Chapter 16: Preconception Care

INTRODUCTION

Number of births in the United States (from preliminary data) in the year 2013 was 3,957,577. Although most infants are born healthy, it is of critical importance that the infant mortality rate in the United States ranks 34th among developed nations. Preconception care has been advocated as a measure to improve pregnancy outcomes. In 2006, the Centers for Disease Control and Prevention (CDC) published a report aimed at improving preconception care. This report outlined the following 10 recommendations: (1) individual responsibility across the life span, (2) consumer awareness, (3) preventive visits, (4) intervention for identified risks, (5) interconception care, (6) prepregnancy checkup, (7) health insurance coverage for women with low incomes, (8) public health programs and strategies, (9) research, and (10) monitoring improvements. Preconception care can be provided most effectively as part of ongoing primary care. It can be initiated during visits for routine health maintenance, during examinations for school or work, at premarital or family planning visits, after a negative pregnancy test, or during well child care for another family member.

NUTRITION

A woman’s nutritional status before pregnancy may have a profound effect on reproductive outcome. Obesity is the most common nutritional disorder in developed countries. Obese women are at increased risk for prenatal complications such as hypertensive disorders of pregnancy, gestational diabetes, and urinary tract infections. They are more likely to deliver large-for-gestational age infants and, as a result, have a higher incidence of intrapartum complications. Maternal obesity is also associated with a range of congenital malformations, including neural tube defects, cardiovascular anomalies, cleft palate, hydrocephalus, and limb reduction anomalies. Because dieting is not recommended during pregnancy, obese women should be encouraged to lose weight prior to conception.

On the other hand, underweight women are more likely than women of normal weight to give birth to low-birth-weight infants. Low birth weight may be associated with an increased risk of developing cardiovascular disease and diabetes in adult life (the “fetal origin hypothesis”).

At the preconception visit, the patient’s weight and height should be assessed and the history should include inquiries regarding anorexia, bulimia, pica, vegetarian eating habits, and use of megavitamin supplements.

Vitamin A is a known teratogen at high doses. Supplemental doses exceeding 5000 IU/d should be avoided by women who are or may become pregnant. The form of vitamin A that is teratogenic is retinol, not β-carotene, so large consumption of fruits and vegetables rich in β-carotene is not a concern.

Folic acid supplementation is recommended to avoid neural ...