Trimester zero (Part 1 of 2)
Pregnancy wellness begins before the positive pregnancy test.
Preconception care is primary prevention. The goal is to affirm pregnancy intention, reduce any potential harm, and recognize modifiable risk factors related to pregnancy while stratifying pregnancies on a continuum of low- to high-risk. The Centers for Disease Control and Prevention (CDC) has defined preconception care as “a set of interventions that aim to identify and modify medical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management.”1
A recent consensus statement from the National Preconception Health and Health Care Initiative defined 9 specific preconception wellness measures to confirm high-quality preconception care: 1) pregnancy intention; 2) access to care; 3) preconception multivitamin with folic acid; 4) tobacco avoidance; 5) absence of uncontrolled depression; 6) healthy weight; 7) absence of sexually transmitted infections (STIs); 8) optimal glycemic control in women with pregestational diabetes; and 9) teratogenic medication avoidance.2
By the time most women realize they are pregnant, organogenesis has begun and many prevention strategies (such as folic acid to prevent neural-tube defects (NTDs) or glycemic control to prevent diabetic embryopathy) are suboptimal in effect even if promptly initiated.3 Women who were given preconception counseling demonstrated a 50% greater likelihood of their subsequent pregnancies being intended.4Several organizations have focused on optimizing health before conception, which resulted in development of clinical recommendations and educational materials for providers and patients (Table 1).
Components of preconception counseling
The first step in preconception care is reproductive counseling, including counseling about contraceptive options because nearly half of all pregnancies in the United States are unplanned.5 Following confirmation of pregnancy intention, a thorough history is indicated. Several questionnaires and forms are available for this purpose (Table 2).