Timely preconception interventions for certain conditions can substantially improve maternal health and birth outcomes. Separating childbearing from the management of chronic health problems and infectious diseases places women, their future pregnancies, and their future children at unnecessary risk. Conditions and risk factors have been identified for which the following exist 1) evidence of potential harm to mother or baby, 2) high prevalence of adverse pregnancy outcome or effective interventions for reducing adverse pregnancy outcomes, and 3) one or more effective interventions that have been evaluated.

Certain women and men need additional counseling and interventions. For example, women who have conditions treated with medications that are known teratogens (e.g., anticonvulsant or anticoagulant medications and isotretinoins) might need to change prescriptions. Women with medical conditions associated with increased risks for morbidity and mortality to mother and fetus (e.g., diabetes, hypertension, heart disease, rubella sero-negativity, thrombophilias, dental disease, or obesity) need to control these conditions. Women with behaviors associated with increased health risks for the fetus (e.g., smoking and alcohol and illicit drug use) also need targeted interventions. Another group with specific counseling needs includes prospective parents with a family history of inherited (i.e., genetic) disorders.

The preparers of this report analyzed the National Ambulatory Medical Care Survey and demonstrated that diabetes affects approximately 1.85 million (21 per 1,000) women in the United States aged 18--44 years, and that preconceptional diabetes management has the potential to reduce the risk for pregnancy loss and congenital malformation for approximately 113,000 births per year. Anti-epileptic/antiseizure drugs are prescribed for approximately 1 million women (19 per 1,000), potentially affecting an estimated 75,000 pregnancies. Approximately 7 million (125 per 1,000) women of childbearing age are frequent drinkers, and without preconception interventions, alcohol misuse might affect approximately 577,000 births per year. Women with chronic medical conditions and their specialty providers should take advantage of every opportunity to discuss preconception health and risks. These conditions and risk factors affect substantial proportions of the approximately 4 million pregnancies that occur in the United States each year.

Studies of preconception care have indicated that providers do not routinely provide interventions for identified preconception risks. Dissemination of professional guidelines and evidence-based interventions are two vital ways to encourage changes in practice. However, quality improvement tools and techniques offer increased potential, particularly for specific interventions for women with identified conditions. Research has increasingly indicated that providers and health-care organizations are more likely to engage in evidence-based or best clinical practices, after participation in quality improvement projects (e.g., rapid improvement cycles using the plan/do/study/act approach, collaborative groups, or the model of improvement process that involves an aim/change/measure cycle). Incorporation of preconception care modules into the curricula of medical graduate, postgraduate, and continuing medical education might be another method of disseminating messages regarding the importance and content of preconception care for women .