The Bible records the first preconception counseling. Judges 13 documents this message delivered by an angel to the mother of Samson before she conceived her son. The message instructed, "Now see to it that you drink no wine or other fermented drink and that you do not eat anything unclean, because you will conceive and give birth to a son" (Judges 13:4-5, NIV). Today, we know from science and research that promoting the health and wellness of women and couples before pregnancy improves birth outcomes.
Preconception care is defined as a set of interventions that aims to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management. The March of Dimes Foundation has created a series of nursing education modules to assist nurses in working with women and families to help them make healthy decisions to decrease birth defects. The modules can be obtained in writing or online and offer professional continuing education credit (March of Dimes, 2007).
Maternal and child health researchers and providers have recommended that health risks and behaviors be addressed during any encounter with the healthcare system because approximately half of the pregnancies in the United States are unintended. Clinical trials have indicated that provision of preconception care can increase pregnancy planning and intention. This finding is vital because studies have consistently demonstrated that planned pregnancies typically have improved outcomes for both the women and the infants.
The Centers for Disease Control (CDC) and its partners have developed specific recommendations and action plans designed to reach four preconception goals: improve knowledge/behaviors about preconception health; assure women of childbearing age receive preconception care; reduce risk through interventions during the interconception period; and reduce disparities in adverse pregnancy outcomes. The CDC also has released 14 preconception interventions which have proven to be effective in improving pregnancy outcomes (CDC, 2006, April 12):
1. Isotretinoins. The use of isotretinoins (e.g., Accutane) in pregnancy to treat acne can result in miscarriage and birth defects. Effective pregnancy prevention should be implemented to avoid unintended pregnancies among women with childbearing potential who use this medication.
2. Alcohol intake. At no time during pregnancy is it safe to drink alcohol, and harm can occur early, before a woman has realized that she is or might be pregnant. Fetal alcohol syndrome and other alcohol-related birth defects can be entirely prevented if women cease intake of alcohol before conception.
3. Antiepileptic drugs. Certain antiepileptic drugs are known teratogens (e.g., valproic acid). Recommendations suggest that before conception, women receiving a regimen of these drugs who are contemplating pregnancy should be prescribed a lower dosage.
4. Diabetes (preconception). The threefold increase in the prevalence of birth defects among infants of women with types 1 and 2 diabetes mellitus is substantially reduced through proper management of diabetes before and during pregnancy.
5. Folic acid deficiency. Daily use of vitamin supplements containing folic acid has been demonstrated to reduce the occurrence of neural tube defects by at least 50%.
6. Hepatitis B. Vaccination is recommended for men and women at risk for acquiring hepatitis B virus (HBV) infection. Preventing HBV infection in women of childbearing age prevents transmission of infection to infants and eliminates the risk to the woman of HBV infection and sequelae including hepatic failure, liver carcinoma, cirrhosis, and death.
7. HIV/AIDS. If HIV infection is identified before conception, timely antiretroviral treatment can be administered, and women (or couples) can be given additional information that can help prevent mother-to-child transmission.
8. Hypothyroidism. The dosages of medication (Levothyroxine) required for the treatment of hypothyroidism increase during early pregnancy. Levothyroxine dosage needs to be adjusted for proper neurologic development of the fetus.
9. Maternal phenylketonuria (PKU). Women diagnosed with PKU as infants have an increased risk for delivering neonates/infants with mental retardation. However, this adverse outcome can be prevented if mothers adhere to a low-phenylalanine diet before conception and continue it throughout their pregnancy.
10. Rubella seronegativity. Rubella vaccination provides protective seropositivity and prevents congenital rubella syndrome.
11. Obesity. Adverse perinatal outcomes associated with maternal obesity include neural tube defects, preterm delivery, diabetes, cesarean section, and hypertensive and thromboembolic disease. Appropriate weight loss and nutritional intake before pregnancy reduces these risks.
12. Oral anticoagulant. Warfarin, used to control blood clotting, is demonstrated to be a teratogen. To avoid exposure to warfarin during early pregnancy, medications can be changed to a nonteratogenic anticoagulant before the onset of pregnancy.
13. Sexually transmitted diseases.Chlamydia trachomatis and Neisseria gonorrhoeae have been strongly associated with ectopic pregnancy, infertility, and chronic pelvic pain. Sexually transmitted diseases during pregnancy may result in fetal death or substantial physical and developmental disabilities, including mental retardation and blindness. Early screening and treatment prevents these adverse outcomes.
14. Smoking. Preterm birth, low birthweight, and other adverse perinatal outcomes associated with maternal smoking in pregnancy can be prevented if women stop smoking before or during early pregnancy. Because only 20% of women successfully control tobacco dependence during pregnancy, cessation of smoking before pregnancy is recommended.-JCN