Preconception Care: A Comparative Review of Major Guidelines

Importance: Preconception care represents a crucial aspect of healthy pregnancy as it aims to optimize the health status of women and men before conception by mitigating the modifiable individual and environmental risk factors and providing education, counseling and timely interventions. Objective: The aim of this study was to review and compare the most recently published influential guidelines on the pre-pregnancy counseling and management of chronic medical conditions. Evidence Acquisition: A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Public Health Agency of Canada (PHAC) on preconception care was carried out. Results: There is a consensus among the reviewed guidelines that a detailed personal and family history along with risk factors assessment and counseling against smoking, alcohol and substance abuse are the main areas to focus when providing preconception care. In addition, the assessment of immunization status, the screening for intimate partner violence and sexual coercion as well as the screening for HPV and cervical cancer are unanimously recommended. All medical societies also agree that counseling on diet, BMI and physical activity should be routinely offered along with a review of supplements and advice on folic acid supplementation. Furthermore, the need of medication review for potential teratogenic effects and the importance of assessing for environmental and occupational exposure to teratogens are underlined by all guidelines. Moreover, ACOG and PHAC recommend a discussion about contraception, support an optimal interpregnancy interval of at least 18 months and underline that screening for STIs should be offered only in case of existing risk factors. ACOG and RANZCOG also suggest that patients should be offered guidance on proper food handling and traveling restrictions to prevent certain infectious diseases. Finally, ACOG and PHAC provide guidance on the preconception management of chronic medical conditions, whereas RANZCOG although mentioning that all pre-existing medical conditions should be optimized before achieving pregnancy, it provides no further guidance. Conclusion: Preparing for a healthy pregnancy not only drives favorable perinatal outcomes, but is also associated with long-lasting benefits for the offspring. Health care professionals are ideally positioned to offer clear, accurate and timely counseling to the parents-to-be, screen for and act upon any potential impediments to a successful outcome, support the decision-making process and offer referral to relevant services when required. Therefore, the development of consistent international guidelines on preconception care to guide clinical practice seems of insurmountable importance.