CHAPTER 9: Preconceptional Counseling

The Centers for Disease Control and Prevention (CDC) defines preconceptional health to encompass the overall health of nonpregnant women during their reproductive years (Robbins, 2018). The American College of Obstetricians and Gynecologists (2019b) and the Society for Maternal–Fetal Medicine (2014, 2021) attest to the importance of preconceptional care and promote the following objectives to advance it:

1. Improve knowledge, attitudes, and behaviors of men and women related to preconceptional health

2. Assure that all childbearing-aged women receive preconceptional care services—including evidence-based risk screening, health promotion, and interventions—that will enable them to enter pregnancy in optimal health

3. Implement interconceptional interventions to prevent or minimize recurrent adverse outcomes

4. Reduce the racial and socioeconomical disparities in adverse pregnancy outcomes

Table 9-1 lists the prevalence of many conditions often amenable to preconceptional intervention (Robbins, 2018). These are frequently encountered by generalist obstetrician–gynecologists, who can help optimize health entering pregnancy (Arluck, 2018). For example, by the time most women realize they are pregnant—usually 1 to 2 weeks after the first missed period—the embryo has already begun to form. Thus, many preventive steps—such as folic acid to avoid neural-tube defects—will be ineffective if initiated at this time. Moreover, 45 percent of all pregnancies in the United States are unplanned, and often these are at greatest risk (Finer, 2016). Last, a disproportionate number of indigent women receive less preconceptional care compared with their more affluent counterparts (Easter, 2017).

Few randomized trials evaluate preconceptional care efficacy, in part because withholding such counseling would be unethical. Also, pregnancy outcomes are dependent on the interaction of various maternal, fetal, and environmental factors. Thus, ascribing a salutary outcome to a specific intervention is difficult (Temel, 2014; Tieu, 2017). However, prospective observational and case-control studies have demonstrated the successes of preconceptional counseling (Yamamoto, 2018). Therefore, routine pregnancy intention screening should be done (Manze, 2020).

COUNSELING SESSION

Obstetricians–gynecologists, internists, family practitioners, and pediatricians have the best opportunity to provide preventive counseling during periodic health maintenance examinations. The occasion of a negative pregnancy test is also an excellent time for education (Skogsdal, 2018). Jack and colleagues (1995) administered a comprehensive preconceptional risk survey to 136 such women, and almost 95 percent reported at least one problem that could affect a future pregnancy (see Table 9-1). Providers should be knowledgeable regarding relevant medical diseases, prior surgery, reproductive disorders, or genetic conditions and be able ...