Preconception Care Questions and Answers: General Public

1. What is preconception health?
2. What is preconception health care?
3. Why are there new recommendations on preconception health and health care now?
4. Does preconception health apply to women who do not plan to get pregnant?
5. How long before becoming pregnant should a woman start preparing for pregnancy? What are the five most important things she should do before pregnancy for her and her baby’s health?
6. The new recommendations say that everyone should have a reproductive life plan. What does this really mean?
7. What can men do to support the preconception health of their female partners and their future babies?
8. What is the role of community groups in promoting preconception health?
9. What should my health care provider be doing about preconception care at my regular visits?

1. What is preconception health?
Preconception health is a woman’s health before she becomes pregnant. It focuses on the conditions and risk factors that could affect a woman if she becomes pregnant. Preconception health applies to women who have never been pregnant, and also to women who could become pregnant again. Preconception health looks at factors that can affect a fetus or infant. These include factors such as taking prescription drugs or drinking alcohol. The key to promoting preconception health is to combine the best medical care, healthy behaviors, strong support, and safe environments at home and at work.


2. What is preconception health care?
Preconception health care is care given to a woman before pregnancy to manage conditions and behaviors which could be a risk to her or her baby. There are many topics covered under preconception care.

• Folic acid supplements to prevent neural tube defects.
  
• Rubella vaccinations to prevent Congenital Rubella Syndrome.
  
• Detecting and treating existing health conditions to prevent complications in the mother, and reduce the risk of birth defects:
  
  • Diabetes
    
  • Hypothyroidism
    
  • HIV/AIDS
    
  • Hepatitis B
    
  • PKU
    
  • Hypertension
    
  • Blood diseases
    
  • Eating disorders
    
• Reviewing medications that can affect the fetus or the mother, such as epilepsy medicine, blood thinners, and some medicines used to treat acne, such as Accutane.
  
• Reviewing a woman’s pregnancy history – has she lost a baby before?
  
• Stopping smoking to reduce the risk of low birth weight
  
• Eliminating alcohol consumption to prevent Fetal Alcohol Syndrome, and other complications.
  
• Family planning counseling to avoid unplanned pregnancies.
  
• Counseling to promote healthy behaviors such as appropriate weight, nutrition, exercise, oral health. Counseling can help a woman avoid substance abuse and toxic substances. It can help women and couples understand genetic risks, mental health issues (such as depression), and intimate partner domestic violence.
  

Good preconception health care is about managing current health conditions. By taking action on health issues BEFORE pregnancy, future problems for the mother and baby can be prevented. Preconception health care must be tailored to each individual woman. It means helping women and their partners reduce risks and get ongoing care. Men and other family members are also very important in supporting the goals of preconception health.


3. Why are there new recommendations on preconception health and health care now?

There have been important advances in medicine and prenatal care in recent years. Despite these advances, birth outcomes are worse in the United States than in other developed countries. Many babies are born prematurely or have low birthweight. In some groups of people, the problems are actually getting worse.
Experts agree that women need to be healthier before becoming pregnant. While this is not a new idea, there has not been an organized effort to promote preconception health and health care until now. The recommendations shown here have been developed by local, state, and federal government agencies, with help from national medical organizations and groups such as the March of Dimes. They offer guidance to individuals and their families, health care providers, planners, and policy makers. The goal is to improve the health of women so that babies can be born healthier in the future.

4. Does preconception health apply to women who do not plan to get pregnant?

Absolutely. Every woman should be thinking about her health, whether or not she wants to get pregnant. Some of the basic recommendations for preconception health include healthy weight and nutrition, and identifying and managing existing conditions and infections. All women should quit smoking and avoid other harmful substances. These are important health goals for everyone, not just women planning to get pregnant.
Since over half of all pregnancies in the United States are unplanned, women who might be sexually active with male partners should consider their health. As they might not know they are pregnant, women need to avoid risks, such as using medications that could harm a fetus, whenever possible.
CDC recommends that men and women think about a reproductive life plan. This means deciding the ideal time and conditions for having children and learning how to achieve these goals. This can include effective contraception. (See Question 6 below) Women’s lives are rich and complex, and the possibility of pregnancy is only one factor affecting women’s health choices. The more that women know about the health care relevant to their own circumstances, the more empowered they are to make the right choices for their lives.


5. How long before becoming pregnant should a woman start preparing for pregnancy? What are the five most important things she should do before pregnancy for her and her baby’s health?

Every man and woman should prepare for pregnancy before becoming sexually active, or at least three months before conception. Women should begin some of the recommendations even sooner – such as quitting smoking, reaching healthy weight, and adjusting medications. Planning for pregnancy is also a good time to talk about other concerns. Issues such as intimate partner domestic violence, mental health, and previous pregnancy problems need to be discussed. Although men and women can do much on their own, a health care provider is necessary for finding and treating existing health problems. They can also help a woman improve her health before pregnancy.
The five most important things a woman can do for preconception health are:

1. Take 400 mcg of folic acid a day for at least 3 months before becoming pregnancy to reduce the risk of birth defects.
   
2. Stop smoking and drinking alcohol.
   
3. If you currently have a medical condition, be sure these conditions are under control. Conditions include but are not limited to asthma, diabetes, oral health, obesity, or epilepsy. Be sure that your vaccinations are up to date.
   
4. Talk to your doctor and pharmacist about any over the counter and prescription medicines you are taking, including vitamins, and dietary or herbal supplements, you are taking.
   
5. Avoid exposures to toxic substances or potentially infectious materials at work or at home, such as chemicals, or cat and rodent feces.
   

6. The new recommendations say that everyone should have a reproductive life plan. What does this really mean?

A reproductive life plan is a set of personal goals about having (or not having) children. It also states how to achieve those goals. Everyone needs to make a reproductive plan based on personal values and resources. Here are some examples:

• “I’m not ready to have children now. I’ll make sure I don’t get pregnant. Either I won’t have heterosexual sex, or I’ll correctly use effective contraception.”
  
• “I’ll want to have children when my relationship feels secure and I’ve saved enough money. I won’t become pregnant until then. After that, I’ll visit my doctor to discuss preconception health. I’ll try to get pregnant when I’m in good health.”
  
• “I’d like to be a father after I finish school and have a job to support a family. While I work toward those goals, I’ll talk to my wife about her goals for starting a family. I’ll make sure we correctly use an effective method of contraception every time we have sex until we’re ready to have a baby.”
  
• “I’d like to have two children, and space my pregnancies by at least two years. I’ll visit my certified nurse midwife to discuss preconception health now. I’ll start trying to get pregnant as soon as I’m healthy. Once I have a baby, I’ll get advice from a health professional on birth control. I don’t want to have a second baby before I’m ready.”
  
• “I will let pregnancy happen whenever it happens. Because I don’t know when that will be, I’ll make sure I’m in optimal health for pregnancy at all times.”
  

There are many kinds of reproductive life plans. What’s important is that you think about when and under what conditions you want to become pregnant. Then make sure your actions support these goals. Health care providers and counselors can help you understand the clinical and lifestyle options that are best for you.


7. What can men do to support the preconception health of their female partners and their future babies?

Men can make a big difference in promoting good preconception health. As boyfriends, husbands, fathers-to-be, partners, and family members, they can learn how their loved ones can achieve optimal preconception health. They can encourage and support women in every aspect of preparing for pregnancy.
There are other ways men can help. Men who work with chemicals or other toxins need to be careful that they don’t expose women to them. For example, men who use fertilizers or pesticides in agricultural jobs should change out of dirty work clothes before coming near their female partners. They should handle and wash soiled clothes separately.
The family health histories of men are also important when planning a pregnancy. Understanding genetic risks from both sides enables providers to give more accurate advice. Screening for and treating STIs (sexually transmitted infections) in men can help make sure that the infections are not passed to female partners. Men can improve their own reproductive health by reducing stress, eating right, avoiding excessive alcohol use, not smoking, and talking to their health care providers about their own medications. It is also important for men who smoke to stop smoking around their partners, to avoid the harmful effects of second-hand smoke.

8. What is the role of community groups in promoting preconception health?

Since preconception health affects so many women, community groups can help ensure that no one gets left out. They can learn about preconception health and make sure their members know. Also, because community groups are often trusted sources of support, they can be effective in encouraging healthy choices.
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9. What should my health care provider be doing about preconception care at my regular visits?

Health care providers have a lot to cover during an appointment, so it’s always a good idea to make a list and bring up any issues on your mind. Do this even if the health care provider doesn’t ask about them. The first thing to discuss is your plan for pregnancy. If you tell your provider that you might become pregnant in the near future, there will be a number of things to discuss. You may need to schedule another visit to make sure everything gets covered.
Your health care provider should:

• Review your family’s medical history. This includes your previous experiences with pregnancy, fertility, birth, and use of birth control methods.
  
• Ask about your lifestyle, behaviors, and social support concerns that affect your health. Do you smoke, drink alcohol, use drugs, or have psychological problems, including depression? Do you have nutrition and diet issues? Concerns about health conditions in your or your partner’s family? Are there issues around intimate partner domestic violence? What are the medications you are taking? Are there chemicals, solvents, radiation, or other potential risks at your workplace or home that could harm you or your baby?
  
• Schedule health screening tests – Pap smear, urinalysis, blood tests. Your provider needs to know your blood type, Rh factor, and whether you have diabetes, hypertension, sexually transmitted infections, or other conditions.
  
• Review your immunization status and update them if needed.
  
• Perform a physical exam, including a pelvic exam and a blood pressure check.
  

Based on your individual health, your health care provider will suggest a course of treatment or follow up care as needed.