Chapter 15: Pregnancy Planning and Care

LEARNING OBJECTIVES

1. Define preconception and interconception care.

2. List evidence-based recommendations for preconception care.

3. List essential discussion points when educating women of childbearing age on ways to promote a healthy pregnancy.

4. Explain the importance of proper diet and nutrition before conception.

5. Describe pregnancy-related complications and birth defects related to substance abuse.

6. Discuss vaccine recommendations during pregnancy.

7. Identify pregnancy risks associated with selected medications and disease states in women of childbearing age.

8. Describe the use of ovulation kits and pregnancy tests.

INTRODUCTION

All women of childbearing age should receive preconception care regardless of whether they are planning to conceive, as nearly half of pregnancies in the United States are unintended.¹ The American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG) recommend that all health encounters during a woman’s reproductive years should include preconception care.² The objective of preconception care is to improve the health of all women before pregnancy to improve pregnancy outcomes. Interconception care focuses on the health of women between pregnancies and is therefore a subset of preconception care.² The term “preconception care” is often used to denote both preconception and interconception care, and it will be used as such throughout this chapter. Both the content of preconception care and counseling methods utilized should be personalized for each patient based on medical needs and plans to have a pregnancy in the near future (contemplator) or not (non-contemplator). Non-contemplators are typically quite concerned about their overall health and well being; therefore, the health benefits of the intervention for the woman should be stressed to the non-contemplator. For those contemplating a pregnancy, explaining the benefits to infant outcomes may resonate more than with a non-contemplator.³

There are many potential aspects to preconception care⁴ (Figure 15-1). Key components include, but are not limited to, identification of risks prior to conception through an assessment of the woman’s reproductive, family, and medical history; the family and medical history of the father; the woman’s nutritional status, social concerns, and any drug or substance exposures she or the father may have; discussions regarding birth spacing (at least 18 months from a woman’s last delivery to conception of next pregnancy); management of preexisting medical conditions and potential interventions; screening for infectious diseases with treatment and immunization; and discussions about environmental exposures.^4,5 The Centers for Disease Control and Prevention (CDC) has developed national recommendations to improve health and health care for women before and between pregnancies⁶ (Figure 15-1). Delaying discussions about preconception care until the first prenatal visit may delay targeted interventions needed to minimize poor pregnancy, fetal/infant, and maternal outcomes because detection of pregnancy typically does not occur until the early weeks of gestation, when fetal organs are already developing.^1-6 Interdisciplinary approaches for pregnancy planning can help promote optimal health outcomes for the infant ...