Preconception counseling is defined as health education and promotion. The goal of preconception care is health education and promotion, risk assessment, and intervention before pregnancy to reduce the chances of poor perinatal outcomes. Nearly half of the 200 million pregnancies that occur annually are unplanned. Preconception counseling can play a major role in reducing poor perinatal outcomes. Preconception counseling targeted at the mother, father, and family can reduce maternal and infant morbidity and mortality. Preconception counseling and education must include early health promotion and information to guide families in identifying risks and addressing those risks before pregnancy.
In anticipation of future childbearing years, every individual benefit from education about pregnancy readiness and the role of family and parenting with age-appropriate education. As children enter puberty, both boys and girls must be educated about the delay in sexuality, pregnancy prevention, and prevention of sexually transmitted infections. Although education may not correlate with delayed sexual activity, it is important to educate young males about their responsibilities in reproductive health. Every couple must have the opportunity to choose when they are ready to reproduce. Family planning and pregnancy prevention are key to pregnancy readiness.  Unplanned and unintended pregnancy results in late prenatal care which can subsequently contribute to adverse events during pregnancy and poor perinatal outcomes. Both the woman and man must be assessed for risks and educated about the risks associated with poor perinatal outcomes. This risk assessment must include an evaluation of overall well-being, medical history, surgical risks, social and behavioral risks, medication risks, occupational risks, education risks, and any other barriers that may pose an undue risk to fertility or pregnancy. A few important items to discuss during preconception counseling include:
Any woman with a chronic disease should review her desire to become pregnant with the primary care physician or provider and her family. Pregnancy can increase risks for both the mother and the child requiring additional visits, changes in routine care, and possible prolonged hospital stays if the perinatal period and pregnancy outcomes are not optimal. Preconception counseling must focus on optimizing both primary and secondary prevention, treatment compliance, and improving overall well-being prior to becoming pregnant. Any identified risks including disease history and status, current medications, social barriers, and limited support systems or financial barriers must also be reviewed. Patients with diseases or health issues associated with progression during pregnancy such as severe depression and anxiety, seizure disorders, diabetes, cardiac, renal disease, and other long-term illnesses should be referred for further counseling with a high-risk provider to discuss possible changes in medical management during pregnancy.
Families with histories of genetic disorders should be referred to a genetic counselor to discuss the risks of passing the disorder to the newborn. The genetic counselor can also educate the family on disorders that might impact fertility.
Short interval pregnancies are associated with preterm deliveries, premature rupture of membranes, maternal morbidity, and mortality, the third trimester bleeding, myometritis, and anemia. Counseling about short interval pregnancy and the negative impact would likely reduce the number of short interval pregnancies (Level B)
Tobacco use is associated with preterm labor, intrauterine growth retardation, low birth weight, and placental abruption. Smoking cessation can reduce perinatal mortality and low birth weight by at least 20%. Smoking cessation should be offered to the woman and her partner before and during early pregnancy (Level A). Women should be counseled that secondhand smoke can impact both fertility and the perinatal period.
Alcohol use in pregnancy is associated with fetal alcohol syndrome and fertility problems. Women should be advised to avoid alcohol if they are planning a pregnancy. The literature is unable to recommend a safe level of alcohol use (Level A). The use of alcohol during pregnancy can result in neuropsychologic adverse outcomes in the newborn. Preconception counseling should include addressing this issue prior to pregnancy.
Women with malnutrition may be at risk for nutrient deficiencies that increase the risk for low birth weight in the fetus and preterm labor.
Preconception assessment of the home environment, community, and occupational hazards are important to recognizing and reducing potential risks during pregnancy, especially during the organogenesis period. The assessment must include exposure history and duration of exposure. Education and counseling must include the warnings of birth defects and potential transmission of toxins in breastfeeding. Exposure to chemicals in the community and work environment may be linked to birth defects, fetal loss, and low fertility. Couples should be encouraged to inquire about potential hazards in the workplace.
Preconception counseling must include careful evaluation of medications taken by the women prior to pregnancy. Allowing adequate time for the transition to less harmful medicines and optimizing dosing can lead to both improved perinatal outcomes and avoidance of anomalies and poor outcomes for the fetus.
Preconception counseling, risk identification, and intervention require an interprofessional approach and consistent documentation in the healthcare record. The healthcare team should have access to the complete plan of care from the services used by the patient within the system. In order to improve patient outcomes, every provider should address the potential impacts of health status on pregnancy in women and men of reproductive age. In women seeing multiple providers for medical and behavioral care, an interprofessional approach to planning pregnancy can be advantageous in identifying and addressing risks prior to pregnancy.
If you consult with an expert in pregnancy, book an appointment with Dr. Pallavi Agrawal