The US Centers for Disease Control and Prevention (CDC)
and a select panel of external partners issued guidelines for
preconception care of women, emphasizing the importance of providing
this type of care in the primary care setting. The new national recommendations, which are published in the January-February issue of Journal of the American Board of Family Medicine, aim to improve preconception health and healthcare in response to unfavorable aspects of the health status of women and children in the United States.
"The national recommendations are part of a strategic plan for improving preconception health through the provision of clinical care as well as the promotion of changes in individual behaviors, health policy, and public health strategies," write Anne L. Dunlop, MD, MPH, from the Emory University School of Medicine in Atlanta, Georgia, and colleagues. "The concept of preconception care has been articulated for well over a decade but has not become part of the routine practice of family medicine. Because all women of reproductive age presenting to the primary care setting are candidates for preconception care, the essential and critical role of family physicians in the provision of preconception care is apparent."
In the United States, rates of adverse birth outcomes (preterm and low birth weight deliveries, infant deaths, and birth defects), maternal pregnancy complications, and unintended pregnancies are all higher than goals targeted in Healthy People 2010.
Key recommendations issued in these guidelines are as follows:
Monitoring improvements: To monitor preconception health, public health surveillance and related research mechanisms should be maximized.
One barrier to providing preconception care is lack of clinician knowledge of recommended interventions, which the new guidelines address by outlining 14 specific preconception healthcare interventions with clinical practice guidelines and evidence of efficacy. These include folic acid supplementation, rubella vaccination, diabetes management, hypothyroidism management, hepatitis B vaccination for at risk women, HIV/AIDS screening and treatment, sexually transmitted infection screening and treatment, maternal phenylketonuria management, oral anticoagulant use management, antiepileptic drug use management, accutane use management, smoking cessation counseling, eliminating alcohol use, and obesity control.
"As a specialty, we are now challenged to effectively translate the concept of preconception care into clinical reality," the authors conclude. "First, ask every women of reproductive age whether she intends to become pregnant in the next year. Asking every woman about her reproductive intentions promotes the idea that pregnancies should be intended and planned by providing contraception to the woman who does not intend to conceive and promotes the initiation of preconception care strategies for women if and when they do desire to become pregnant. Second, inform women that health conditions and medications can affect pregnancy outcomes and that pregnancy can affect a woman's health."
J Am Board Fam Med. 2007;20:81-84.
Preconception counseling offers an effective and efficient means to reduce complications of pregnancy for both the mother and baby. Primary care clinicians, particularly family physicians and family nurse practitioners, are in a privileged position to deliver preconception care. The current article recommends that family physicians inquire about conception plans annually among all women of childbearing age. Women should be made aware that specific preconception interventions may improve not only the outcomes of pregnancy, but their overall health as well.
The current article summarizes recommendations from the CDC for promoting preconception healthcare as well as specific interventions that have been demonstrated to improve pregnancy outcomes.
Preconception health should be encouraged by public health measures and education, including encouragement of a reproductive life plan for all couples. These efforts should include improved health coverage for low-income women.
Preconception care may begin after a negative pregnancy outcome, but all couples planning a pregnancy should receive a clinician visit for counseling. At these visits, clinicians should focus on the most efficacious interventions for preconception health. Such interventions may include:
Pearls for Practice
Clinicians should inquire about plans for pregnancy in the next year among all women of childbearing age. Women should also be informed that preconception care can improve health outcomes for both mother and baby.
During preconception screening visits, clinicians should focus on issues such as folate supplementation, hypothyroidism management, obesity control, hepatitis B vaccination for at risk women, and rubella vaccination among previously unvaccinated women.