregnancy, counseling should be offered on all options for contraception (and emergency contraception) such as long-acting reversible contraception (intrauterine devices, contraceptive implants) as well as the vaginal ring, the patch, oral contraceptives, hormonal injections, male/female condoms, diaphragm, and withdrawal. The effectiveness of these methods should be provided (see “Contraception”).

There's more to see -- the rest of this topic is available only to subscribers.