National Recommendations for Preconception Care: The Essential Role of the Family Physician

Anne L. Dunlop; Brian Jack; Keith Frey

doi:10.3122/jabfm.2007.01.060143

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Table 1.

Summary of 10 Key Recommendations to Improve Preconception Health

1	Individual responsibility across the life span. Encourage each woman and every couple to have a reproductive life plan.
2	Consumer awareness. Increase public awareness of the importance of preconception health behaviors and increase individuals’ use of preconception care services using information and tools appropriate across varying age, literacy, health literacy, and cultural/linguistic contexts.
3	Preventive visits. As a part of primary care visits, provide risk assessment and counseling (education and health promotion) to all women of childbearing age to reduce risks related to the outcomes of pregnancy.
4	Interventions for identified risks. Increase the proportion of women who receive interventions as follow up to preconception risk screening, focusing on high priority interventions (ie, those with high population impact and sufficient evidence of effectiveness).
5	Interconception care. Use the interconception period to provide intensive interventions to women who have had a prior pregnancy ending in adverse outcome (eg, infant death, low birthweight, or preterm birth).
6	Prepregnancy check ups. Offer, as a component of maternity care, one pre-pregnancy visit for couples planning pregnancy.
7	Health coverage for low-income women. Increase Medicaid coverage among low-income women to improve access to preventive women’s health, preconception, and interconception care.
8	Public health programs and strategies. Infuse and integrate components of preconception health into existing local public health and related programs, including emphasis on those with prior adverse outcomes.
9	Research. Augment research knowledge related to preconception health.
10	Monitoring improvements. Maximize public health surveillance and related research mechanisms to monitor preconception health.

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Table 2.

Preconception Interventions with Evidence for Improving Pregnancy Outcomes

Intervention	Proven Health Effect
Folic acid supplementation	Reduces occurrence of neural tube defects by two thirds.
Rubella vaccination	Provides protection against congenital rubella syndrome.
Diabetes management	Substantially reduces the 3-fold increase in birth defects among infants of diabetic women.
Hypothyroidism management	Adjusting levothyroxine dosage early in pregnancy protects proper neurologic development.
Hepatitis B vaccination for at risk women	Prevents transmission of infection to the infant and eliminates the risk to the woman of hepatic failure, liver carcinoma, cirrhosis, and death due to HBV infection.
HIV/AIDS screening and treatment	Allows for timely treatment and provides women (or couples) with additional information that can influence the timing of pregnancy and treatment.
STD screening and treatment	Reduces the risk of ectopic pregnancy, infertility, and chronic pelvic pain associated with Chlamydia trachomatis and Neisseria gonorrhoea and reduces the possible risk to the fetus of fetal death and physical and developmental disabilities, including mental retardation and blindness.
Maternal PKU management	Prevents babies from being born with PKU-related mental retardation.
Oral anticoagulant use management	Switching women off teratogenic anticoagulants (ie, warfarin) before pregnancy avoids harmful exposure.
Antiepileptic drug use management	Changing to a less teratogenic treatment regimen reduced harmful exposure.
Accutane use management	Preventing pregnancy for women who use isotretinoin (Accutane) or ceasing isotretinoin use before conception, eliminates harmful exposure.
Smoking cessation counseling	Completing smoking cessation before pregnancy care can prevent smoking-associated preterm birth, low birth weight, or other adverse perinatal outcomes.
Eliminating alcohol use	Controlling alcohol binge drinking and/or frequent drinking before pregnancy prevents fetal alcohol syndrome and other alcohol-related birth defects.
Obesity control	Reaching a healthy weight before pregnancy reduces the risks of neural tube defects, preterm delivery, diabetes, cesarean section, and hypertensive and thromboembolic disease that are associated with obesity.