Pre-conception counseling in the United States allows for optimization of US prenatal care. ''Pre-conception counseling'' is a meeting with a health-care professional (generally a

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

midwife A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; co ...

) by a woman ''before'' attempting to become

pregnant Pregnancy is the time during which one or more offspring develops (gestation, gestates) inside a woman, woman's uterus (womb). A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occur ...

. It generally includes a ''pre-conception risk assessment'' for any potential

complications of pregnancy Complications of pregnancy are health problems that are related to pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal di ...

Obstacles to pre-conception counseling in the United States

Obstacles to pre-conception counseling in the United States include: *It is too late in unintended pregnancies. The rate of

Unintended pregnancy in the United States Unintended pregnancies are pregnancies that are mistimed, unplanned or unwanted at the time of conception. Sexual activity without the use of effective contraception through choice or coercion is the predominant cause of unintended pregnancy. Wo ...

is approximately 49%. Half of unintended pregnancies result from not using birth control, and 45% of them from using birth control inconsistently or incorrectly. *Women not knowing, realizing, or understanding the benefits of visiting their physician or

before trying to become pregnant. *Another common obstacle to pre-conception counseling and assessment may be the lack of

health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...

. However, most insurances will cover this as a screening visit. Also, many physicians will do the pre-conception screening during a regular office visit or gynecological visit if the woman just informs the doctor of her desire to become pregnant. Most gynecologists will inquire about child-bearing intentions anyway.

Screening and monitoring in the United States

Screening Screening may refer to: * Screening cultures, a type a medical test that is done to find an infection * Screening (economics), a strategy of combating adverse selection (includes sorting resumes to select employees) * Screening (environmental), a ...

and

monitoring Monitoring may refer to: Science and technology Biology and healthcare * Monitoring (medicine), the observation of a disease, condition or one or several medical parameters over time * Baby monitoring * Biomonitoring, of toxic chemical compounds, ...

of women prior to conception is recommended to include the following: * Height and weight to calculate BMI *

Blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...

Medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is information gained by a physician by asking specific questions, either to the patient or to other peo ...

Abdominal The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...

and

pelvic examination A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, dis ...

Rubella Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and ...

* Varicella *

Domestic violence Domestic violence (also known as domestic abuse or family violence) is violence or other abuse that occurs in a domestic setting, such as in a marriage or cohabitation. ''Domestic violence'' is often used as a synonym for ''intimate partner ...

* Depression *

Blood lipids Blood lipids (or blood fats) are lipids in the blood, either free or bound to other molecules. They are mostly transported in a protein capsule, and the density of the lipids and type of protein determines the fate of the particle and its influence ...

(cholesterol and HDL) *

Cervical screening Cervical screening is the process of detecting and removing abnormal tissue or cells in the cervix before cervical cancer develops. By aiming to detect and treat cervical neoplasia early on, cervical screening aims at Preventive healthcare#Seconda ...

However, the overall lack of evidence precludes a recommendation for universal screening for

thyroid disease in pregnancy Thyroid disease in pregnancy can affect the health of the mother as well as the child before and after delivery. Thyroid disorders are prevalent in women of child-bearing age and for this reason commonly present as a pre-existing disease in pregnan ...

Rubella screening

Screening for rubella susceptibility by history of vaccination or by

serology Serology is the scientific study of Serum (blood), serum and other body fluids. In practice, the term usually refers to the medical diagnosis, diagnostic identification of Antibody, antibodies in the serum. Such antibodies are typically formed in r ...

is recommended in the US for all women of childbearing age at their first

preconception counseling Pre-conception counseling (also called pre-conceptual counseling) is a meeting with a health-care professional (generally a physician or midwife) by a woman ''before'' attempting to become pregnant. It generally includes a pre-conception risk ass ...

visit to reduce incidence of

congenital rubella syndrome Congenital rubella syndrome (CRS) can occur in a developing fetus of a pregnant woman who has contracted rubella, usually in the first trimester. If infection occurs 0–28 days before conception, the infant has a 43% risk of being affected. If ...

(CRS).Health Care Guideline: Routine Prenatal Care. Fourteenth Edition.
By the Institute for Clinical Systems Improvement July 2010. It is recommended that all susceptible non-pregnant women of childbearing age should be offered

rubella vaccination Rubella vaccine is a vaccine used to prevent rubella. Effectiveness begins about two weeks after a single dose and around 95% of people become immune. Countries with high rates of immunization no longer see cases of rubella or congenital rubella ...

Varicella screening

Immunity status of varicella should be performed at the pre-conception counseling session, in order to prevent the occurrence of

congenital varicella syndrome Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab ...

and other adverse effects of varicella in pregnancy. Generally, a person with a positive

medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is information gained by a physician by asking specific questions, either to the patient or to other peo ...

of varicella infection can be considered immune. Among adults in the United States having a negative or uncertain history of varicella, approximately 85%-90% will be immune. Therefore, an effective method is that people with a negative or uncertain history of varicella infection have a

to check antibody production before receiving the vaccine. The

CDC The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...

recommends that all adults be immunized if seronegative.

Domestic violence

It is recommended to screen for

domestic violence Domestic violence (also known as domestic abuse or family violence) is violence or other abuse that occurs in a domestic setting, such as in a marriage or cohabitation. ''Domestic violence'' is often used as a synonym for ''intimate partner ...

at a preconception visit, because

domestic violence during pregnancy Pregnancy when coupled with domestic violence is a form of intimate partner violence (IPV) where health risks may be amplified. Abuse during pregnancy, whether physical, verbal or emotional, produces many adverse physical and psychological effec ...

a risk factor for

miscarriage Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical lo ...

, late entry into prenatal care,

stillbirth Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can result in the feeling of guilt or grief in the mother. The term ...

premature labor Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...

and

birth Birth is the act or process of bearing or bringing forth offspring, also referred to in technical contexts as parturition. In mammals, the process is initiated by hormones which cause the muscular walls of the uterus to contract, expelling the f ...

, fetal injury and

low birth weight Low birth weight (LBW) is defined by the World Health Organization as a birth weight of an infant of or less, regardless of gestational age. Infants born with LBW have added health risks which require close management, often in a neonatal intensi ...

, and detection can avail for specific counseling and intervention. There is evidence that direct interview screening result in a higher rate of reporting prenatal domestic abuse than a written, self-report questionnaire method.

Education

Education of women intending to be pregnant is recommended to include: *

Preterm labor Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...

education and prevention *Substance use *Weight and

nutrition and pregnancy Nutrition and pregnancy refers to the nutrient intake, and dietary planning that is undertaken before, during and after pregnancy. Nutrition of the fetus begins at conception. For this reason, the nutrition of the mother is important from before co ...

Domestic violence and pregnancy Pregnancy when coupled with domestic violence is a form of intimate partner violence (IPV) where health risks may be amplified. Abuse during pregnancy, whether physical, verbal or emotional, produces many adverse physical and psychological effe ...

*List of medications,

dietary supplement A dietary supplement is a manufactured product intended to supplement one's diet by taking a pill, capsule, tablet, powder, or liquid. A supplement can provide nutrients either extracted from food sources or that are synthetic in order ...

herbal supplement Herbal medicine (also herbalism) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. With worldwide research into pharmacology, some herbal medicines have been translated into modern remedies ...

s *Accurate recording of menstrual dates *Counseling in case of potential vaginal birth after Caesarean

Vaccination and prophylaxis

Vaccination Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating ...

and other prophylaxis of women intending to become pregnant is recommended to include: *

Tdap The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis (whooping cough), and tetanus. The vaccine components include diphtheria and tetanus toxoids and either kille ...

or tetanus booster if needed *

rubella Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and ...

and/or varicella vaccination if needed. Conception should be avoided for 4 weeks after administration of

live attenuated An attenuated vaccine (or a live attenuated vaccine, LAV) is a vaccine created by reducing the virulence of a pathogen, but still keeping it viable (or "live"). Attenuation takes an infectious agent and alters it so that it becomes harmless or less ...

influenza vaccine Influenza vaccines, also known as flu shots, are vaccines that protect against infection by influenza viruses. New versions of the vaccines are developed twice a year, as the influenza virus rapidly changes. While their effectiveness varies fr ...

MMR vaccine The MMR vaccine is a vaccine against measles, mumps, and rubella (German measles), abbreviated as ''MMR''. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, ...

. *

Hepatitis B vaccine Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with poor immune function such as from HIV/AIDS and th ...

* Folic acid supplementation

References

{{reflist Counseling Maternity in the United States Reproduction in the United States