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PubMed2002

Preconception health care.

Appropriate preconception health care improves pregnancy outcomes. When started at least one month before conception, folic acid supplements can prevent neural tube defects. Targeted genetic screening and counseling should be offered on the basis of age, ethnic background, or family history. Before conception, women should be screened for human immunodeficiency virus and syphilis infection and begin treatment to prevent the transmission of disease to the fetus. Immunizations against hepatitis B, rubella, and varicella should be completed, if needed. Women should be counseled on ways to prevent infection with toxoplasmosis, cytomegalovirus, and parvovirus B19. Environmental toxins such as cigarette smoke, alcohol, and street drugs, and chemicals such as solvents and pesticides should be avoided. In women with diabetes, it is important to optimize disease control through intensive management before pregnancy. Medications for hypertension, epilepsy, thromboembolism, depression, and anxiety should be reviewed and changed, if necessary, before the patient becomes pregnant. Counseling about exercise, obesity, nutritional deficiencies, and the overuse of vitamins A and D is beneficial. Physicians may also choose to discuss occupational and financial issues related to pregnancy and to screen patients for domestic violence.

Chronic Disease↗
PubMed2006

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.

This report provides recommendations to improve both preconception health and care. The goal of these recommendations is to improve the health of women and couples, before conception of a first or subsequent pregnancy. Since the early 1990s, guidelines have recommended preconception care, and reviews of previous studies have assessed the evidence for interventions and documented the evidence for specific interventions. CDC has developed these recommendations based on a review of published research and the opinions of specialists from the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. The 10 recommendations in this report are based on preconception health care for the U.S. population and are aimed at achieving four goals to 1) improve the knowledge and attitudes and behaviors of men and women related to preconception health; 2) assure that all women of childbearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health; 3) reduce risks indicated by a previous adverse pregnancy outcome through interventions during the interconception period, which can prevent or minimize health problems for a mother and her future children; and 4) reduce the disparities in adverse pregnancy outcomes. The recommendations focus on changes in consumer knowledge, clinical practice, public health programs, health-care financing, and data and research activities. Each recommendation is accompanied by a series of specific action steps and, when implemented, can yield results within 2-5 years. Based on implementation of the recommendations, improvements in access to care, continuity of care, risk screening, appropriate delivery of interventions, and changes in health behaviors of men and women of childbearing age are expected to occur. The implementation of these recommendations will help achieve Healthy People 2010 objectives. The recommendations and action steps are a strategic plan that can be used by persons, communities, public health and clinical providers, and governments to improve the health of women, their children, and their families. Improving preconception health among the approximately 62 million women of childbearing age will require multistrategic, action-oriented initiatives.

Female↗
PubMed2006

Association of preconceptional health care utilization and early initiation of prenatal care.

OBJECTIVE: To assess whether women having preconceptional health care utilization were more likely to have early initiation of prenatal care than were women not having preconceptional health care utilization. STUDY DESIGN: In this cohort study, data were collected prospectively from a population-based Perinatal Health Care Surveillance System in China. The analysis included 195 796 women who delivered single live births in 13 cities/counties during 1997 to 2000. Mantel-Haenszel test was employed to calculate risk ratios and 95% confidence intervals (CI). Multivariate logistic regression was conducted to assess the association between preconceptional health care utilization and early initiation of prenatal care after controlling for maternal residence, age at delivery, educational attainment, occupation, parity, preconceptional medical disorders, and high-risk medical experiences during the first trimester. SPSS 11.5 (SPSS Inc.) was employed for data analysis. RESULTS: Women having preconceptional health care utilization were 2.6 times (95%CI: 2.5 to 2.6) more likely to have early initiation of prenatal care compared with women not having preconceptional health care utilization. When stratified by maternal residence, age at delivery, educational attainment, occupation, parity, preconceptional medical disorder, high-risk medical experiences during the first trimester, and preconceptional medical disorders, this association still existed. After controlling for stratification factors mentioned above and the interaction of maternal age, educational attainment, and parity, women having preconceptional health care utilization were 2.7 times (95%CI: 2.6 to 2.8) more likely to have early initiation of prenatal care than were women not having preconceptional health care utilization. CONCLUSION: Women who had preconceptional health care utilization were more likely to have early prenatal care than were women not having preconceptional health care utilization.

Adult↗
PubMedDate not supplied

Preconception health care: a critical task for family physicians.

Health care leaders in the United States have recently advised that preconception care be made available to all prospective parents because health in pregnancy depends on health status prior to pregnancy. Prenatal care usually begins after the early critical period of pregnancy has passed, and optimal early prenatal care can be achieved only through preconception care. Family physicians, who are ideally suited to provide this care, can readily integrate it into the routine health maintenance they currently provide for their patients of childbearing age. This review highlights components of the medical, family, and social histories, current health, and physical examination that are important to preconception health. There is good evidence that attention to patients' health needs before conception is related to improved perinatal outcomes.

Female↗
PubMed1998

Preconceptional health care model.

During the last 10 years, there has been a movement to expand the definition of prenatal care to encompass preconceptional counseling. Major organizations throughout the world have endorsed preconceptional counseling as an integral component of care for all women contemplating pregnancy. This article will assist health care providers who interact with women of reproductive age to understand the potential benefits and limitations of preconceptional counseling and to develop an approach to that service relating to nutrition, infections, and metabolic diseases as they impact on reproductive outcome. Although there are many potential benefits of the preconception health care model, barriers to its implementation remain.

Counseling↗
PubMed1994

Preconception evaluation and intervention.

Many pregnancies are predisposed to complications by events that occur in the first weeks of gestation. In fact, these complications may occur prior to the time that a woman knows she has become pregnant. Preconception care offers patients the opportunity to address these conditions before conception; the potential for a satisfactory pregnancy outcome is thereby increased. In the following report, I summarize current understandings in preconception care. Recent advances in preconception care have expanded the opportunities for preventing adverse reproductive outcome. Although the study of preconception care is a relatively new innovation, recent studies have shown the value of preconception intervention.

Female↗
PubMed2002

Genetics issues in preconception health care.

Genetics is an important area of focus for the preconception visit (Table 4). Folic acid should be recommended for all women. The genetic and pregnancy history should be evaluated for clues to a genetic disorder. Preconception screening and counseling are available for many diseases that are indicated in the family history. Screening may be offered for sickle cell anemia, thalassemia, Tay Sachs disease, and cystic fibrosis in the appropriate population groups. Older couples should be counseled about their increased risks for having complications during pregnancy and for having children with genetic disorders.

Age Factors↗