ACOG Committee

Opinion
Committee on
Gynecologic Practice

This document reflects emerging

clinical and scientific advances as of Number 313, September 2005
the date issued and is subject to
change. The information should not
be construed as dictating an exclu-
sive course of treatment or procedure
to be followed.
The Importance of Preconception
The Committee wishes to thank the
ACOG Preconception Care Work
Care in the Continuum of Women’s
Group co-chairs, Michele G. Curtis,
MD, and Paula J. Adams Hillard, Health Care
MD, and members, Hani K. Atrash,
MD, MPH; Alfred Brann Jr, MD; ABSTRACT: The goal of preconception care is to reduce the risk of adverse
Siobhan M. Dolan, MD, MPH; Ann health effects for the woman, fetus, or neonate by optimizing the woman’s health
Lang Dunlop, MD; Ann Weathersby, and knowledge before planning and conceiving a pregnancy. Because reproduc-
CNM, MSN; and Gerald Zelinger,
MD, for their assistance in the devel- tive capacity spans almost four decades for most women, optimizing women’s
opment of this opinion. health before and between pregnancies is an ongoing process that requires
access to and the full participation of all segments of the health care system.
Copyright © September 2005 by the
American College of Obstetricians Although most pregnancies result in good maternal and fetal outcomes, some
and Gynecologists. All rights
reserved. No part of this publication pregnancies may result in adverse health effects for the woman, fetus, or
may be reproduced, stored in a neonate. Although some of these outcomes cannot be prevented, optimizing
retrieval system, or transmitted, in any a woman’s health and knowledge before planning and conceiving a preg-
form or by any means, electronic,
mechanical, photocopying, recording, nancy—also referred to as preconception care or prepregnancy care—may
or otherwise, without prior written eliminate or reduce the risk. For example, initiation of folic acid supplemen-
permission from the publisher. tation at least 1 month before pregnancy reduces the incidence of neural tube
Requests for authorization to make defects such as spina bifida and anencephaly (1–3). Similarly, adequate glu-
photocopies should be cose control in a woman with diabetes before conception and through-
directed to:
out pregnancy can decrease maternal morbidity, spontaneous abortion, fetal
Copyright Clearance Center malformation, fetal macrosomia, intrauterine fetal death, and neonatal mor-
222 Rosewood Drive
Danvers, MA 01923 bidity (4).
(978) 750-8400 Nearly half of all pregnancies in the United States are unintended (5).
Therefore, the challenge of preconception care lies not only in addressing
pregnancy planning for women who seek medical care and consultation
The American College of
Obstetricians and Gynecologists specifically in anticipation of a planned pregnancy but also in educating and
409 12th Street, SW screening all reproductively capable women on an ongoing basis to identify
PO Box 96920 potential maternal and fetal risks and hazards to pregnancy before and
Washington, DC 20090-6920
between pregnancies.
12345/98765 This Committee Opinion reinforces the importance of preconception
The importance of preconception care, provides resources for the woman’s health care clinician, and pro-
care in the continuum of women’s poses that every reproductively capable woman create a reproductive health
health care. ACOG Committee plan. The specific clinical content of preconception care is outlined else-
Opinion No. 313. American College
of Obstetricians and Gynecologists. where (6–8).
Obstet Gynecol 2005;106:665–6 Several national and international medical organizations and advocacy
groups have focused on the optimization of health before conception, result-
VOL. 106, NO. 3, SEPTEMBER 2005 OBSTETRICS & GYNECOLOGY 665
ing in the development of clinical recommendations Preconception and interpregnancy care are com-
and educational materials (see Resources). Core pre- ponents of a larger health care goal—optimizing the
conception care considerations addressed by all health of every woman (9). Because reproductive
include the following factors: capacity spans almost four decades for most women,
optimizing women’s health before and between
• Undiagnosed, untreated, or poorly controlled
pregnancies is an ongoing process that requires
medical conditions
access to and the full participation of all segments of
• Immunization history the health care system.
• Medication and radiation exposure in early
pregnancy
• Nutritional issues
References
1. Czeizel AE, Dudas I. Prevention of the first occurrence of
• Family history and genetic risk neural-tube defects by periconceptional vitamin supple-
• Tobacco and substance use and other high-risk mentation. N Engl J Med 1992;327:1832–5.
behaviors 2. Prevention of neural tube defects: results of the Medical
Research Council Vitamin Study. MRC Vitamin Study
• Occupational and environmental exposures Research Group. Lancet 1991;338:131–7.
• Social issues 3. Botto LD, Moore CA, Khoury MJ, Erickson JD. Neural-
tube defects. N Engl J Med 1999;341:1509–19.
• Mental health issues 4. Pregestational diabetes mellitus. ACOG Practice Bulletin
As medical care rapidly advances, the list of issues No. 60. American College of Obstetricians and Gynecol-
ogists. Obstet Gynecol 2005;105:675–85.
to consider when planning a pregnancy continues to 5. Henshaw SK. Unintended pregnancy in the United States.
grow. Fam Plann Perspect 1998;30:24–9, 46.
Clinicians should encourage women to formu- 6. American Academy of Pediatrics, American College of
late a reproductive health plan and should discuss it Obstetricians and Gynecologists. Guidelines for perinatal
in a nondirective way at each visit. Such a plan would care. 5th ed. Elk Grove Village (IL): AAP; Washington,
DC: ACOG; 2002.
address the individual’s or couple’s desire for a child 7. American College of Obstetricians and Gynecologists.
or children (or desire not to have children); the opti- Guidelines for women’s health care. 2nd ed. Washington,
mal number, spacing, and timing of children in the DC: ACOG; 2002.
family; and age-related changes in fertility. Because 8. American College of Obstetricians and Gynecologists,
many women’s plans change over time, creating a American College of Medical Genetics. Preconception
and prenatal carrier screening for cystic fibrosis. Clinical
reproductive health plan requires an ongoing consci- and laboratory guidelines. Washington, DC: ACOG; 2001.
entious assessment of the desirability of a future 9. American College of Obstetricians and Gynecologists.
pregnancy, determination of steps that need to be Access to women’s health care. ACOG Statement of
taken either to prevent or to plan for and optimize a Policy. Washington, DC: ACOG; 2003.
pregnancy, and evaluation of current health status and
other issues relevant to the health of a pregnancy. Resources
A question such as “Are you considering preg-
American College of Obstetricians and Gynecologists
nancy, or could you possibly become pregnant?” can www.acog.org
initiate several preconception care interventions,
American Academy of Family Physicians
including those listed as follows: www.aafp.org
• A dialogue regarding the patient’s readiness for American Academy of Pediatrics
pregnancy www.aap.org
• An evaluation of her overall health and opportu- American College of Nurse-Midwives
nities for improving her health www.acnm.org
• Education about the significant impact that American Society for Reproductive Medicine
social, environmental, occupational, behavioral, www.asrm.org
and genetic factors have in pregnancy Association of Women’s Health, Obstetric and Neonatal
• Identification of women at high risk for an Nurses
www.awhonn.org
adverse pregnancy outcome
Centers for Disease Control and Prevention National Center
If pregnancy is not desired, current contraceptive use on Birth Defects and Developmental Disabilities
and options should be discussed to assist the patient www.cdc.gov/ncbddd
in identifying the most appropriate and effective March of Dimes
method for her. www.marchofdimes.com

666 ACOG Committee Opinion The Importance of Preconception Care OBSTETRICS & GYNECOLOGY