It's often said that preconception counseling is necessary before "having children," and obstetricians and gynecologists frequently encounter people seeking this advice. So, what are the benefits of preconception counseling? What questions are typically asked?
The American College of Obstetricians and Gynecologists (ACOG) has released authoritative guidelines. Here are the key points:
Fertility planning and pregnancy interval
Medical, surgical and psychiatric history
Drug usage
Family history and genetics
Vaccination status
Infectious disease screening
Alcohol, nicotine, and other intake assessment
Family sexual relationships and other situations
Nutritional status assessment
Exercise and physical activity assessment
Environmental assessment
From a doctor's perspective, in addition to asking about the couple's menstrual and reproductive history, medical history, family history, work and lifestyle habits, it should also include their vaccination status, assess their immune capacity, and conduct other appropriate screenings and tests.
Through preconception counseling, obstetricians and gynecologists can offer advice to clients to optimize their health, improve certain risk factors, and provide education on healthy pregnancy to reduce adverse effects on women, fetuses, and newborns.
For example, identifying and reducing risk factors can reduce pregnancy complications, while necessary genetic screening can provide couples with some information to make appropriate decisions about their family's fertility plans.
In addition, understanding the patient’s social background during preconception counseling may help in finding ways to improve prenatal care, including understanding the barriers (physical or psychological) that the counselor may face when receiving healthcare.
Fertility planning and pregnancy interval
Fertility planning forms the basis of preconception counseling, and couples planning to conceive should ideally have a plan for the size of their family. In the United States, approximately 45% of pregnancies are unplanned, and unplanned pregnancies increase the risk of pregnancy complications.
Doctors should advise couples seeking consultation to have a pregnancy interval of no less than 6 months, and to also discuss the pros and cons if they plan to conceive again within 18 months postpartum. If they intend to conceive using assisted reproductive technology, it is recommended that the pregnancy interval be between 6 and 18 months.
If a woman under 35 years old is ovulating and wants to get pregnant, and there are no clear causes of infertility, she should go to the hospital for relevant examinations as soon as possible after 12 months of unprotected sexual intercourse if she has not become pregnant.
Women aged 36 and older should be tested after 6 months. For women with anovulation or clear risk factors for infertility, further testing and treatment are necessary.
Medical, surgical and psychiatric history
Many chronic diseases, such as diabetes, hypertension, mental illness, and thyroid disease, can affect pregnancy outcomes and should be managed before pregnancy.
Drug usage
All prescription and over-the-counter medications should be evaluated during preconception counseling, including nutritional supplements and traditional Chinese medicine.
Those seeking advice may not consider certain products to be drugs, but they may actually affect reproduction and pregnancy, so it is necessary to explain and consult with a doctor about whether there is any impact.
Doctors need to review potentially teratogenic medications and discuss the specific risks of each medication in detail with the client. When the client is taking potentially teratogenic medications, the importance of contraception should be emphasized. For patients who want to become pregnant, potentially teratogenic medications should be switched before stopping contraception.
Wherever it is medically justifiable, the lowest effective dose of the safest drug should be used.
For male partners, it should be asked whether they are using male hormones (such as testosterone). Androgens can cause male azoospermia and infertility, which in some cases can be reversed after discontinuing androgen use.
Family history and genetics
It is necessary to understand the family history and genetic conditions of both spouses, including family history of genetic diseases, birth defects, mental illnesses, breast cancer, ovarian cancer, uterine cancer, and colon cancer.
When one or both partners are diagnosed as carriers of any genetic trait, a comprehensive review of medical records and genetic counseling are recommended, informing the counselor of the impact of the condition and its effect on offspring during preconception and early pregnancy screening.
Vaccination status
Women of childbearing age should have their pertussis-dap (Tdap), measles-mumps-rubella (MMR), hepatitis B, and varicella vaccination status assessed annually.
Everyone should receive an annual flu vaccine, while human papillomavirus (HPV) vaccination and cervical cancer screening should be conducted according to current guidelines.
HPV vaccination is not currently recommended during pregnancy; it is best to complete the vaccination before conception. Rubella and chickenpox vaccines should be administered at least 28 days before pregnancy.
During the preconception screening, it is important to assess whether additional immunizations are needed by understanding health status, lifestyle, and occupational risks that may lead to other infections.
Infectious disease screening
Screening for diseases such as human immunodeficiency virus (HIV), gonorrhea, chlamydia, and syphilis should be conducted based on age and risk factors. High-risk groups for tuberculosis should be screened and treated appropriately before pregnancy.
If you have been exposed to toxoplasmosis pathogens, you should be tested and advised to avoid further exposure.
Alcohol, nicotine, and other intake assessment
For all clients, their intake of alcohol, nicotine products, and medications should be inquired about regularly, including prescription opioids and other medications used for non-medical reasons.
Understand the client's drinking habits and advise them to abstain from alcohol during pregnancy.
Family sexual relationships and other situations
In the United States, more than one-third of women experience rape, physical violence, or being stalked by an intimate partner in their lifetime.
Intimate partner violence screening should be conducted during preconception counseling. Ensuring privacy is a crucial part of this screening. However, patients should be informed that, under the law, they may be required to disclose information or report certain incidents of harm to authorities.
Consultation options include filling out a questionnaire or meeting with a doctor in person.
Sexual coercion includes a range of sexually related behaviors that a sexual partner may use, such as forcing someone to have sex without the use of force. The most common examples include not using contraception, forcing pregnancy, and putting pressure on someone to get pregnant.
If abuse is confirmed to be occurring, the safety of the victim and their family should be ascertained, and community resources should be provided to the victim.
Nutritional status assessment
All women of childbearing age (15-45 years) should supplement with folic acid. Women at moderate risk of neural tube defects (NTD) in their fetus need to supplement with 400 μg of folic acid daily. Women at higher risk, including those who had NTD or epilepsy symptoms before pregnancy, are advised to take 4 mg of folic acid daily.
Taking vitamins before childbirth can reduce the risk of miscarriage, but diet and vitamin supplements should be carefully selected to determine whether the recommended daily intake of calcium, iron, vitamin A, vitamin B, vitamin D, and other nutrients is being met.
Moderate caffeine intake (<200 mg per day) is generally not a major factor leading to miscarriage or premature birth.
Listeria infection in pregnant women is associated with premature birth, other obstetric diseases, and neonatal complications. Pregnant women should be advised to avoid foods with a high risk of Listeria contamination.
Exercise and physical activity assessment
Couples trying to conceive should engage in moderate exercise for at least 30 minutes daily, 5 days a week, with a total weekly exercise time of at least 150 minutes. Combining exercise with dietary adjustments is more effective for weight loss than exercise alone.
Competitive athletes should pay special attention to avoiding heat therapy and maintaining adequate hydration and calorie intake to prevent weight loss from negatively impacting fetal growth.
Environmental assessment
A growing body of strong evidence suggests that environmental pollution, workplace teratogens, and endocrine disruptors can affect fertility and pregnancy. By the time a woman discovers she is pregnant, her organs may already be damaged.
For these reasons, it is recommended to confirm medical history and environmental exposures before pregnancy.
Exposure can occur at home (e.g., bisphenol A-containing plastics, pesticides, lead paint, asbestos) and at work, especially in sectors with potentially hazardous exposure, including agriculture (pesticides), manufacturing (organic solvents and heavy metals), dry cleaning (solvents), and the medical industry (biological agents and radiation).
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