Preconception health care should be part of routine medical visits

Every visit to the doctor for women of childbearing age should be considered an opportunity to discuss reproductive health- especially since more than half of all pregnancies are unintended, according to a report published today in the U.S. Centers for Disease Control and Prevention's journal Morbidity and Mortality Weekly Report Recommendations and Reports.

Making preconception health care part of routine medical visits can help identify risk factors for pregnancy complications and adverse birth outcomes, allowing doctors to offer women additional services to reduce the risk of premature birth and birth defects to help give their future babies a healthy start in life.

"We could do much more to improve the health of mothers and babies if we could identify risk factors before pregnancy and educate women about what health changes they can make," said Janis Biermann, co-author of the study and vice president for Education and Health Promotion of the March of Dimes. "For some of these problems, the preconception period, or the time between pregnancies, is the only chance to make a difference."

Ms. Biermann says providing care before a woman becomes pregnant is crucial because many factors that can harm fetal development do serious damage early in pregnancy, often before a woman realizes she is pregnant.

For example, women can be told of the dangers to the fetus of smoking and drinking alcohol during pregnancy, and informed of the benefits of taking folic acid to reduce the risk of serious birth defects. Chronic diseases such as diabetes, asthma and high blood pressure can be diagnosed and managed, allowing the mother to maintain good health while protecting the health of her future children. Medications may need to be changed to maximize the chance of a healthy baby.

Recommendations to Improve Preconception Health and Health Care was published April 21 in Volume 55, No. RR-6 of the CDC's MMWR.

The recommendations are:

1. Encourage everyone to have a reproductive life plan.
2. Increase public awareness about preconception health.
3. Provide risk assessment and counseling during primary care visits.
4. Increase the number of women who receive interventions after risk screening.
5. Use the time between pregnancies to provide intensive interventions to women who have had a pregnancy that resulted in infant death, low birthweight or premature birth.
6. Offer one pre-pregnancy visit.
7. Increase health insurance coverage among low-income women.
8. Integrate preconception health objectives into public health programs
9. Augment research.
10. Maximize public health surveillance.