ACOG releases Prepregnancy Counseling recommendations

The American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM) has provided recommendations on pre-pregnancy counseling.

Pre-pregnancy visit (when the patient presents to discuss a potential future pregnancy) provides an excellent opportunity to counsel patients about maintaining a healthy lifestyle and minimizing health risks. Prepregnancy counseling should include a review of a patient’s immunizations, an assessment for immunity, and other screenings and tests, as appropriate

The goal of prepregnancy care 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. All those planning to initiate a pregnancy should be counseled, including heterosexual, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and gender nonconforming individuals.

Pregnancy complications may be reduced by appropriate identification and mitigation of risk factors, while genetic screening may allow a couple to make informed decisions regarding family planning. Management of preexisting medical conditions may be optimized during the prepregnancy period, reducing the chances of pregnancy-related complications.

The recommendations are as follows:

• Any patient encounter with nonpregnant women or men with reproductive potential (eg, not post hysterectomy or post-sterilization) is an opportunity to counsel about wellness and healthy habits, which may improve reproductive and obstetric outcomes should they choose to reproduce.
• Counseling can begin with the following question: “Would you like to become pregnant in the next year?”
• The goal of prepregnancy care 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.
• Women should be counseled to seek medical care before attempting to become pregnant or as soon as they believe they are pregnant to aid in correct dating and to be monitored for any medical conditions in which treatment should be modified during pregnancy.
• Many chronic medical conditions such as diabetes, hypertension, psychiatric illness, and thyroid disease have implications for pregnancy outcomes and should be optimally managed before pregnancy.
• All prescription and nonprescription medications should be reviewed during prepregnancy counseling. This review also should include nutritional supplements and herbal products that patients may not consider to be medication use but could affect reproduction and pregnancy. c Women who present for prepregnancy counseling should be offered to screen for the same genetic conditions as recommended for pregnant women. c Women of reproductive age should have their immunization status assessed annually for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap); measles–mumps–rubella; hepatitis B; and varicella.
• All patients should receive an annual influenza vaccination; those women who are or will be pregnant during the influenza season will have additional benefits.
• Assessment of the need for sexually transmitted infection (STI) screening should be performed at the time of pre-pregnancy counseling.
• Patients with potential exposure to certain infectious diseases, such as the Zika virus, should be counseled regarding travel restrictions and appropriate waiting time before attempting pregnancy.
• All patients should be routinely asked about their use of alcohol, nicotine products, and drugs, including prescription opioids and other medications used for nonmedical reasons.
• Screening for intimate partner violence should occur during prepregnancy counseling. c Female prepregnancy folic acid supplementation should be encouraged to reduce the risk of neural tube defects (NTDs).
• Patients should be screened regarding their diet and vitamin supplements to confirm they are meeting recommended daily allowances for calcium, iron, vitamin A, vitamin B12, vitamin B, vitamin D, and other nutrients.
• Patients should be encouraged to try to attain a body mass index (BMI) in the normal range before attempting pregnancy because abnormal high or low BMI is associated with infertility and maternal and fetal pregnancy complications.