Few Americans are aware of the risk factors related to childbearing. Preconception care aims to improve the health of women, children, and families through strategies to prevent or manage risks to healthy pregnancies before pregnancy. Since preconception care is not yet a routine component of the U.S. health care system, the Centers for Disease Control and Prevention (CDC) recently brought together groups of experts to evaluate the evidence and make the following 10 recommendations for improvement.

* Approximately 50% of pregnancies in the U.S. are unintended; each man, woman, and couple should have a "reproductive life plan," which involves setting goals about whether and when they might have children and how many they might have.

* Awareness of the importance of preconception health should be improved, through school programs and public health campaigns.

* Preconception care for all women of childbearing age should be integrated into primary care. Women should learn, for example, of the known benefits of supplements that contain folic acid for the reduction of neural tube defects.

* Evidence-based strategies should be employed in identifying risk factors (smoking, alcohol use, hypertension, diabetes, HIV infection).

* Special care should be given to women who've had a poor pregnancy outcome-it's often a reproductive risk factor.

* Women and couples should receive one prepregnancy visit to a health care provider.

* Low-income women of childbearing age should have increased access to health coverage, especially through expansion of Medicaid.

* Public health programs should include preconception care.

* More research should be conducted on "the effectiveness of interventions, the value of better service integration, and the potential cost benefit of preconception care."

* Public health surveillance should monitor the improvements in preconception care.

Read the report at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm.