"Educate a man and you educate an individual. Educate a woman and you educate a family." ~ A.Cripps
Preconceptual Counseling
Optimizing the health of the mother before conception is important for improving pregnancy outcome.
Since most pregnancies are unplanned, we try to use our annual visits with our patients of reproductive age as an opportunity to discuss future plans. In doing so we can improve the outcome of future pregnancies.
This is particularly true for certain populations of women, such as those with medical disorders (eg, diabetes mellitus, chronic hypertension, phenylketonuria), nutritional deficiencies (eg, iron, folate), and exposure to toxins or teratogens (eg, cigarettes, alcohol, warfarin, isotretinoin), in whom preconception care has been shown to reduce neonatal morbidity and mortality.
In particular, preconception care is more important than prenatal care for prevention of congenital anomalies since as many as 30 percent of pregnant women begin traditional prenatal care in the second trimester (>13 weeks of gestation), which is after the period of maximal organogenesis (between 3 and 10 weeks of gestation.)
We recommend women of childbearing age include preconception evaluation and counseling as part of their routine annual gynecology care. The goals of preconception care are to identify risks of pregnancy for the mother and fetus, educate our patient about these risks, and institute appropriate interventions, when possible.
Preconceptional Counseling Questionnaire
1. Are you considering getting pregnant within the next year?
2. Are you currently attempting to conceive?
3. Do you use birth control on a regular basis?
- Condoms
- Oral contraceptive pill
- The nuvaring
- Implanon
- IUD
- Natural Family Planning
4. Chronic medical and psychiatric issues requiring Rx
Current Medications
Prior Surgeries
Drug Allergies
Prior infections
- Chlamydia, gonorrhea
- Hepatitis, HIV+
- Syphilis
- Genital herpes
5. Have you ever been pregnant? If yes, did it result in:
- Miscarriage, more than one?
- Ectopic pregnancy
- Baby born with complications
- Phenylketonuria
- Baby born with birth defects
- Pregnancy complications
- Diabetes
- High Blood Pressure
- Premature Rupture of membranes
- Preterm Labor
- Other
- Full term delivery: vaginal delivery or c/s?
6. Is there a family history of any of the following?
- Tay Sachs disease
- Beta or alpha thalessemia
- Cystic fibrosis
- Sickle cell disease or trait
- Epilepsy
- Mental retardation
- Fragile X
- Spinal muscle atrophy
- Deafness
- Other family h/o birth defects or genetic syndromes
7. Do you smoke? If so, how many cigarettes per day?
We'll work with you to quit for every reason. (see quitsmoking)
8. Daily caffeine intake > 2 cups/day?
9. Have you used any of the following in the past year?
- excessive alcohol
- cocaine
- crack
- marijuana
- heroin
- prescription narcotics
10. Have you ever received blood products?
11. Do you have any dietary restrictions or intolerances?
12. Do you use any herbal, dietary or vitamin supplements?
13. Do you exercise on a regular basis?
14. Do you have any cats?
15. Are you currently employed?
16. Potential Work Hazards?
- Teachers: exposed to childhood illnesses, vaccines uptodate?
- Landscapers, gardners: certain soil-based infections
- X-rays or radiation
- Radioactive substances
- Chemical solvents
- Anesthetic gases
- TB? Date and status of last PPD placement?
- Needle stick injury possible
- Hepatitis B status
Obtaining a thorough history will help in identifying risks to you and to your future pregnancy.
17. Updating Vaccinations
Given a little forethought, we can check on pertinent lab tests and immunizations prior to conception to allow time for intervention, if required. In particular, rubella, varicella and pertussis immunizations should be up to date as these are live virus vaccines that should not be given to pregnant women.
18. Folate Supplementation
We recommend women take preconceptual folic acid supplements to reduce the occurrence of neural tube defects in their future children. Since the optimal dose is unclear, we suggest a daily multivitamin with 400 to 800 mcg/day of folic acid, based on the largest studies. These are found in prenatal vitamins, but if you find prenatal vitamins too big, or difficult to take, folic acid on its own is a small pill, and very manageable. We may suggest more if you are taking a certain antiseizure medication, or had a previously affected infant.
"Women are never stronger than when they arm themselves with their weakness." ~ Marie de Vichy-Chamrond, Marquise du Deffand, Letters to Voltaire
