The journey to healthy parents and babies begins long before conception — before someone is even trying to conceive (TTC). With a few simple steps, people of childbearing age can improve their own health and increase their chances of conception, as well as reduce the chances of maternal and infant morbidity and mortality.
Women’s health before, during, and after pregnancy is a key objective of the Healthy People 2030 initiative of the U.S. Department of Health and Human Services. It might shock you to find out that women living in the United States are twice as likely to die during childbirth than women living in other developed countries. In addition, significant disparities exist in successful pregnancy outcomes among racial and ethnic groups.
Turning this dire situation around means beginning conversations about preconception health long before a patient is ready to start a family.
What is preconception care?
As defined by the American Academy of Family Physicians, preconception care is individualized and focuses on good health and reducing risks for both the patient and the fetus. Preconception care also encompasses “interconception care,” or care between pregnancies, a time that carries the same risk factors as pre-pregnancy.
Why is preconception care such a critical issue in maternal health?
The American healthcare system has a fragmented delivery system, with patients seeing multiple providers who don’t provide a holistic approach. Physicians aren’t adequately reimbursed for the type of counseling services preconception care falls under, and those most in need of preconception care are the least likely to receive it, despite rising rates of obesity and associated conditions, including hypertension and diabetes. (These conditions occur at higher rates among people of color, who are also more likely to be uninsured.) Additionally, almost half of the pregnancies in the U.S. are unplanned, which means the parents-to-be haven’t been focusing on preparing their bodies for a successful pregnancy.
Preconception health tips
Even if you’re not TTC, men and women alike benefit from preconception health strategies. They’re good health strategies, period. Patients should be counseled on:
- The importance of eating a healthy diet and maintaining an active lifestyle, with information about the effects of high body mass index (BMI) on conception and carrying a baby.
- Stopping smoking altogether, and for women, not drinking alcohol when TTC.
- The effects of sexually transmitted infections (STIs) on long-term fertility and understanding how to prevent STIs as well as unplanned pregnancies.
- How current medications, including over-the-counter medications and dietary or herbal supplements, can affect their ability to get pregnant and fetal health.
- Ensuring vaccinations are up to date.
- Family health histories to determine whether genetic counseling might be necessary. A preconception counselor might recommend genetic counseling if there is history of birth defects, chromosomal disorders, cancer or other genetic conditions.
- (For women) Avoiding contact with toxic chemicals, including cat feces.
- (For women) Taking 400 mcg of folic acid daily to lower the risk of some birth defects, including spina bifida.
- Managing stress, as well as receiving support related to past or current physical, sexual or emotional abuse.
Who is responsible for preconception care?
Everyone — potential parents, physicians, health plan providers, and employers — has a role to play in reducing maternal and infant morbidity and mortality. Patients need to ask for this type of care, physicians need to provide it, and employers need to work with health-plan providers to increase access to it. Progyny, for instance, matches its members with dedicated patient care advocates (PCAs) and paired digital resources to optimize unassisted conception by focusing on nutrition, mental health, and lifestyle, as well as understanding ovulation and intercourse tracking, making the most of fertile windows, and deciphering test results. The PCA helps the patient see healthcare from a holistic perspective to prepare for starting and building a family — even connecting the patient with behavioral health, leave, and legal resources.
A healthy baby starts with healthy parents, and the journey to good health is lifelong. Preconception care prepares us for whatever surprises life may throw at us.