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Pregnancy may be associated with certain diseases that existed before the inception of pregnancy. As a rule, all diseases which subject the organism to a considerable strain are much more serious when occurring in a pregnant woman.

—J. Witridge Williams (1903)

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INTRODUCTION

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The Centers for Disease Control and Prevention (CDC) (2015) 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.” To achieve this goal, the CDC has developed an action plan for preconceptional health care in the United States (Johnson, 2006). The American College of Obstetricians and Gynecologists (2015a) and the Society for Maternal-Fetal Medicine (2014) also reaffirm the importance of preconceptional care, and the following objectives have been established for advancing it:

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

  2. Assure that all childbearing-aged women 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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To illustrate potentially modifiable conditions, data that describe the health status of women who delivered liveborn neonates 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. To be successful, however, 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 preventive steps—for example, folic acid to avoid neural-tube defects—will be ineffective if initiated at this time. Importantly, up to half of all pregnancies in the United States in 2008 were unplanned according to the Guttmacher Institute (2015), and often these are at greatest risk.

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Table Graphic Jump Location
TABLE 8-1Prevalence of Prepregnancy Maternal Behaviors, Experiences, Health Conditions, and Previous Poor Birth Outcomesa
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