When Planned, Risk Assessment, Health Promotion, Barriers and Role of Providers

Preconception Care when Pregnancy is planned

Three elements which must be accomplished prior to conception are:

  • Risk assessment
  • Health promotion
  • Medical and psycho-social interventions

1 Risk Assessment

The primary objective of risk assessment is to identify problems that need to be addressed.. The average women of child bearing age is healthy and should have no major problems during pregnancy or during post partum. However some medical, behavioral or psychosocial problems may be overlooked, and others may develop during the innatal period. It is therefore important the providers of well-women's care should pay particular attention to six problems that are commonly missed during prenatal or postpartum care. They are:

  • Family violence - is common among pregnant and postpartum women in the US. Pregnancy is the leading cause of homicide among women of child bearing age in the US
  • Infectious diseases
  • Immunization
  • Nutrition assessment
  • Psycho-social assessment -depression and stress
  • Medical history - preexisting disease states, Heart, Diabetes
  • Physical exam
  • Laboratory tests
  • Family history - genetic issues
  • Teratogens and environmental toxicans
  • Substance abuse, alcohol and tobacco use
  • Financial assessment
  • Obesity - underweight

2 Health Promotion

Factors that could change timing of or choice to conceive include:

Domestic violence

Birth spacing

Genetic disease

Disease with poor prognosis (e.g. AIDS)

Diseases dangerous to pregnancy (e.g. CHF)

Conflict between needed maternal care and fetal well-being

Barriers to Preconception Care Include the Following:

Unintended pregnancy - Incidence if unplanned pregnancy is 49%

Usual entry into prenatal care in the 3rd month after LMP

Planned pregnancies are seldom planned with a health care provider

Unpreparedness of health care providers

Ignorance about the importance of good health habits prior to conception

Limited access to health services

Role of Providers in Preconception Health Care

Every provider of health care services, should provide preconception information and counseling to women of child-bearing age, and should take advantage of opportunities to recruit women into preconception care. These include advising:

  • Patients with a negative pregnancy test about preconception care
  • Patients having evaluation of irregular menses about preconception
  • All sexually active women of child-bearing age to be available for preconception care.
  • Creating public awareness by stimulating consumer demand for preconception and in-conception care. (Recommendations from Perinatal Guidelines, Georgia 1999)