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 domestic 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; and
• risk of genetic diseases with offer for genetic testing if appropriate (e.g., Tay Sachs, Canavan’s, cystic fibrosis, hemoglobin electrophoresis, PKU, history of birth defects or intellectual disability)

Review environmental exposures such as:

1. lead, pesticides, workplace hazards
2. infectious exposures, including toxoplasmosis, Zika, 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).