Preconceptional

Counseling
Counseling Session

Preconceptional care
A set of interventions that aim to identify and

modify biomedical, behavioral, and social risks

to a womans health or pregnancy outcome
through prevention and management
CDC (Johnson, 2006)

The Goals
Improve knowledge, attitudes, and behaviors of men

and women related to preconceptional health

Assure that all women of childbearing age receive
preconceptional care services including evidence
based risk screening, health promotion, and
interventions that will enable them to enter pregnancy
in optimal health
Reduce risks indicated by a previous adverse
pregnancy
outcome
through
interconceptional
interventions to prevent or minimize recurrent adverse
outcomes
Reduce the disparities in adverse pregnancy outcomes

Preconceptional
Counseling
The

American College of Obstetricians and

Gynecologists (2012) also has reaffirmed the
importance of preconceptional and interpregnancy
care
To illustrate potentially modifiable conditions, data
that describe the health status of women who gave
birth to liveborn infants in the United States in 2004
are reviewed. Table 8-1 demonstrates the high
prevalence of many conditions that may be
amenable to intervention during the preconceptional
and interpregnancy periods (DAngelo, 2007).

Preconceptional
Counseling
Preventative strategies (mitigate these potential
pregnancy risks) conception
Realizing pregnancy (1 to 2 weeks after the first
missed period)the embryo begun to form
prevention strategies
e.g folic acid to prevent NTD will be ineffective if
initiated at this time
Up to half of all pregnancies are unplanned, and often
these are at greatest risk

Preconceptional
Counseling
Moos, 2004
Moos and
coworkers
(1996)

Randomized trials : PCC efficacy

Withholding such counseling would be
unethical
Pregnancy outcomes are dependent on the
interaction of various maternal, fetal, and
environmental factors
Difficult to ascribe salutary outcomes to a
specific intervention

Prospective observational and case-control

studies : demonstrate the successes of PCC
(assessed the effectiveness of a PCC program
administered during routine health care
provision to reduce unintended pregnancies)

Preconceptional
Counseling
van der
Zee and
associat
es
(2013)

Ethical aspects of paternal lifestyle

modification reviewed
456 counseled women had a 50% greater
likelihood of subsequent pregnancies that
they considered intended compared with
309 uncounseled women
Counseled group had a 65% higher rate of
intended pregnancy compared with women
who had no health care before pregnancy.

Counseling Session
Gynecologists
Internists
Family
practitioners
Pediatricians
Negative pregnancy test
education

Best opportunity
to prevent
counseling
during periodic
health
maintenance
examinations
excellent time for

Jack and
colleagu
es
(1995)

Comprehensive preconceptional risk survey to 136 such

women
Reported at least one problem that could affect a future
pregnancy (almost 95%)
Included medical or reproductive problems (52%)
Family history of genetic disease (50%)
Increased risk of human immunodeficiency virus
infection (30%)
Increased risk of hepatitis B and illegal substance
abuse (25%)
Alcohol use (17%)
Nutritional risks (54%)

Counseling Session
Counselors knowledge :
Relevant medical diseases
Prior surgery
Reproductive disorders/genetic interpret data
and recommendations provided by other
specialists
Refer
to appropriate counselor if the

practitioner is uncomfortable providing

guidance

Counseling Session
Information collection may be time consuming
depending on the number and complexity of factors that
require assessment

The intake evaluation review of :

medical
obstetrical
social
family histories

Useful information asking specific questions (history

and each family member than by asking general, openended questions)

Counseling Session
Some important information
questionnaires
Answers are reviewed with the couple to
ensure appropriate follow-up, including
obtaining relevant medical records