Pre-conception counseling (also called pre-conceptual 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 ...

as well as modifications of risk factors, such as increasing folic acid intake to reduce the risk of neural tube defects and counseling on smoking cessation, alcohol reduction, and medications that may compromise fetal development. Physicians, midwives and baby experts recommend that a woman visit them as soon as the woman is contemplating having a child, and optimally around 3 to 6 months before actual attempts are made to conceive. This time frame allows a woman to better prepare her body for successful conception (

fertilization Fertilisation or fertilization (see spelling differences), also known as generative fertilisation, syngamy and impregnation, is the fusion of gametes to give rise to a new individual organism or offspring and initiate its development. Proce ...

) and pregnancy, and allows her to reduce any health risks which are within her control. Agencies such as the

March of Dimes March of Dimes is a United States nonprofit organization that works to improve the health of mothers and babies. The organization was founded by President Franklin D. Roosevelt in 1938, as the National Foundation for Infantile Paralysis, to comba ...

have developed

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 ...

tools that healthcare providers can use with their patients. In addition, obstetricians or

midwives 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; con ...

(see

Obstetrics Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgi ...

Midwifery Midwifery is the health science and health profession that deals with pregnancy, childbirth, and the postpartum period (including care of the newborn), in addition to the sexual and reproductive health of women throughout their lives. In many cou ...

, General Practitioner) have developed comprehensive check-lists and assessments for the woman who is planning to become pregnant. In one sense, pre-conception counseling and assessment can be compared to a well-baby visit in which a baby is screened for normal health, normal development, with the benefit of identifying emerging problems that may have gone unnoticed in an infant. For a woman, the Pre-Conception Counseling Assessment and Screening is intended to assess normal health of a child-bearing woman, while at the same time identifying: *Existing or emerging illness or disease which may have gone undetected before, and *Existing risks for the woman who may become pregnant, and *Existing risks which may affect a fetus if the woman does become pregnant.

Obstacles to pre-conception counseling

A common obstacle to pre-conception counseling and assessment is that many pregnancies are still unplanned. Globally, 38% of pregnancies are unintended. For this reason, many experts recommend that all women of childbearing age be offered preconception care counseling regardless of intent to become pregnant. Another common obstacle to pre-conception counseling and assessment is of women not knowing, realizing, or understanding the benefits of visiting their physician or

before trying to become pregnant. Most women still take for granted the biological aspects of becoming pregnant, and do not consider the value of pre-screening before becoming pregnant. Most women who want and anticipate having a baby are naturally prone to thinking in terms of having a well baby. In the majority of cases, women do not think about having a baby who has any kind of problem. Most women do not know how their own medical history could pose risks to a developing

fetus A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal deve ...

. Likewise, they may not understand that pregnancy carries a certain number of risks as well. When family history risks and pregnancy risks are considered together, it may point to potential problems for that particular woman, or to her unborn baby once she becomes pregnant.

What is involved in pre-conception counseling?

Questionnaire

Pre-screening covers many body-system areas (not just the reproductive organs), as well as aspects of the woman's lifestyle, and family history information. It begins with basic information and becomes more in-depth, especially if the woman has had previous illnesses, diseases, etc. Pre-screening assessments begin with a questionnaire which the woman fills out, generally before seeing the physician or

. Some offices have the woman go over parts of the questionnaire with a

Nurse Practitioner A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe m ...

, if available.

Blood work

Certain blood work may be ordered. Preconception counseling and testing identify couples at risk for hemoglobinopathies that might affect their offspring. This often includes a CBC (Complete Blood Count) which can show

anemia Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, th ...

. A CBC includes WBC (White Blood Cell Count) which can show the presence of infection. Anemia and infection, indicating problems with the woman's overall health at that moment, can both affect a woman's ability to become pregnant at that time as well as affect the stability of the pregnancy and the health of the fetus. In the majority of cases, both infection and anemia can be treated once the cause is identified. Anemia may require ongoing evaluation and iron supplement. Based on these results, patients may be offered genetic counseling, hematology consultation, and fetal diagnostic testing.

Urinalysis

Urine sample or

urinalysis Urinalysis, a portmanteau of the words ''urine'' and ''analysis'', is a panel of medical tests that includes physical (macroscopic) examination of the urine, chemical evaluation using urine test strips, and microscopic examination. Macroscopic e ...

can reveal the presence of

proteinuria Proteinuria is the presence of excess proteins in the urine. In healthy persons, urine contains very little protein; an excess is suggestive of illness. Excess protein in the urine often causes the urine to become foamy (although this symptom ma ...

(protein in the urine), a possible indicator of infection or kidney disease, or the presence of blood which can indicate a

urinary tract infection A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...

. Urinalysis might also show the presence of glucose (

glycosuria Glycosuria is the excretion of glucose into the urine. Ordinarily, urine contains no glucose because the kidneys are able to reabsorb all of the filtered glucose from the tubular fluid back into the bloodstream. Glycosuria is nearly always caused ...

), but women of child-bearing age are unlikely to have undiagnosed diabetes (this is separate from

gestational diabetes Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms; however, it increases the risk of pre-eclampsia, depression, and of ...

that may occasionally develop during the course of a subsequent pregnancy).

Using the assessment

Physicians

When women have pre-existing illnesses / conditions / diseases, these may add to pre-natal risks and will need ongoing evaluation. Also any medications which are used to treat these conditions will need monitored and possibly reduced or increased. The presence of Diabetes remains a huge risk for the unborn child, and a woman will be screened specifically for this condition. Known diabetics will need monitored closely. For more information, see this online article Diabetes and Diabetic risks.

The woman's role

A woman may need to adjust certain aspects of her health and well-being which are in her control. These usually include aspects of lifestyle, drug and alcohol use, exercise, rest and stress reduction. In addition, she may need to discontinue certain herbs or over-the-counter medications as recommended by her healthcare provider. Many physicians will also recommend pre-natal vitamins before a woman actually conceives in order to boost her overall health.

In the United States

Pre-conception counseling in the United States 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 or midwife) by a woman ''before'' attempting to become p ...

is recommended to include:Health Care Guideline: Routine Prenatal Care. Fourteenth Edition.
By the Institute for Clinical Systems Improvement. July 2010. * 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 screening * Varicella screening * Domestic violence screening * Depression screening * Testing for

Gonorrhea Gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium '' Neisseria gonorrhoeae''. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with ...

and

Chlamydia Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium ''Chlamydia trachomatis''. Most people who are infected have no symptoms. When symptoms do appear they may occur only several wee ...

for women at high risk for

STD Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and oral sex ...

References

{{DEFAULTSORT:Pre-Conception Counseling Counseling Maternal health Midwifery