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There were 4,317,119 births in the United States in 2007, the highest number of births ever registered. Although most infants are born healthy, of critical importance is that the infant mortality rate in the United States ranks 29th 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.

Hamilton BE et al: Births: preliminary data for 2007. Natl Vital Stat Rep 2009;57:12.
Johnson K et al: Recommendations to improve preconception health and health care-United States. A report of the CDC/ATSDR preconception care work group and the select panel on preconception care. MMWR Recomm Rep 2006;55(RR-6):1.  [PubMed: 16617292]

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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.

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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").

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

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Vitamin A is a known teratogen at high doses. Supplemental doses exceeding 5000 IU/d should be avoided by women who are, or who 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.

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Folic acid supplementation: Neural tube defects (NTDs), including spina bifida, anencephaly, and encephalocele, affect approximately 4000 pregnancies each year in the United States. ...

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