1. Why Preconception Care Matters
- Reduces adverse outcomes – Early screening for chronic disease, nutritional deficiencies, and psychosocial stress cuts the risk of miscarriage, preterm birth, and congenital anomalies[[1]].
- Optimises maternal health – Addressing obesity, hypertension, and diabetes before conception improves fertility and lowers maternal‑mortality risk[[2]].
- Long‑term benefits for the child – A balanced diet and adequate micronutrients (folic acid, vitamin D, DHA) during the pre‑conception window are linked to better neurodevelopment and lower risk of chronic disease later in life[[3]][[4]].
2. Core Components of a Preconception Visit
| Domain | Key Actions | Evidence |
|---|---|---|
| Medical assessment | Full history, BMI, blood pressure, labs (CBC, HbA1c, thyroid, rubella immunity), medication review | WHO defines PCC as “biomedical, behavioural and social health interventions”[[5]] |
| Reproductive planning | Discuss pregnancy intention, timing, contraception, and family‑planning goals (One‑Key Question)[[6]] | |
| Nutrition & supplements | • Folic acid 400 µg daily (≥ 800 µg if high risk) • Vitamin D 400–600 IU daily • Iron if ferritin < 30 ng/mL • Emphasise whole‑food, plant‑rich diet, limit processed sugars and saturated fat | National PCC guideline recommends folic‑acid fortification and diet counseling[[7]]; plant‑based diets improve outcomes[[8]] |
| Lifestyle | • ≥150 min moderate‑intensity exercise weekly • Smoking cessation, limit alcohol (< 1 drink/week) • Stress management (mindfulness, counseling) | Lifestyle behaviours before conception have the greatest impact on offspring health[[9]] |
| Immunisation | Update tetanus, diphtheria, pertussis, HPV, hepatitis B, COVID‑19 as indicated[[10]] | |
| Mental health | Screen for depression, anxiety (PHQ‑9, GAD‑7) and provide referral if needed[[11]] | |
| Chronic disease management | Optimise control of diabetes, hypertension, HIV, thyroid disease; coordinate with specialists[[12]][[13]] | |
| Environmental & occupational exposures | Review exposure to chemicals, radiation, heavy metals; advise avoidance or mitigation[[14]] |
3. Timeline – When to Start
| Time before conception | Recommended actions |
|---|---|
| ≥12 months | Begin lifestyle optimisation (weight, diet, exercise), update vaccinations, schedule chronic‑disease review |
| 6 months | Initiate folic‑acid supplementation, complete full labs, address mental‑health concerns |
| 3 months | Confirm medication safety, finalize pregnancy timing, conduct pre‑conception counseling with partner |
| 1 month | Final health check, ensure all immunisations up‑to‑date, discuss birth‑plan preferences |
4. Practical Checklist for Clinicians
- Reproductive life‑plan – Ask “Do you plan to become pregnant in the next 12 months?”[[15]]
- Anthropometrics – Measure height, weight, calculate BMI; counsel if < 18.5 or > 25 kg/m²[[16]]
- Laboratory panel – CBC, ferritin, fasting glucose/HbA1c, lipid profile, thyroid‑stimulating hormone, rubella IgG, hepatitis B surface antigen, HIV test (if risk)[[17]]
- Medication audit – Identify teratogenic drugs; discuss alternatives or tapering[[18]]
- Nutrition review – 24‑hour recall, assess folate‑rich foods, recommend fortified cereals or supplements[[19]]
- Lifestyle screen – Tobacco, alcohol, caffeine, physical activity, sleep quality[[20]]
- Mental‑health screen – PHQ‑9, GAD‑7; refer for counseling if scores elevated[[21]]
- Immunisation check – Verify tetanus‑diphtheria‑pertussis, HPV, hepatitis B, COVID‑19 boosters[[22]]
- Environmental exposure – Ask about occupational chemicals, lead, pesticides[[23]]
- Follow‑up plan – Set a revisit in 3–6 months to reassess progress and finalize pregnancy timing[[24]]
5. Integrating PCC into Health Systems
- Primary‑care embedding – Offer PCC during routine women’s health visits, family‑planning clinics, and immunisation appointments[[25]].
- Community outreach – Use health‑extension workers to raise awareness and distribute folic‑acid tablets in rural settings[[26]].
- Electronic prompts – Incorporate “One‑Key Question” alerts into electronic medical records to trigger PCC discussions[[27]].
6. Resources for Couples
- WHO Preconception Care Fact Sheet – downloadable PDF with global recommendations.
- National Nutrition Guidelines – folic‑acid fortification policies and dietary advice.
- Mental‑Health Screening Tools – PHQ‑9 and GAD‑7 questionnaires (available online).
Bottom line – Effective preconception care is a multidisciplinary, evidence‑based process that begins at least a year before pregnancy. By systematically addressing medical, nutritional, lifestyle, mental‑health, and environmental factors, couples dramatically improve their chances of a healthy conception, uncomplicated pregnancy, and optimal long‑term health for both mother and child.
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