From the Guidelines
Family planning and preconception visits should include a comprehensive approach to identify and address potential health concerns before pregnancy, significantly improving the chances of a healthy pregnancy and baby, as recommended by the most recent and highest quality study 1. A comprehensive preconception visit typically includes:
- A detailed medical history review, focusing on chronic conditions like diabetes, hypertension, or thyroid disorders that may affect pregnancy
- A physical examination, including weight, blood pressure, and gynecological assessment
- Laboratory tests, such as blood count, blood type, rubella immunity, sexually transmitted infection screening, and genetic carrier testing when appropriate
- Vaccination status review, with updates provided for vaccines like Tdap, MMR, and influenza
- Medication evaluation for pregnancy safety, with adjustments made as needed
- Nutritional counseling, emphasizing the importance of folic acid supplementation (typically 400-800 mcg daily) starting at least one month before conception to prevent neural tube defects, as recommended by 1
- Lifestyle factors discussion, including recommendations to avoid alcohol, tobacco, and recreational drugs, maintain a healthy weight, and reduce stress
- Environmental exposures discussion at home and work to minimize potential risks
- Menstrual cycle tracking to optimize conception timing and discussion of contraception options until pregnancy is desired This comprehensive approach is essential to reduce maternal and fetal morbidity and mortality, increase chances of conception, and prevent unintended pregnancies, as stated in 1 and 1. Key points for practice, as outlined in 1, include:
- Discussing a woman’s reproductive plan at each visit
- Recommending daily folic acid supplementation of 400 to 800 mcg for women of reproductive age
- Addressing health concerns in men, such as diabetes mellitus, erectile dysfunction, and testicular conditions, that may affect fertility
- Discussing lifestyle factors, including tobacco smoking and sexually transmitted infections, that can directly impact a partner’s pregnancy
- Providing routine counseling about emergency contraception when needed
- Evaluating immunization status annually in all women of reproductive age, as recommended in 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Family Planning and Preconception Visit
- A preconception consultation typically includes reviewing pregnancy-related risks in the setting of patients' medical and obstetrical comorbidities, recommending strategies to reduce risks, and providing contraceptive methods if desired 2.
- The creation of a combined preconception and complex contraception clinic for individuals with significant medical and obstetrical comorbidities can promote reproductive autonomy 2.
- Combining preconception and contraceptive visits is crucial for obstetrically and/or medically complex patients, as it allows for a comprehensive review of pregnancy risks and the provision of appropriate contraceptive methods 2.
Components of a Preconception Visit
- Review of medical and obstetrical history to identify potential risks and complications 2.
- Discussion of contraceptive options and provision of contraceptive methods if desired 2.
- Evaluation of pregnancy-related risks and recommendation of strategies to reduce risks 2.
Importance of Combined Preconception and Contraceptive Visits
- Separating preconception and contraceptive visits can burden patients and fragment reproductive healthcare 2.
- Combining these visits can promote comprehensive reproductive healthcare and reproductive autonomy 2.
- There is no direct evidence from the provided studies 3, 4 to support the inclusion of specific components in a preconception visit, such as diet quality or genetic predisposition, although these factors may be relevant to overall health and wellness.