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:

1. Lead, pesticides, workplace hazards
2. Infectious exposures, including toxoplasmosis, latent TB, malaria, HIV, STIs (with offer of HIV, STI testing)
3. Evaluation of vaccine status and offer vaccines if indicated (e.g., rubella, Tdap, hepatitis B, varicella, HPV, influenza, COVID-19)