Preconception health care is care a woman of childbearing age receives before pregnancy or between pregnancies. This type of care looks at health conditions and lifestyle factors that may affect a woman's health. The goal is to provide treatment and information before pregnancy that can improve the woman's health and help reduce risks to her future baby.
All women of childbearing age can take steps before they get pregnant to improve their chances of having a healthy full-term baby. More and more babies are born prematurely (before 37 completed weeks of pregnancy), which increases the risk of serious health problems. By seeking preconception health care, a woman can learn what steps she can take before pregnancy to protect her health and give her baby the best chance to be healthy.
Why is a preconception checkup important?
A preconception checkup can help assure that a woman is as healthy as possible before she conceives. Her provider can identify, and often treat, health conditions that can pose a risk in pregnancy, such as high blood pressure, diabetes or certain infections. The provider can give her information on lifestyle factors, such as nutrition and reaching a healthy weight, smoking, drinking alcohol, and occupational exposures that can pose pregnancy risks. The provider also can make sure a woman's vaccinations are up to date and that any medications she takes are safe during pregnancy.
The provider can ask a woman about her health history, as well as that of her partner and her family. If the woman or her partner has a history of birth defects or prematurity, or has a high risk of a genetic disorder based on ethnic background or age, the provider may suggest seeing a genetic counselor.
What does a genetic counselor do?
A genetic counselor discusses the risks of a genetic disease in a couple's future children. The counselor can arrange blood tests (called carrier tests) that can identify carriers of many genetic diseases. If both parents are carriers of a disease, each child has a 25 percent chance of inheriting the disease. Examples of carrier tests are:
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Cystic fibrosis (CF), a disease of the lungs and digestive system that is most common in Caucasians, but can affect children from many backgrounds
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Tay-Sachs disease, which causes fatal brain damage and is more common in people of Eastern European Jewish ancestry and in some non-Jewish individuals of French-Canadian and Cajun ancestry
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Sickle cell disease, a blood disorder that mainly affects African-Americans
- Thalassemia, a blood disorder primarily affecting those of Mediterranean, African and South Asian descent
Genetic screening and counseling before pregnancy may reassure a couple that their children are not at increased risk for a specific inherited disease. Genetic counseling also allows carriers the opportunity to understand their risk and discuss options. Other women who can benefit from genetic counseling include:
- Women who have had a child with a neural tube defect (NTD), a birth defect of the brain and spinal cord
Why should women of childbearing age take folic acid?
Folic acid is a B vitamin that can help prevent NTDs. Studies show that if all women consumed the recommended amount of folic acid before and during early pregnancy, up to 70 percent of all NTDs could be prevented (1, 2). Studies also suggest that folic acid may help prevent some other birth defects, including cleft lip and palate and some birth defects involving the heart (1).
To prevent NTDs, the March of Dimes recommends that all women who could become pregnant take a multivitamin containing 400 micrograms of folic acid every day starting before pregnancy, as part of a healthy diet. This advice, based on recommendations from the Institute of Medicine (IOM) (3), assures that a woman gets all the folic acid and other vitamins she needs. She also can get folic acid by consuming each day a serving of folic acid-enriched cereal that contains 100 percent of the daily value (DV) of folic acid (400 micrograms).
A healthy diet includes foods that are fortified with folic acid and foods that contain folate, the natural form of folic acid found in foods. Many grain products, including flour, rice, pasta, bread and cereals, are fortified with folic acid. Folate-rich foods include green leafy vegetables, dried beans, legumes, oranges and orange juice.
A woman who has had a pregnancy affected with an NTD should take a higher dose of folic acid. Taking a larger dose of folic acid daily (4,000 micrograms or 4 milligrams), beginning at least one month before pregnancy and in the first trimester of pregnancy, reduces by about 70 percent the risk of having another affected pregnancy (4). Women with diabetes or epilepsy and women who are obese also are at increased risk of having a baby with an NTD (1). Women with these conditions should consult their providers before pregnancy about taking a larger dose of folic acid.
What vaccines might a woman need before pregnancy?
At a preconception visit, the health care provider may do a blood test to see if a woman is immune to rubella (German measles) and chickenpox. Both of these diseases can cause birth defects and other complications if a woman gets them during pregnancy. If a woman is not immune, she should be vaccinated before pregnancy. She should then wait one month after vaccination before attempting to get pregnant.
Women who are at high risk of hepatitis B (such as health care workers) should consider getting the hepatitis B vaccine before or during pregnancy. This disease can be passed on to the baby during delivery, although prompt immunization and treatment of the baby after birth usually can prevent infection. A provider also may recommend other vaccines, such as the flu shot.
What maternal illnesses should be treated before pregnancy?
Diabetes: Women with poorly controlled diabetes that started before pregnancy are about three times more likely than women without diabetes to have a baby with a serious birth defect (5). They also are at increased risk of miscarriage and stillbirth, and of having a baby that is very large. Controlling blood sugar before pregnancy and during the first few months of pregnancy can help prevent birth defects. Maintaining good blood-sugar control throughout pregnancy, along with appropriate weight gain, helps prevent the baby from growing very large and may reduce the risk of labor and delivery complications.
High blood pressure: Chronic high blood pressure can increase risk of pregnancy complications, including placental problems, poor fetal growth and preeclampsia.
Systemic lupus erythematosus (SLE): This autoimmune disorder can cause arthritis-like symptoms, kidney disease, skin rashes and other problems. Affected pregnant women are at increased risk of miscarriage, poor fetal growth, preterm labor and stillbirth (6). However, if symptoms are well controlled before pregnancy, the risk of these complications is reduced.
Seizures: Some seizure-control medications increase the risk of birth defects. During a preconception visit, a provider may adjust a woman's dose or switch her to a safer drug. A woman should not stop taking seizure medications without asking her provider, as seizures themselves might harm a fetus.
Phenylketonuria (PKU): Women with this inherited condition cannot process certain proteins. They must be on a special diet and be carefully monitored before and during pregnancy to prevent mental retardation and birth defects in their offspring (5).
Kidney disease: Some women with severe kidney disease may suffer additional kidney damage during pregnancy, and their babies may be at increased risk of death, preterm delivery or poor growth (6). Women with mild kidney disease usually have healthy pregnancies, although they must make sure that their blood pressure is well controlled before and during pregnancy.
How can preconception care help prevent problems of past pregnancies?
Even if a woman has not had problems in a previous pregnancy, preconception care can help prevent birth defects or pregnancy complications in a future pregnancy. For example, taking folic acid can help prevent NTDs, and treatment of certain health conditions, such as high blood pressure, can help prevent preterm delivery. A 2006 report from the Centers for Disease Control and Prevention (CDC) recommends that all women who have had a previous pregnancy that ended in an adverse outcome receive treatment between pregnancies to reduce the risk in future pregnancies (5).
What lifestyle changes should a woman make before pregnancy?
A woman should:
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Avoid alcohol. Drinking alcohol during pregnancy can cause physical and mental birth defects called fetal alcohol syndrome. Because no amount of alcohol is proven safe in pregnancy, pregnant women should avoid it entirely.
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Quit smoking. Smoking during pregnancy nearly doubles the risk of having a low-birthweight baby. It also increases the risk of preterm delivery, other pregnancy complications and sudden infant death syndrome (SIDS) (7). Smoking also may make it more difficult to conceive (7).
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Stay away from cocaine and other illicit drugs. These drugs pose many risks, including preterm birth, low birthweight, birth defects, learning or behavioral problems, and withdrawal symptoms.
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Avoid eating undercooked meat and changing a cat's litter box. Both can cause a parasitic infection called toxoplasmosis that can cause birth defects.
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Avoid hot tubs and saunas. These may elevate body temperature and possibly increase the risk of NTDs (1).
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Avoid hazardous chemicals, such as solvents (substances that dissolve other substances, like paint thinner). Working with solvents may increase a woman's risk of miscarriage or having a baby with birth defects (8).
- Avoid eating fish that can be high in mercury, like shark, swordfish, king mackerel and tilefish (9). Women should limit the amount of fish they eat that contain lower levels of mercury, including shrimp, salmon, pollock, catfish and canned light tuna. They can eat up to 12 ounces of these fish a week. Women should not eat more than 6 ounces of albacore (white) tuna per week. Women should always check with their local health department before eating any fish they catch themselves (9).
Why should a woman try to achieve a healthy weight before pregnancy?
Women who begin pregnancy overweight or obese may be at increased risk of (5, 6):
- Having high blood pressure and diabetes
- Having a baby with certain birth defects
- Having labor and delivery complications
- Having a stillborn baby
They also may have more difficulties becoming pregnant (10). A woman can help reduce her risk of these complications by attaining a healthy weight before pregnancy. Women who are already pregnant should never try to lose weight during pregnancy because it could harm the baby.
Women who are underweight may be at increased risk of having a premature or low-birthweight baby (6).
The Video: Don't U Dare
The goal of this brief video is to heighten awareness about physical fitness, good nutrition, and multivitamin use among women between the ages of 18 and 24. To view the video, click here.
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References
- Centers for Disease Control and Prevention (CDC). Folic Acid: Frequently Asked Questions. Updated 11/16/05.
- Berry, R.J., et al. Prevention of Neural Tube Defects with Folic Acid in China. New England Journal of Medicine, volume 341, number 20, November 11, 1999, pages 1485-1490.
- Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes: Folate, Other B Vitamins, and Choline. Washington, D.C., National Academy Press, April 7, 1998.
- Centers for Disease Control and Prevention (CDC). Folic Acid: PHS Recommendations. Updated 7/26/05.
- Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) Preconception Care Work Group and the Select Panel on Preconception Care. Recommendations to Improve Preconception Health and Health Care—United States. Morbidity and Mortality Weekly Reports, volume 55, no. RR-6, April 21, 2006.
- American College of Obstetricians and Gynecologists (ACOG). Your Pregnancy and Birth, 4th edition. ACOG, Washington, D.C., 2005.
- U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General, 2004. Office on Smoking and Health, Atlanta, GA.
- Khattak, S., et al. Pregnancy Outcome Following Gestational Exposure to Organic Solvents. Journal of the American Medical Association, March 24/31, 1999, volume 281, number 12, pages 1106-1109.
- U.S. Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA). What You Need to Know About Mercury in Fish and Shellfish. Accessed 5/4/06.
- American Society for Reproductive Medicine. Patient's Fact Sheet: Weight and Fertility. Revised 8/01, accessed 5/8/06.
July 2007 (11-07)
