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Introduction

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The Centers for Disease Control and Prevention defines preconceptional care as “a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management” (Johnson, 2006). The following goals were established for advancing preconceptional care:

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  1. Improve knowledge, attitudes, and behaviors of men and women related to preconceptional health.

  2. Assure that all women of childbearing age receive preconceptional care services—including evidence-based risk screening, health promotion, and interventions—that will enable them to enter pregnancy in optimal health.

  3. Reduce risks indicated by a previous adverse pregnancy outcome through interconceptional interventions to prevent or minimize recurrent adverse outcomes.

  4. Reduce the disparities in adverse pregnancy outcomes.

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The American College of Obstetricians and Gynecologists (2012c) also has reaffirmed the importance of preconceptional and interpregnancy care.

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To illustrate potentially modifiable conditions, data that describe the health status of women who gave birth to liveborn infants in the United States in 2004 are reviewed. Table 8-1 demonstrates the high prevalence of many conditions that may be amenable to intervention during the preconceptional and interpregnancy periods (D’Angelo, 2007). To be successful, however, preventative strategies that mitigate these potential pregnancy risks must be provided before conception. By the time most women realize they are pregnant—usually 1 to 2 weeks after the first missed period—the embryo has already begun to form. Thus, many prevention strategies—for example, folic acid to prevent neural-tube defects—will be ineffective if initiated at this time. Importantly, up to half of all pregnancies are unplanned, and often these are at greatest risk (Cheng, 2009).

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Table Graphic Jump Location
TABLE 8-1Prevalence of Prepregnancy Maternal Behaviors, Experiences, Health Conditions, and Previous Poor Birth Outcomes in the United States in 2004
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Few randomized trials evaluate preconceptional counseling efficacy, in part because withholding such counseling would be unethical. Also, because pregnancy outcomes are dependent on the interaction of various maternal, fetal, and environmental factors, it is often difficult to ascribe salutary outcomes to a specific intervention (Moos, 2004). There are, however, prospective observational and case-control studies that demonstrate the successes of preconceptional counseling. Moos and coworkers (1996) assessed the effectiveness of a preconceptional counseling program administered during routine health care provision to reduce unintended pregnancies. The 456 counseled women had a 50-percent ...

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