Preconception Health Services
Definition
Preconception describes anytime that a woman of reproductive potential is not pregnant but at risk of becoming pregnant, or when a man is at risk for impregnating his female partner. Preconception health services promote health before conception thereby reducing pregnancy-related adverse outcomes (low birth weight, premature birth, and infant mortality) and improve the health of male and female clients even if they choose not to have children.
Subjective
Must include:
A. Reproductive Life Plan
B. Medical history
1. Immunizations
2. Medications
3. Present infectious or chronic health conditions
4. Genetic conditions
5. Environmental exposures
6. Social history/risk behaviors
7. Sexual health assessment and risk assessment
8. Mental health
9. Zika Risk Assessment
a. Travel-self and partner(s)
1) Past travel –last 8 months –where and when
2) Plans for future travel –where and when
Must Include for Females:
1. Reproductive history
2. Obstetrical/Gynecology history
3. Family history
4. Intimate partner violence
Must include for Men:
1. Past medical/surgical history that might impair reproductive health
2. Medical conditions associated with reproductive failure that could reduce sperm quality
Objective
Must include:
A. Height, weight, BMI (screen for obesity)
B. BP (screen for hypertension)
1. All clients—screen yearly
2. If BP <120/80---screen yearly, continue yearly
3. If BP 120-139/80-89 (either treated or untreated), recheck BP again in same visit and if average BP >140/90 recheck at next visit or in 1 week and refer if sustained BP >140/90.
C. No physical exam is needed for Preconception. Exams may be needed to evaluate problems raised by review of systems or complaints raised by the client.
Laboratory
May include, as indicated based on client history, risk for pregnancy, and level of readiness
A. STD testing
B. Diabetic screening
C. Consider Zika screening if indicated by Zika Risk Assessment.
Assessment
To improve preconception health and health care for non-pregnant clients of reproductive age.
Plan
Identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcomes through prevention and management.
A. Develop an action plan on how to maintain and/or attain a healthy lifestyle to promote a positive planned pregnancy outcome in the future
B. Zika sexual transmission counseling
C. Encourage the client to examine potential health risks (including chronic conditions) and make positive changes where indicated---see client education and referrals below.
D. Facilitate contraceptive services if pregnancy not desired
E. Provide client with listing of community resources
Patient Education
A. Importance of regular preventive health care and chronic disease management.
B. Some medications might be contraindicated in pregnancy, and any current medications taken during pregnancy need to be reviewed by a prenatal care provider (e.g., an obstetrician or midwife).
C. Encourage to take a daily supplement containing (400-800 mcg) of folic acid (or a prenatal vitamin).
D. Avoid smoking, alcohol and other drugs
E. Avoid eating fish that might have high levels of mercury (e.g., King Mackerel, Shark, Sword fish, Tile fish)
F. Offer/Refer for any needed STD screening (including HIV)
G. Refer for age appropriate vaccinations, if indicated
H. Zika virus education and prevention strategies
1. Avoid traveling to impacted areas
2. Avoiding mosquito bites if traveling to impacted areas
3. Using condoms to prevent transmission of virus
4. Avoiding pregnancy if infected or partner infected
a. Risk to unborn fetus
Referral
All clients with high-risk medical/social conditions
References
1. Centers for Disease Control and Prevention (CDC). Providing Quality Family Planning Services, 2014. MMWR: 59(RR-4):1-86.
Available at CDC Providing Quality Family Planning Services PDF
2. Centers for Disease Control and Prevention (CDC) Zika Virus Homepage-http://www.cdc.gov/zika/index.html
Resources
CDC Preconception Health Link
CDC Show Your Love Campaign Link
CDC Vaccine Schedule Link
FDA Fish Pregnancy Advisory Link
CDC Reproductive Life Plan Link
CDC Zika Virus Link
Reviewed/Revised 2017