Prepregnancy counseling offers patients and physicians an opportunity to improve fetal and maternal pregnancy outcomes. Both the American College of Gynecologists and the American Society for Reproductive Medicine support prepregnancy counseling services as a “core component” of women’s healthcare. According to the ACOG and ASRM, “the goal of prepregnancy counseling is to reduce the risk of adverse health effects for the woman, fetus, and neonate by working with the woman to optimize health, address modifiable risk factors, and provide education about healthy pregnancy.” At IRMS many new patients come initially to determine the status of their fertility, as well as, to discuss concerns they may have about pregnancy, if they have known pre-existing health issues.
Prepregnancy counseling can be provided by a patient’s OB/GYN, as well as, a Reproductive Endocrinologist or a Perinatalogist, all depending on the depth and level of work-up the patient is seeking to obtain.
Who Should Seek Prepregnancy Counseling?
All individuals and couples may benefit from prepregnancy counseling, but it is particularly recommended for those with concerns about conception, about carrying a pregnancy to term, or who have experienced recurrent pregnancy loss. Anyone with a known genetic inheritable trait may seek genetic testing and counseling to determine the risk factors that may exist for any offspring.
What Happens During Prepregnancy Counseling?
Prepregnancy counseling begins with the question, “Would you like to become pregnant in the next year?” and from there, develops into a comprehensive evaluation of a patient’s physiological and social factors, which can affect reproduction. Physicians work to identify any health issues that can hinder pregnancy and form plans to mitigate risk factors in order to reduce potential complications. Physicians also learn about patients’ social contexts so they can anticipate any barriers patients may face when accessing healthcare. In particular, patients can access:
- Discussions of family planning (including family size planning, identifying optimal intervals between pregnancies, and education about the effect of age on fertility and the risk of pregnancy complications posed by unintended pregnancies)
- Reviews of family and genetic history
- Screenings for the same genetic conditions as recommended for pregnant women
- Encouragement to seek medical care before attempting pregnancy or once patients believe they are pregnant to aid in correct dating and to be monitored for any medical conditions that could affect pregnancy
- Discussions of chronic medical conditions such as diabetes, psychiatric illness, hypertension, and thyroid disease and their implications for pregnancy outcomes
- Assessments of immunization status for tetanus toxoid, acellular pertussis (Tdap), measles-mumps-rubella, reduced diphtheria toxoid, hepatitis B, and varicella
- Influenza vaccinations
- For women an immediate move to daily pre-natal vitamins with extra folic acid to reduce the risk of neural tube defects
- Discussions of alcohol, nicotine as well as prescription and non-prescription drug use
- Screenings of diet and vitamin supplements to ensure patients are meeting recommended daily allowances for iron, calcium, vitamin A, B-12, B, D, and other nutrients
- Encouragement to maintain a normal BMI, discussions of how abnormally high and low BMI’s are associated with infertility and other pregnancy complications
- Assessments of the need for STI screening
- Screenings for intimate partner violence
- Discussions of potential travel restrictions and appropriate waiting times before attempting pregnancy after travel
- Assessments of exposure to teratogens, endocrine disruptors, and environmental pollutants, referrals to occupational medical programs if detected exposure is severe
- Referrals to reproductive endocrinologists if infertility issues are identified
When Should Prepregnancy Counseling Occur?
The ACOG and ASRM suggest that women seek prepregnancy counseling several times during their reproductive lifespans “because health status and risk factors change over time” and doing so can increase their education opportunities and potentially maximize their reproductive success.
At IRMS, we strongly recommend that our patients—and all those hoping to become pregnant— make use of prepregnancy counseling to manage and strengthen their reproductive outcomes. We especially encourage our patients with known medical conditions to seek preconception counseling in order to receive clearance for infertility treatments and pregnancy.