Guideline
OB Guideline 6: Preconception Care
When feasible, the clinician should discuss pregnancy and preconception issues with a patient who is anticipating pregnancy. The patient should be encouraged to consider a preconception visit. Such a visit may include:
- Lifestyle issues including tobacco, alcohol, drugs of abuse, diet, exercise, caffeine, weight, oral care
- Assessment for intimate partner violence and psychosocial issues
- Safety of prescribed and non-prescribed medications, including herbal remedies and alternative choices
- Dietary supplements, including recommendation for folic acid supplementation
- Review of major medical problems or risk factors, such as hypertension, diabetes, advanced age, obesity, eating disorders
- Review of risks of infectious exposure related to travel
- Review of previous pregnancy problems such as date of last birth, gestational age, prior cesarean delivery, gestational diabetes, hypertension in pregnancy
- Review of family history with specific attention to conditions that may place the patient at risk (e.g., parental thromboembolic disease, diabetes)
- Ethnicity
- Genetic counseling, including:
- Providing information about targeted and expanded screening options
- Offering testing for cystic fibrosis and spinal muscular atrophy (SMA) to all patients
- Offering testing as appropriate for ethnicity including:
- Tay Sachs testing, such as for patients of Ashkenazi Jewish, French-Canadian, or Cajun descent
- Canavan’s disease and familial dysautonomia screening, such as for patients of Ashkenazi Jewish descent
- Hemoglobin electrophoresis for those at risk for hemoglobin disorders, such as for patients of Asian, African, Caribbean, or Mediterranean descent
- Others as appropriate to history, family history, or ethnicity - Offering counseling on methods available to screen or test for fetal aneuploidy, including non-invasive prenatal testing (NIPT) in the first trimester
Review environmental exposures such as:
- Lead, pesticides, workplace hazards
- Infectious exposures, including toxoplasmosis, latent TB, malaria, HIV, STIs (with offer of HIV, STI testing)
- Evaluation of vaccine status and offer vaccines if indicated (e.g., rubella, Tdap, hepatitis B, varicella, HPV, influenza, COVID-19)
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