Family Planning

Women of childbearing age and their partners should participate in preconceptional evaluation and counseling. This information will help prepare patients for pregnancy, can benefit the fetus and may also lead to a more healthy lifestyle for the patient.

Up to 30 percent of pregnant women begin traditional prenatal care in the second trimester, after the period of maximal organ development. However, optimizing the health of the mother before conception is important for improving pregnancy outcome. This is particularly true for certain populations of women, such as those with medical disorders or nutritional deficiencies, and those exposed to toxins or substances that can cause birth defects and abnormalities.

Preconceptional evaluation and counseling provide an opportunity to identify some of the risks of pregnancy for the mother and fetus, educate the patient about these risks, and institute appropriate interventions, when possible, before conception. Potential opportunities for preconceptional counseling include:

• Premarital examination and testing

• Contraception counseling

• Evaluation for sexually transmitted disease or vaginal infection

• After a negative pregnancy test

• Anytime a woman of childbearing age presents for a periodic health examination
   

The Preconceptional Evaluation

The three goals of a preconceptional evaluation are:

• Identification of risks related to pregnancy

• Patient education regarding pregnancy risks, management options and reproductive alternatives

• Initiation of interventions, when possible, to provide an optimal pregnancy outcome
   

Additional common concerns that may be addressed at this time include:

• Timing the initial pregnancy and interval between pregnancies

• Concerns about infertility

• Fears concerning the pregnancy

• Work-related issues and maternity leave

• Marital issues

The evaluation will include counseling, a physical exam and lab work.

A complete medical history is useful for discussing how pregnancy can affect maternal medical conditions and the effect of a medical disorder on the fetus and pregnancy. The patient's medications (including over-the-counter medications, herbal supplements and prescription drugs) should be discussed. A dietary evaluation will include an assessment of body mass index and eating habits.

The patient's family, gynecologic and obstetric histories are important for identifying factors that may contribute to infertility or complications in a future pregnancy, including genetic risks. Questions about the woman's work, hobbies, pets and home environment can identify potentially toxic exposures.

Healthy pregnancy habits will be discussed, including diet and nutrition needs, important immunizations, exercise, healthy and unhealthy weight gain, recommendations for caffeine consumption and much more.

For women at risk of substance abuse, the consequences of exposure to tobacco, alcohol and illicit drugs will be outlined. Women at risk of domestic violence, lack of social support, psychosocial stress and financial struggles will be directed to community resources.