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Preconception Care

Berghella, Vincenzo MD*; Buchanan, Edward MD; Pereira, Leonardo MD; Baxter, Jason K. MD, MSCP§

Obstetrical & Gynecological Survey: February 2010 - Volume 65 - Issue 2 - p 119-131
doi: 10.1097/OGX.0b013e3181d0c358
CME Program: CME REVIEW ARTICLES 4, 5, AND 6: CME REVIEW ARTICLE 5
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CME

Our objective was to provide the clinician with easy-to-use evidence-based guidelines, based on the best available literature, for offering effective preconception care, aimed at decreasing maternal and fetal/neonatal morbidity and mortality. We searched the Cochrane Library, MEDLINE, and PUBMED from 1966 until January 2009. We used the search terms “preconception,” “preconception care,” “prepregnancy,” and “inter-pregnancy.” We focused on level I publications, randomized studies, and meta-analyses of these studies in particular. We included non-English publications, if pertinent. We searched the reference lists of manuscripts identified, and selected those we judged relevant. Preconception care has been defined as a set of interventions that aim to identify and modify risks to a woman’s health or pregnancy outcome through prevention and management. It should occur any time any healthcare provider sees a reproductive age woman. Personal and family history, physical exam, laboratory screening, reproductive plan, nutrition, supplements, weight, exercise, vaccinations, and injury prevention should be reviewed in all women. Folic acid 400 mcg per day, as well as proper diet and exercise should be encouraged. Women should receive the influenza vaccine if planning pregnancy during flu season; the rubella and varicella vaccines if there’s no evidence of immunity to these viruses; and tetanus/diphtheria/pertussis if lacking adult vaccination. Specific interventions to reduce morbidity and mortality for both the woman and her baby should be offered to those identified with chronic diseases, or exposed to teratogens or illicit substances. There are several interventions that have been proven to effectively improve pregnancy outcome when provided as preconception care. These should be consistently provided to reproductive-age women.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Leaning Objectives: After completion of this educational activity, the participant should be better able to assess potential benefits for women and their offspring that result from preconception care, translate specific evidence-based preconception strategies into clinical practice, and select resources for practitioners and patients that are print media or online related to preconception health.

*Director, Division of Maternal-Fetal Medicine; Director, MFM Fellowship Program, Professor, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA; †Assistant Professor, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA; ‡Director, Division of Maternal-Fetal Medicine; Associate Professor, Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, OR; §Director, Division of Research; Associate Professor, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA

Chief Editor’s Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credits™ can be earned in 2006. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

Unless otherwise noted below, each faculty’s spouse/life partner (if any) has nothing to disclose.

The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

The Faculty and Staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Reprint requests to: Vincenzo Berghella, MD, Division of Maternal- Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, 834 Chestnut Street, Suite 400, Philadelphia, PA 19107. E-mail: vincenzo.berghella@jefferson.edu.

© 2010 Lippincott Williams & Wilkins, Inc.