Clinical Review

Prepregnancy care

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3467 (Published 31 May 2012) Cite this as: BMJ 2012;344:e3467
  1. Srividya Seshadri, subspecialty training fellow in reproductive medicine1,
  2. Pippa Oakeshott, reader in general practice2,
  3. Catherine Nelson-Piercy, professor of obstetric medicine1,
  4. Lucy C Chappell, clinical senior lecturer in maternal and fetal medicine3
  1. 1Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  2. 2Population Health Sciences and Education, St George’s, University of London, London, UK
  3. 3Women’s Health Academic Centre, King’s College, London SE1 7EH, UK
  1. Correspondence to: L C Chappell lucy.chappell{at}kcl.ac.uk

Summary points

  • Consider offering opportunistic prepregnancy advice to all women of reproductive age, particularly when providing contraception

  • Behavioural changes include stopping smoking, reducing alcohol and caffeine intake, avoiding substance misuse, and optimisation of weight

  • Folic acid is recommended from before conception until 12 weeks’ gestation to prevent neural tube defects

  • Check immunity to rubella in women suspected to be non-immune

  • Review chronic medical and psychiatric conditions, in addition to therapeutic drugs, to optimise care; liaise with specialists

  • Offer genetic counselling to couples with an affected child or family history of a genetic disorder

Prepregnancy care aims to recognise and amend lifestyle, behavioural, medical, and social risks to a woman’s health or pregnancy outcome, and ultimately it aims to reduce maternal and perinatal morbidity and mortality.1 Where such risks are not modifiable, prepregnancy counselling aims to ensure that a woman is told of the potential risks and can make an informed decision about the pregnancy. Prepregnancy advice can be offered to a woman of reproductive age by any healthcare professional who has contact with her with the aim of optimising pregnancy outcomes. With around half of pregnancies in the United Kingdomw1 and the United Statesw2 unplanned, a proactive approach is needed. This review is relevant to general practitioners, nurses, and family planning doctors in the community and to specialists in secondary care who see women of reproductive age.

Sources and selection criteria

We searched PubMed (in January 2012) for articles on prepregnancy care, advice, and counselling, together with those on modification of lifestyle behaviour before pregnancy. The MeSH terms for the search included: “preconception”, “periconception”, “pre-pregnancy”, “pre-conceptional”, in addition to keyword variations. We obtained information from prospective randomised clinical trials, cohort studies, systematic reviews, and meta-analyses. We searched national guidelines for those including advice on prepregnancy care.

Why should prepregnancy advice become an integral part of healthcare services?

More than half of maternal deaths in …

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