Table 2.

Preconception Interventions with Evidence for Improving Pregnancy Outcomes

InterventionProven Health Effect
Folic acid supplementationReduces occurrence of neural tube defects by two thirds.
Rubella vaccinationProvides protection against congenital rubella syndrome.
Diabetes managementSubstantially reduces the 3-fold increase in birth defects among infants of diabetic women.
Hypothyroidism managementAdjusting levothyroxine dosage early in pregnancy protects proper neurologic development.
Hepatitis B vaccination for at risk womenPrevents 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 treatmentAllows for timely treatment and provides women (or couples) with additional information that can influence the timing of pregnancy and treatment.
STD screening and treatmentReduces 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 managementPrevents babies from being born with PKU-related mental retardation.
Oral anticoagulant use managementSwitching women off teratogenic anticoagulants (ie, warfarin) before pregnancy avoids harmful exposure.
Antiepileptic drug use managementChanging to a less teratogenic treatment regimen reduced harmful exposure.
Accutane use managementPreventing pregnancy for women who use isotretinoin (Accutane) or ceasing isotretinoin use before conception, eliminates harmful exposure.
Smoking cessation counselingCompleting smoking cessation before pregnancy care can prevent smoking-associated preterm birth, low birth weight, or other adverse perinatal outcomes.
Eliminating alcohol useControlling alcohol binge drinking and/or frequent drinking before pregnancy prevents fetal alcohol syndrome and other alcohol-related birth defects.
Obesity controlReaching 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.
  • PKU, phenylketonuria.