In 2006, the Centers for Disease Control and Prevention defined preconceptional care as “a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management.” In addition, it established the following goals for improving preconceptional care:
Improve knowledge, attitudes, and behaviors of men and women related to preconceptional health.
Assure that all women of childbearing age receive preconceptional care services—including evidence-based risk screening, health promotion, and interventions—that will enable them to enter pregnancy in optimal health.
Reduce risks indicated by a previous adverse pregnancy outcome through interconceptional interventions to prevent or minimize recurrent adverse outcomes.
Reduce the disparities in adverse pregnancy outcomes.
The American College of Obstetricians and Gynecologists (2005a) also has reinforced the importance of preconceptional and interpregnancy care. Moreover, recent data from the Centers for Disease Control and Prevention describe the health status of women who gave birth to live-born infants in the United States in 2004 (Table 7-1). This table demonstrates the high prevalence of many conditions that may be amenable to intervention during the preconceptional and interpregnancy periods (D'Angelo and associates, 2007).
Table 7-1. Prevalence of Prepregnancy Maternal Behaviors, Experiences, Health Conditions, and Previous Poor Birth Outcomes in the United States in 2004 |Favorite Table|Download (.pdf)
Table 7-1. Prevalence of Prepregnancy Maternal Behaviors, Experiences, Health Conditions, and Previous Poor Birth Outcomes in the United States in 2004
Prior low-birthweight infant
Prior preterm infant
Randomized trials that evaluate preconceptional counseling efficacy are scarce, partly because withholding such counseling would be unethical. In addition, because maternal and perinatal outcomes are dependent on the interaction of various maternal, fetal, and environmental factors, it is often difficult to ascribe salutary outcomes to a specific intervention (Moos, 2004). That said, there are a few prospective and case-control studies that clearly demonstrate the successes of preconceptional counseling.
Counseling about potential pregnancy risks and preventative strategies must be provided before conception. By the time most women realize they are pregnant—1 to 2 weeks after the first missed period—the fetal spinal cord has already formed and the heart is beating. Thus, many prevention strategies, for example folic acid to prevent neural-tube defects, are ineffective if initiated at this time. It is estimated that up to half of all pregnancies are unplanned, and that these may be at greatest risk (American College of Obstetricians and Gynecologists, 2006; Finer ...