What are the preconception recommendations and screening tests for women planning to become pregnant?

From the Guidelines

Preconception care should begin 3-6 months before attempting pregnancy and includes several key recommendations, with the most critical being the attainment of glycemic goals prior to conception for women with diabetes, as highlighted in the 2022 standards of medical care in diabetes 1.

Key Recommendations

• Women should start taking folic acid supplements (400-800 mcg daily) to prevent neural tube defects, and those with higher risk factors, such as obesity or diabetes, may need higher doses (5 mg daily) 1.
• A comprehensive medical evaluation should assess chronic conditions like diabetes, hypertension, and thyroid disorders, which should be optimally controlled before conception, with special attention paid to medication review to identify potentially teratogenic drugs that may need adjustment 1.
• Screening should include testing for infectious diseases such as HIV, hepatitis B, syphilis, and rubella immunity, with appropriate vaccinations administered if needed, as well as genetic carrier screening based on ethnicity or family history to identify potential hereditary conditions 1.
• Lifestyle modifications are crucial, including discontinuing tobacco, alcohol, and recreational drugs; achieving a healthy weight; limiting caffeine to 200 mg daily; and avoiding environmental toxins, with men also being involved in preconception care as factors like smoking, alcohol use, and certain medications can affect sperm quality 1.
• Nutritional assessment and appropriate supplementation beyond folic acid may be necessary, with women who have had bariatric surgery requiring closer monitoring of nutrition and potential supplementation with vitamins and minerals, such as vitamin B12, calcium, and vitamin D 1.

Importance of Preconception Care

Preconception care is essential for reducing maternal and fetal morbidity and mortality, increasing chances of conception, and preventing unintended pregnancies, with the American College of Obstetricians and Gynecologists (ACOG) highlighting the need for preconception counseling for all women 1.

Involvement of Men in Preconception Care

Men should also be involved in preconception care, as factors like smoking, alcohol use, and certain medications can affect sperm quality, with health concerns in men, such as diabetes mellitus, erectile dysfunction, and testicular conditions, potentially affecting fertility 1.

From the Research

Preconception Recommendations and Screening

• Preconception health is crucial for a successful pregnancy and a healthy child 2
• A healthy diet and lifestyle before conception can have a positive impact on maternal and child health outcomes 2
• Poor nutrition and obesity are common among women of reproductive age, and can have negative consequences for pregnancy outcomes 2
• Folate supplementation is important for women of childbearing age, particularly those with sickle cell disease, to prevent folate deficiency 3, 4, 5, 6
• However, the effect of folic acid supplementation on anaemia and symptoms of anaemia in sickle cell disease patients remains unclear 3, 4, 6
• More research is needed to determine the optimal dose and duration of folic acid supplementation for women with sickle cell disease 5, 6

Folate Supplementation in Sickle Cell Disease

• Folate supplementation is commonly recommended for children and adults with sickle cell disease to replace depleted folate stores and reduce symptoms of anaemia 3, 4, 5, 6
• However, the evidence for the efficacy of folate supplementation in sickle cell disease is limited and of low quality 3, 4, 6
• High-dose folic acid supplementation may have potential risks, such as accelerated growth of some cancers, and the biological effects of circulating unmetabolized folic acid are not fully understood 5
• Further research is needed to determine the optimal dose and duration of folic acid supplementation for individuals with sickle cell disease 5, 6

Preconception Screening and Recommendations

• Health professionals should be alerted to ways of identifying women who are planning a pregnancy, particularly those with sickle cell disease or other high-risk conditions 2
• Preconception screening and recommendations should include assessment of folate status and provision of folic acid supplementation as needed 2, 3, 4, 5, 6
• A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases 2