3. A set of prevention and management
interventions that aim to identify and modify
biomedical , behavioral, and social risks to a
woman’s health or pregnancy outcome.
7. To limit assessments to this population is likely to result in
missed opportunities for prevention education because
nearly half (49.2%) of all pregnancies in the United
States occur to women who were not intending to
become pregnant at the time they did. These
pregnancies, which are termed unintended, occur in all
subgroups of sexually active women; rates vary by age
and socioeconomic and marital status. The highest rates
are for women younger than 20 years and women older
than 40 years, but the largest number of unintended
pregnancies occur in women aged 20–24 years. Among
married women, 31% of pregnancies are self-reported
8. As approximately half of all pregnancies in the United States are
In 1995, Conway and associates studied the type of
preconceptional counseling likely to be offered to women of
reproductive age by 140 internal medicine and 42 family
practice residents at Cook County Hospital. Residents were
asked to answer an anonymous, self-administered
questionnaire. During a 2-week period, 115 of 140 (82%)
internal medicine residents and 28 of 42 (67%) family practice
residents completed the questionnaire. The knowledge score
consisted of a total of 46 items in a true-or-false format.
Hypothetical patients and recommended management
decisions were presented relating to rubella immunization,
potential for congenital anomalies in diabetic patients, and
management of chronic hypertension. More than 40% of the
residents failed to indicate that they would provide a healthy
woman information about rubella immunization, family
planning, or counseling on sexually transmitted disease and
9. Adverse pregnancy outcomes remain a prevalent health
–12% of babies are born premature, 8% with low birth
–3% have major birth defects
–31% of women giving birth suffer pregnancy
•Risk factors for adverse pregnancy outcomes remain
prevalent among woment of reproductive age
–Smoking, obesity, teratogenic drugs, preexisiting medical
13. Is preconception care best targeted to the general
population or to specific subsets?
Should it always be offered as a routine component of
well-woman care or delegated to a special visit?
Do all potentially fertile women want preconception
Is preconception care cost-effective?
Must preconception risk assessment and related
education be provided in a clinical setting?
How do multiple providers avoid competing or
What strategies best encourage busy providers to
incorporate a prevention emphasis into routine
17. Medical History
Is the patient under current or former treatment for:
*Deep venous thrombosis?
*Systemic lupus erythematosus?
18. Medical history
*Does the patient have occupational exposure to the blood
or bodily secretions of others?
*Does the patient engage in high-risk behaviors for
exposure to the human immunodeficiency virus?
*Does the patient handle feline litter boxes or eat raw
or very rare meat?
*Does the patient routinely or occasionally take any
*Does the patient routinely or occasionally take any
19. Reproductive History
Has the patient had:
*Uterine or cervical abnormalities?
*Two or more pregnancies ending in first trimester
miscarriage without an intervening successful
*One or more fetal deaths?
*One or more preterm deliveries?
*One or more small-for-gestational-age infants?
*One or more infants requiring care in a neonatal
intensive care unit?
*One or more infants with a birth defect?
Does the patient:
*Folic acid supplement?
*Eat a special diet?
*Have a history of bulimia or anorexia?
*Use vitamin supplements in excess of the RDA
*Have a history of pica?
*Weight < 85% or > 135% of the ideal for height?
21. Family History
Does the patient, her partner, any of their offspring, or
any members of their families have:
*Tay-Sachs trait or disease?
*Sickle cell disease or trait?
22. Social History
Does the patient
*Drink beer, wine, or hard liquor?
*Smoke cigarettes or use other tobacco products?
*Use marijuana, cocaine, or any similar drugs?
*Use lead or chemicals at home or at work?
*Participate in activities that could result in
overheating (e.g. saunas, hot tubs, demanding exercise
in hot, humid conditions)?
*Have evidence of current or former physical, sexual,
or psychological abuse?
*Have a plan for spacing and timing her pregnancies?
*Have maternity benefits in her insurance program
that cover her and a future neonate?
*Know her employer’s policies around pregnancy and
30. In a study of 22 women who delivered infants with this
syndrome in four Southern California counties, 57% of
the women had 22 known missed opportunities, such as
induced and spontaneous abortion.
31. Each year in the United States more than 4000 pregnancies
are complicated by NTDs, and between 2500 and 3000
infants are born with the condition.
Because the research indicated that 50–70% of NTDs could
be prevented by adequate periconceptional folic acid
intake, the US Public Health Service (USPHS) released a
landmark recommendation in 1992 that read: “All
women of childbearing age in the United States who are
capable of becoming pregnant should consume 0.4 mg
of folic acid per day for the purpose of reducing their
risk of having a pregnancy affected with spina bifida or
other neural tube defects
33. Little attention has been given to men’s
preconception health and health care
•In the US, there has been a steady increase in
research and programs on men’s health
“ Men as Partners in reproductive health”
34. Why Preconception care for men is important?
–Improving family planning and pregnancy
outcomes, enhancing the reproductive health
and health behavior of their female partners,
and preparing men for fatherhood
–Offer an opportunity for disease prevention and
health promotion in men