Preconception Care in Family Practice

Preconception Care in Family Practice

• Preconception healthcare aims to decrease maternal and neonatal mortality through preventative and social change strategies.

Challenges/Barriers

• Lack of coverage
• Limited access to care
• Inadequate training of healthcare professionals
• Stigma surrounding pregnancy care only being needed during pregnancy.

Benefits & Evidence

• "Life course" perspective
• Importance of folate supplementation
• Vaccinations
• Treatment of STIs
• Controlling chronic disease

Health History

• Three generations of health data are pertinent
• Includes pregnancy outcomes, health outcomes, and psychosocial history
• See Jordan pg 52 Table 5.2 for details

Physical Exam & Labs

• Physical examinations and relevant labs are part of preconception care.

Mental Health

• Mental health screenings should be conducted for all women, especially during their reproductive years.
• Adverse effects on both mother and baby can result from untreated mental health issues
• Assessment of medications, and consideration of alternatives as needed

Substance Use/Abuse

• Assessment of tobacco use
• Assessment of marijuana use
• Assessment of prescription opioid use
• Assessment of alcohol use
• Assessment of illicit substance use

IPV

• Routine annual exams should be conducted
• First prenatal visit is important
• Prenatal checkups should be conducted on a trimester basis
• Postpartum checkups are crucial

Infections

• Screening of women and partners for infections to prevent transmission during pregnancy and TTC (trying to conceive)
• Focus on infections, such as toxoplasmosis, cytomegalovirus, and listeria.
• See Jordan text pg 66 table 5.3 for more information

Chronic Health Conditions

• Cardiovascular disease (CVD) and hypertension (HTN) are a primary cause of death in women
• Blood pressure should be monitored at every visit

Diabetes

• Increased risk of stillbirths, miscarriage, congenital malformations, and neonatal death.
• Risk for childhood diabetes is also increased

Thyroid Disorders

• Screen for hyperthyroidism or hypothyroidism for a positive maternal and neonatal outcome
• Normal thyroid function should be achieved before pregnancy.
• Medications should be safe to use during pregnancy

Conception Counseling

• Most fertile time is 6 days before ovulation
• Intercourse should occur every 1-2 days during this period
• If infertility is suspected after 12 months, a referral is warranted

Counseling: Nutrition, Vitamins, Weight, Activity

• Consider patient beliefs regarding nutrition
• Frequent reviews of vitamin intake, specifically folic acid (see Jordan pg. 73)
• Encourage a healthy BMI
• Recommend regular exercise for better pregnancy outcomes

Genetic Screening

• Preconception is the ideal time for genetic screenings
• Carrier testing is becoming more affordable
• Referrals to genetic counselors (GC) may be needed