Preconceptional counseling

A large number of pregnancies are unplanned. This, and the haphazard seeking of pre-pregnancy advice by many patients, means that many opportunities for pre-pregnancy counselling are missed. By the first antenatal visit, organogenesis is well underway and interventions to avoid malformations may be too late. For example, folic acid supplementation before conception and during the first trimester prevents the majority of cases of neural tube defect (NTD). Similarly, control of glucose in women with diabetes both before pregnancy and in early pregnancy helps to reduce the incidence of miscarriage, congenital malformation, stillbirth and neonatal death, so targeted care needs to occur before and in early pregnancy. Toxins such as alcohol can cause damage from the very early stages.

Efforts need to be made to offer preconceptual care opportunistically as part of other consultations - eg, contraception, diabetes or epilepsy reviews. Any couple being referred for infertility assessment should have had a full pre-conception assessment prior to further investigation or treatment. School-based programmes, in the context of children's reproductive and sex education, might offer better public health coverage.

Pre-conception counselling is also relevant to men. Their lifestyle and health may also affect pregnancy outcome.