A comprehensive peri-natal program involves a coordinated approach to medical and psycho-social support that optimally begins before conception. Preconception care therefore should be an integral part of Well Women health care because it permits identification of those conditions or risk factors that could affect a future pregnancy or fetus, and promotes early intervention. Preconception care therefore, permits targeted prenatal care to optimize outcomes and potentially renders mother and fetus amenable to intervention. Preconception healthcare improves pregnancy outcomes for example, one of the causes of infant mortality in the United States is birth defects. Most birth defects occur between 17 and 56 days after conception, often before pregnancy is confirmed and advent of the first prenatal visit.
Additionally, when started at least one month before conception, folic acid supplements reduce the incidence of neural tube defects including Spina Bifida and Anencephaly. Many women have their first prenatal visit at eight weeks of pregnancy or later, the period of time before the first prenatal visit, however, carries the greatest risk to fetal development. (American Family Physician; June15, 2002)
The purpose of this curriculum, is to provide a manual of instruction for Nurses and other practitioners serving women of childbearing age. It is designed to assist local health departments improve the knowledge base of reproductive health care providers, and to assure the delivery of preconception health care that will significantly impact infant mortality in populations at risk. Recommendations for maternal and child care are based on current practice standards from the American College of Obstetrics and Gynecology (ACOG), and the American Academy of Pediatrics (AAP), as well as State guidelines and other materials listed in the reference section. These materials reflect a consensus that women of child bearing age need preconceptional/ inter-conceptional care that is consistent, comprehensive, and risk-appropriate.
Preconception Care Defined
Preconception care is the provision of services directed towards the identification of medical and social problems prior to conception. It can be defined as care which adds a different dimension to the usual primary care, as it focuses on the provision of prevention and intervention strategies designed to promote healthy pregnancy outcomes. (American Academy of Pediatrics Fifth Edition)
Goal of Preconception Care
- To enhance knowledge, and improve attitudes and value for health care prior to conception
- To assure that women of childbearing age in the State of Illinois receive evidenced-based risk screening, health promotion, and intervention that will enable them to enter a pregnancy in good health.
- To identify reversible health risks to pregnancy outcome, emphasizing factors that must be acted on before conception or to achieve optimal pregnancy outcomes.
- To educate women on risk prevention before pregnancy. Education regarding exercise, obesity, nutrition, occupational hazards, family support, and financial issues related to pregnancy contribute to a better-prepared patient, whose prospects are good for a healthy outcome.
CDC recommendations to improve reproductive health include the following :
- Individual responsibility across the life span
- Consumer Awareness
- Preventive visits
- Interventions for identified risks
- Inter-conception Care
- Pre-pregnancy Checkup
- Health Insurance Coverage for women with low incomes
- Public health programs and strategies
These recommendations require changes in consumer knowledge, clinical practice and public health programming, which will necessitate in-service education and training.
At the completion of a period of training, providers of preconception care will be able to:
- Assist client to develop a reproductive life plan.
- Increase public awareness of the importance of preconception health.
- Provide risk assessment, and health promotion counseling to women of child bearing age.
- Provide interventions for identified risks.
- Provide interventions to women who have had a previous pregnancy that ended in an adverse outcome.
- Provide pre-pregnancy check-up to couples planning a pregnancy.
- Increase awareness regarding the necessity of Health Insurance Coverage for women with low income
- Integrate components of preconception health into existing local public health programs
- Increase evidence based practice, and use of the evidence to improve preconception health.
- Develop measurable outcomes, and evaluate them to determine program effectiveness.