CONCISE REVIEW FOR CLINICIANS
Preconception Care by the Nonobstetrical Provider

https://doi.org/10.4065/77.5.469Get rights and content

Clinicians who provide health care to women during their childbearing years have the opportunity to affect pregnancy outcomes positively through preconception care. The goal of preconception care is to identify medical and social conditions that may put the mother or fetus at risk. Key elements include screening for certain infectious diseases, obtaining genetic history, updating immunizations, providing specific nutritional advice, and optimizing health status. Some women, and their partners, may require additional care, including a prepregnancy consultation with an obstetrician or maternal-fetal medicine specialist. The clinician can also offer advice that may enhance conception and encourage either early prenatal care when a pregnancy is achieved or early evaluation for infertility.

Section snippets

Medications and Teratogenic Agents

A key challenge is to identify medications and chemicals that are potentially teratogenic before conception and discourage their use during preconception and early pregnancy periods. All current prescription and nonprescription medications as well as herbal supplements must be reviewed. Every clinician should have ready access to references, such as Drugs in Pregnancy and Lactation,4 which include reviews of reproductive literature relevant to drugs. These references also provide

PRECONCEPTION PHYSICAL EXAMINATION AND LABORATORY SCREENING

A thorough physical examination, including breast and pelvic examination, is recommended. From available evidence, all women can be screened for syphilis, gonorrhea, chlamydia, hepatitis B, HIV, and rubella immunity (or document evidence of immunization). The patient's Pap test should be current. Additional laboratory testing should be based on findings on the history and physical examination.

PRECONCEPTION HEALTH ISSUES IN MEN

There is expanding evidence of male-associated health issues and pregnancy outcomes. Both paternal smoking and alcohol consumption have been associated with low birth weight neonates, and smoking specifically has been associated with an increased incidence of fetal malformations. Other substances and chemicals may adversely affect spermatogenesis and male fertility. During a general medical visit, the clinician can educate men about such risks, review their family history for genetic disorders,

SUMMARY RECOMMENDATIONS

The clinician who cares for couples during their childbearing years should do the following.

Encourage women to receive preconception care, noting that some may require a prepregnancy consultation with an obstetrician or maternal-fetal medicine specialist.

Encourage the woman's partner to be included in preconception counseling and care.

Have a preconception focus during annual medical examinations and ask about the patient's conception plans.

Screen for infectious diseases, obtain genetic history

Questions About Preconception Care

  • 1.

    Which one of the following risk factor designations of medications does the FDA recommend be avoidedduring pregnancy?

    • a.

      A

    • b.

      B

    • c.

      C

    • d.

      D

    • e.

      X

  • 2.

    Which one of the following time frames is correctregarding the critical postfertilization period of fetal cell differentiation and organogenesis?

    • a.

      1 to 2 weeks

    • b.

      2 to 3 months

    • c.

      17 to 56 days

    • d.

      4 to 6 months

    • e.

      Unknown

  • 3.

    Which one of the following is not a recommendation for preconception women to minimize their risk of infection by T gondii?

    • b.

      Avoid working as a day

REFERENCES (13)

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Cited by (25)

  • The preconceptional period as an opportunity for prediction and prevention of noncommunicable disease

    2015, Best Practice and Research: Clinical Obstetrics and Gynaecology
    Citation Excerpt :

    It is estimated that 30–90% of women have at least one indication that may benefit by an appropriate preconceptional intervention [6,7]. However, only 30–50% of pregnancies are planned with a proper preconceptional care plan [7–14]. Therefore, it is not merely a matter of the content of the preconceptional care plan, but mainly making it affordable, accessible, and routine for all women in their reproductive age.

  • Where is the "W"oman in MCH?

    2008, American Journal of Obstetrics and Gynecology
    Citation Excerpt :

    In 2002, the March of Dimes suggested that “as the key physician/primary care providers, the obstetrician/gynecologists must take advantage of every health encounter to provide preconception care and risk reduction before and between conceptions—the time when care really can make a difference.”22 The importance of preconception care as a concept was further articulated in family medicine,17,23-25 obstetrics and gynecology,20,21,26,27 nurse midwifery,28 nursing,29-31 and public health.32 Canada's National Guidelines on Family-Centered Maternity and Newborn Care devotes an entire chapter to preconception care and describes the multitude of intrinsic and extrinsic factors that influence preconception health.

  • The future of preconception care. A Clinical Perspective

    2008, Women's Health Issues
    Citation Excerpt :

    In 2002, the March of Dimes Birth Defects Foundation suggested that as the key physician/primary care providers, obstetrician/gynecologists must take advantage of every health encounter to provide PCC and risk reduction before and between conceptions—the time when care really can make a difference (March of Dimes, 1993, 2002). The importance of PCC as a concept was further articulated in family medicine (Gjerdingen & Fontaine, 1991; Frey, 2002; Jack, 1995), nurse-midwifery (Reynolds, 1998), nursing (Moos, 2002, 2003), and public health (US PHS, 1991, 2000). The American Diabetes Association (2004), the American Academy of Neurology (Anonymous, 1998), and the American Heart Association/American College of Cardiologists (Hirsh, Fuster, Ansell, & Halperin, 2003) promulgated recommendations on PCC in their specialties.

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