Pre-conception counseling (also called pre-conceptual counseling) is based on the medical theory that all women of child-bearing years should be pre-screened for health and risk potentials "before" attempting to be
pregnant. Physicians and baby experts recommend that a woman visit her physician as soon as the woman is contemplating having a child, and optimally around 3 to 6 months before actual attempts are made to conceive. This time frame allows a woman to better prepare her body for successful conception ( fertilization) and pregnancy, and allows her to reduce any health risks which are within her control. Agencies such as the March of Dimes[http://www.marchofdimes.com/professionals/681_4182.asp] have developed screening tools that physicians can use with their patients. In addition, obstetricians (see Obstetricsand General Practitioner) have developed comprehensive check-lists and assessments for the woman who is planning to become pregnant.
In one sense, Pre-Conception Counseling and Assessment can be compared to a well-baby visit in which a baby is screened for normal health, normal development, with the benefit of identifying emerging problems that may have gone unnoticed in an infant. For a woman, the Pre-Conception Counseling Assessment and Screening is intended to assess normal health of a child-bearing woman, while at the same time identifying:
*Existing or emerging illness or disease which may have gone undetected before, and
*Existing risks for the woman who may become pregnant, and
*Existing risks which may affect a fetus if the woman does become pregnant.
Obstacles to Pre-Conception Counseling
The most common obstacle to pre-conception counseling and assessment is that many pregnancies are still unplanned. If birth control methods fail, there is no opportunity for pre-screening and assessment.The second most common obstacle to pre-conception counseling and assessment is that most women do not know, realize, or understand the benefits of visiting their physician before trying to become pregnant.Most women still take for granted the biological aspects of becoming pregnant, and do not consider the extreme value of pre-screening before becoming pregnant.Most women who want and anticipate having a baby are naturally prone to thinking in terms of having a well baby. In the majority of cases, women do not think about having a baby who has any kind of problem.Most women do not know how their own medical history could pose risks to a developing fetus. Likewise, they may not understand that pregnancy carries a certain number of risks as well. When family history risks and pregnancy risks are considered together, it may point to potential problems for that particular woman, or to her unborn baby once she becomes pregnant.The third most common obstacle to pre-conception counseling and assessment may be the lack of health insurance. However, most insurances will cover this as a screening visit. Also, many physicians will do the pre-conception screening during a regular office visit or gynecological visit if the woman just informs the doctor of her desire to become pregnant. Most gynecologists will inquire about child-bearing intentions anyway.
What is involved in Pre-Conception Counseling?
Pre-screening covers many body-system areas (not just the reproductive organs), as well as aspects of the woman's lifestyle, and family history information. It begins with basic information and becomes more in-depth, especially if the woman has had previous illnesses, diseases, etc. Pre-screening assessments begin with a questionnaire which the woman fills out, generally before seeing the physician. Some offices have the woman go over parts of the questionnaire with a
Nurse Practitioner, if available.
Certain blood work may be ordered. This often includes a CBC (Complete Blood Count) which can show anemia. A CBC includes WBC (White Blood Cell Count) which can show the presence of infection. Anemia and infection, indicating problems with the woman's overall health at that moment, can both affect a woman's ability to become pregnant at that time as well as affect the stability of the pregnancy and health of the fetus. Fortunately in the majority of cases both infection and anemia can be treated once the cause is identified. Anemia may require ongoing evaluation and iron supplement.
Urine sample or urinalysis can reveal the presence of protein in the urine, often found in diabetes, and the presence of blood which can indicate a urinary tract infection. Urinalysis is useful in other ways also.
Using the assessment
The areas a physician will assess are too numerous to include here. When women have pre-existing illnesses / conditions / diseases, these may add to pre-natal risks and will need ongoing evaluation. Also any medications which are used to treat these conditions will need monitored and possibly reduced or increased.
The presence of Diabetes remains a huge risk for the unborn child, and a woman will be screened specifically for this condition. Known diabetics will need monitored closely. For more information, see this online article Diabetes and Diabetic risks http://journal.diabetes.org/clinicaldiabetes/V18N32000/pg122.htm
The woman's role
A woman may need to adjust certain aspects of her health and well-being which are in her control. These usually include aspects of lifestyle, drug and alcohol use, exercise, rest and stress reduction. In addition, she may need to discontinue certain herbs or over-the-counter medications as recommended by the physician. Many physicians will also recommend pre-natal vitamins before a woman actually conceives in order to boost her overall health.
Pre-Conception Counseling, Assessment and Screening can aide the woman and her unborn child if she conceives. Attention to areas which can be controlled, listed above, can improve a woman's chances to conceive as well as improve the in-utero environment of the fetus and improve the overall health of the fetus. Pre-Conception Counseling, Assessment and Screening also assists the Physician in being aware of pre-existing conditions and areas of potential problems so that he/she can better evaluate and guide the woman-patient. Women who are thinking of getting pregnant should see their physician first, before stopping their current birth control. Investment of time, energy and attention to potential problems during a pre-conception planning stage can greatly benefit both the woman and future pregnancy.
List of counseling topics
1: J Nurse Midwifery. 1993 Jul-Aug;38(4):188-98. Preconception care. An opportunity to maximize health in pregnancy.Summers L, Price RA. Johns Hopkins School of Medicine, Department of Gynecology and Obstetrics, Baltimore, MD 21287-1228.
PMID 8410347 [PubMed - indexed for MEDLINE] 2: Med Clin North Am. 1996 Mar;80(2):337-74. Preconception counseling for the primary care physician.Leuzzi RA, Scoles KS. Division of Internal Medicine, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
PMID 8614177 [PubMed - indexed for MEDLINE]
3: Can Fam Physician. 2003 Jun;49:769-73. Preconception care for women with type 1 diabetes.Klinke J, Toth EL. Department of Medicine, University of Alberta, Edmonton. PMID 12836865
[PubMed - indexed for MEDLINE]
4: J Matern Fetal Med. 2000 Jan-Feb;9(1):14-20. A focused preconceptional and early pregnancy program in women with type 1 diabetes reduces perinatal mortality and malformation rates to general population levels.McElvy SS, Miodovnik M, Rosenn B, Khoury JC, Siddiqi T, Dignan PS, Tsang RC. Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Ohio 45267-0526, USA.
PMID 10757430 [PubMed - indexed for MEDLINE]
5: QJM. 2001 Aug;94(8):435-44. Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis.Ray JG, O'Brien TE, Chan WS. Division of Obstetrical Medicine, Department of Medicine, Women's College Campus, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
PMID 11493721 [PubMed - indexed for MEDLINE]
6: Lupus. 2006;15(3):148-55. Lupus nephritis and renal disease in pregnancy.Germain S, Nelson-Piercy C. Obstetric Medicine, Guy's & St Thomas' Hospitals, London, UK.
PMID 16634368 [PubMed - indexed for MEDLINE]
7: J Postgrad Med. 2006 Jan-Mar;52(1):57-64. Management of epilepsy and pregnancy. Thomas SV. Indian Registry of Epilepsy and Pregnancy, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum. 695011, India.
PMID 16534170 [PubMed - indexed for MEDLINE]
8: Nephron. 2001 Jan;87(1):85-8. Successful pregnancy in a patient with polycystic kidney disease and advanced renal failure without prophylactic dialysis.Hassan K, Weissmam I, Osman S, Gery R, Oettinger M, Shasha SM, Kristal B. Nephrology and Hypertension Unit, Western Galilee Hospital, Nahariya 22100, Israel.
PMID 11174031 [PubMed - indexed for MEDLINE]
9: AIDS Read. 2005 Aug;15(8):420-3,426-8. Comment in: AIDS Read. 2005 Aug;15(8):426. Gynecologic care and family planning for HIV-infected women.Aaron E, Levine AB. Women's Services, Department of Medicine/Division of HIV/AIDS Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
PMID 16110557 [PubMed - indexed for MEDLINE]
10: Lancet. 1985 Dec 7;2(8467):1297-8. Nutrition and pre-conception care. [No authors listed]
PMID 2866353 [PubMed - indexed for MEDLINE]
11: Br J Nurs. 2006 Jan 26-Feb 8;15(2):90-4. Pre-conception care and support for women with diabetes.Hofmanova I. Obstetrics and Gynaecology Outpatients Department, Royal Free Hospital, London.
PMID 16493284 [PubMed - indexed for MEDLINE]
12: J Perinat Neonatal Nurs. 2004 Jan-Mar;18(1):14-25; quiz 26-7. Preconception care of women with diabetes.Kendrick JM.Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, Tenn, USA.
PMID 15027665 [PubMed - indexed for MEDLINE]
13: J Pediatr Health Care. 2004 Jan-Feb;18(1):40-4. Preconception education: caring for the future.Gottesman MM. Ohio State University College of Nursing, Columbus, Ohio, USA.
PMID 14722506 [PubMed - indexed for MEDLINE]
14: Nurse Pract. 1996 Nov;21(11):24-6, 32, 34 passim. Comment in: Nurse Pract. 1997 Mar;22(3):14. Preconception care: a health promotion opportunity. Perry LE.
PMID 8933535 [PubMed - indexed for MEDLINE]
15: Adv Nurse Pract. 2000 Nov;8(11):62. Patient information. Before you become pregnant. [No authors listed]
PMID 12397918 [PubMed - indexed for MEDLINE]
16: Soins Pediatr Pueric. 2002 Aug;(207):10-1. [Nutritional counseling and precautions for the future mother] [Article in French] Almeras C.
PMID 12239823 [PubMed - indexed for MEDLINE]
17: J Obstet Gynecol Neonatal Nurs. 2003 Jul-Aug;32(4):523-32. Preconception health counseling for women exposed to teratogens: the role of the nurse.Postlethwaite D.Kaiser Permanente, Northern California, Oakland 94612, USA.
PMID 12903703 [PubMed - indexed for MEDLINE]
18: J Obstet Gynecol Neonatal Nurs. 2003 Jul-Aug;32(4):533-42. Interconceptional counseling after perinatal and infant loss.Wallerstedt C, Lilley M, Baldwin K. University of New Mexico, School of Medicine, Department of OB/GYN, Maternal Fetal Medicine Division, Albuquerque 87131-5256, USA.
PMID 12903704 [PubMed - indexed for MEDLINE]
19: MCN Am J Matern Child Nurs. 2003 Jan-Feb;28(1):24-30; quiz 31. Unintended pregnancies: a call for nursing action.Moos MK.Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 27599-7516, USA.
PMID 12514353 [PubMed - indexed for MEDLINE]
20: J Fam Health Care. 2005;15(5):149-51. How to take a sexual history.Young F.GU Medicine, Isle of Wight.
PMID 16315683 [PubMed - indexed for MEDLINE] 21: Nurs Times. 2003 Sep 2-8;99(35):47. The nurse role in implementing the national sexual health strategy.Johnson M.
PMID 14528762 [PubMed - indexed for MEDLINE]
22: J Obstet Gynecol Neonatal Nurs. 2003 Jul-Aug;32(4):516-22. Full circle: the evolution of preconception health promotion in America.Hobbins D.Veterans Health Administration Salt Lake City HealthCare System, Utah 84148, USA.
PMID 12903702 [PubMed - indexed for MEDLINE]
23: Pediatrics. 2003 May;111 (5 Part 2):1136-41. Binge drinking in the preconception period and the risk of unintended pregnancy: implications for women and their children.Naimi TS, Lipscomb LE, Brewer RD, Gilbert BC. Alcohol Team, Emerging Investigations and Analytic Methods Branch, Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. firstname.lastname@example.org
PMID 12728126 [PubMed - indexed for MEDLINE]
24: J Fam Pract. 1998 Jul;47(1):33-8. Addressing preconception risks identified at the time of a negative pregnancy test. A randomized trial.Jack BW, Culpepper L, Babcock J, Kogan MD, Weismiller D. Department of Family Medicine, Boston University School of Medicine, MA 02118, USA.
PMID 9673606 [PubMed - indexed for MEDLINE]
25: Am Fam Physician. 1995 Jun;51(8):1875-85, 1888-90. Comment in: Am Fam Physician. 1995 Jun;51(8):1807-8. Preconceptual obstetric risk assessment and health promotion.Swan LL, Apgar BS. Department of Family Practice, University of Michigan Medical School, Ann Arbor, USA.
PMID 7762479 [PubMed - indexed for MEDLINE]
26: Mayo Clin Proc. 2002 May;77(5):469-73. Preconception care by the nonobstetrical provider.Frey KA.Department of Family Medicine, Mayo Clinic, Scottsdale, AZ 85260, USA.
PMID 12004996 [PubMed - indexed for MEDLINE]
27: Prim Care. 1997 Mar;24(1):123-33. Contraception and preconception counseling.Heath CC, Sulik SM. Department of Family Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical Center, New Brunswick, New Jersey 08903-0019, USA.
PMID 9016731 [PubMed - indexed for MEDLINE]
28: Prev Med. 2002 May;34(5):505-11. Preconception care: a screening tool for health assessment and risk detection.de Weerd S, van der Bij AK, Cikot RJ, Braspenning JC, Braat DD, Steegers EA. Department of Obstetrics and Gynecology, University Medical Center Nijmegen, The Netherlands.
PMID 11969350 [PubMed - indexed for MEDLINE]
29: Prim Care. 2000 Mar;27(1):1-12. Periconception care.Morrison EH.Department of Family Medicine, University of California, Orange, 93868, USA.
PMID 10739454 [PubMed - indexed for MEDLINE]
30: Pract Midwife. 2003 Nov;6(10):26-8. Family matters: taking a genetic history.McGregor S, Parker E. University of Glamorgan.
PMID 14639917 [PubMed - indexed for MEDLINE]
31: Nurse Pract. 2004 May;29(5):19-27; quiz 27-9. Assessing adults with mental disorders in primary care.Davis B.University of Mississippi School of Nursing, Jackson, Miss, USA.
PMID 15167531 [PubMed - indexed for MEDLINE]
32: Harefuah. 2004 Jul;143(7):530-6, 547. [Preconception counseling--for all] [Article in Hebrew] Riskin-Mashiah S.Department of Obstetrics and Gynecology, Carmel Medical Center, High Risk Pregnancy Clinic, Lin and Zvulun Women Health Centers, Haifa.
PMID 15669431 [PubMed - indexed for MEDLINE]
33. Fam Pract. 2003 Apr;20(2):142-6. Women's interest in GP-initiated pre-conception counselling in The Netherlands.PMID 12651787 [PubMed - indexed for MEDLINE]
34. Rao S, Lindow SW, Masson EA. Related Articles, Survey of pre-conception counselling.Diabet Med. 2002 Jul;19(7):615. No abstract available. PMID 12099968 [PubMed - indexed for MEDLINE]
35. Isr Med Assoc J. 2000 Jan;2(1):10-3. Maternal obesity and pregnancy outcome.PMID 10892363 [PubMed - indexed for MEDLINE]
36: Seizure. 1999 Sep;8(6):322-7. Betts T, Fox C. Proactive pre-conception counselling for women with epilepsy-is it effective?
PMID 10512771 [PubMed - indexed for MEDLINE]
37: Am J Obstet Gynecol. 2005 Jan;192(1):227-32. Preconception care in managed care: the translating research into action for diabetes study. Kim C, Ferrara A, McEwen LN, Marrero DG, Gerzoff RB, Herman WH; TRIAD Study Group. Department of Internal Medicine, University of Michigan, Ann Arbor, Mich, USA.
PMID 15672029 [PubMed - indexed for MEDLINE]
38: JAMA. 1999 Oct 27;282(16):1583-8. Comment in: JAMA. 1999 Oct 27;282(16):1581-2. Physician counseling about exercise. Wee CC, McCarthy EP, Davis RB, Phillips RS. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass 02215, USA. email@example.com
PMID 10546701 [PubMed - indexed for MEDLINE]
39: Fam Pract. 2003 Apr;20(2):142-6. Women's interest in GP-initiated pre-conception counselling in The Netherlands.de Jong-Potjer LC, de Bock GH, Zaadstra BM, de Jong OR, Verloove-Vanhorick SP, Springer MP. Department of General Practice and Nursing Home Medicine, Leiden University Medical Center, PO Box 2088, The Netherlands. L.C.de_Jong-Potjer@LUMC.nl
PMID 12651787 [PubMed - indexed for MEDLINE]
40: MCN Am J Matern Child Nurs. 2002 Sep-Oct;27(5):275-80; quiz 281. Oral health during pregnancy.Mills LW, Moses DT. Capstone College of Nursing, University of Alabama, Tuscaloosa, AL 35487-0358, USA. firstname.lastname@example.org
PMID 12209058 [PubMed - indexed for MEDLINE]
41: Nurs Stand. 2006 Jun 21-27;20(41):59-64; quiz 66. Chlamydia: the nurse's role in diagnosis, treatment and health promotion.Flannigan J.University of Central Lancashire, Preston. email@example.com
PMID 16827205 [PubMed - indexed for MEDLINE]
42: J Obstet Gynecol Neonatal Nurs. 2005 Jan-Feb;34(1):120-4. Promoting nutrition in breastfeeding women.Wilson PR, Pugh LC. Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205, USA. firstname.lastname@example.org
PMID 15673655 [PubMed - indexed for MEDLINE]
43: Can Fam Physician. 2005 Sep;51:1199-201. Preventing fetal alcohol spectrum disorders. Preconception counseling and diagnosis help.Tough SC, Clarke M, Clarren S.
PMID 16190170 [PubMed - indexed for MEDLINE]
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