National Recommendations for Preconception Care: The Essential Role of the Family Physician

The Centers for Disease Control and Prevention, together with a Select Panel of external partners, recently published national recommendations for improving preconception health and health care.¹ The intent of the recommendations is to address unfavorable aspects of the health status of women and children in the United States, including rates of adverse birth outcomes (preterm and low birth weight deliveries, infant deaths, and birth defects), maternal pregnancy complications, and unintended pregnancies –all which are higher than goals outlined in Healthy People 2010.²

The national recommendations should be viewed as a strategic plan for improving preconception health through the provision of clinical care as well as the promotion of changes in individual behaviors, health policy, and public health strategies. The national recommendations with background information, review of the existing evidence, and references for incorporating preconception care into practice are found on CDC web sites.^3,4 A brief description of the 10 key recommendations are found in Table 1.

The concept of preconception care has been articulated for well over a decade,^5–20 yet has not become part of the routine practice of family medicine. Lack of physician knowledge of recommended interventions is one barrier to the provision of preconception care. The CDC publication addresses the knowledge barrier by outlining 14 specific preconception health care interventions for which clinical practice guidelines and evidence of effectiveness exist (Table 2). A complete overview of existing clinical practice guidelines that address preconception care and the evidence supporting the recommended interventions is available.²¹

Other recognized barriers to the provision of preconception care include lack of patient knowledge of and demand for services, lack of physician time, and lack of insurance coverage. Six of the 10 key recommendations address these barriers through public health outreach and social marketing programs (recommendations 1, 2, 8), policy strategies (recommendation 7), and health services research initiatives (recommendations 9, 10).

The essential and critical role of family physicians in the provision of preconception care is apparent. Family physicians provide much of the health maintenance, family planning, and chronic disease care for women, and strive to maintain continuity of care (often before, after, and between pregnancies) and close relationships with their patients. A recent survey documents that women prefer to receive preconception health information from their primary care physicians.²² As a specialty, we are now challenged to effectively translate the concept of preconception care into clinical reality. This is a clinical and public health domain where Family Medicine must assume a leadership role or be usurped by other disciplines with far less impact than could otherwise be realized.

In the short term, family physicians could do 2 things to promote preconception health and health care. First, ask every women of reproductive age whether she intends to become pregnant in the next year. Asking every woman about her reproductive intentions promotes the idea that pregnancies should be intended and planned by providing contraception to the woman who does not intend to conceive and promotes the initiation of preconception care strategies for women if and when they do desire to become pregnant. Second, inform women that health conditions and medications can affect pregnancy outcomes and that pregnancy can affect a woman’s health.

In the longer term, aspects of the national recommendations could be incorporated into the Future of Family Medicine Project’s “New Model” of family medicine, which promotes the provision of team-based, patient-centered care and a commitment to providing an essential “basket of services.”²³ We advocate that the intentional provision of preconception care be included in family medicine’s essential “basket of services.”

All women of reproductive age and potential presenting to the primary care setting are considered candidates for preconception care.¹ Some have expressed concern that the national recommendations excessively focus the health care encounter on a woman’s reproductive potential. However, the intent of the national recommendations is to empower women by promoting reproductive planning linked with the provision of contraception to prevent unintended pregnancies and by providing them with relevant information to make their own informed decisions.

• Received for publication August 19, 2006.
• Revision received October 24, 2006.
• Accepted for publication October 30, 2006.