Prepregnancy counseling

Abstract

The goal of prepregnancy care is to reduce the risk of adverse health effects for the woman, fetus, and neonate by working with the woman to optimize health, address modifiable risk factors, and provide education about healthy pregnancy. All those planning to initiate a pregnancy should be counseled, including heterosexual, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and gender nonconforming individuals. Counseling can begin with the following question: ''Would you like to become pregnant in the next year?'' Prepregnancy counseling is appropriate whether the reproductive-aged patient is currently using contraception or planning pregnancy. Because health status and risk factors can change over time, prepregnancy counseling should occur several times during a woman's reproductive lifespan, increasing her opportunity for education and potentially maximizing her reproductive and pregnancy outcomes. Many chronic medical conditions such as diabetes, hypertension, psychiatric illness, and thyroid disease have implications for pregnancy outcomes and should be optimally managed before pregnancy. Counseling patients about optimal intervals between pregnancies may be helpful to reduce future complications. Assessment of the need for sexually transmitted infection screening should be performed at the time of prepregnancy counseling. Women who present for prepregnancy counseling should be offered screening for the same genetic conditions as recommended for pregnant women. All patients should be routinely asked about their use of alcohol, nicotine products, and drugs, including prescription opioids and other medications used for nonmedical reasons. Screening for intimate partner violence should occur during prepregnancy counseling. Female prepregnancy folic acid supplementation should be encouraged to reduce the risk of neural tube defects.

Medicaid expansions, preconception insurance, and unintended pregnancy among new parents

“…Insurance coverage in the preconception period is a recommended approach to ensuring access to health care services and addressing modifiable risk factors in the critical preconception and early prenatal period. 6,7 Our results are consistent with recent studies demonstrating that Medicaid expansions for childless adults increased rates of preconception Medicaid coverage. 24,25 However, our study builds on this evidence by incorporating additional years of data, focusing on childless adults who were most likely to benefit from the expansions, and considering the variation in both the timing and size of the Medicaid expansion.…”

“…4,5 With one-third of deaths attributable to preventable complications arising from pre-existing, chronic conditions, the Centers for Disease Control and Prevention (CDC) and American College of Gynecologists and Obstetricians emphasize the need to address these risk factors before pregnancy to reduce morbidity and mortality. 6,7 Health insurance in the preconception period has been emphasized by the CDC as critical for addressing these risk factors and poor outcomes due to its role in increasing access to preconception health care services, particularly among low-income individuals. 8 Preconception insurance coverage has the potential to increase access to family planning and reduce unintended pregnancies, which are associated with adverse physical and mental health outcomes, including depression.…”

“…[12][13][14] Furthermore, increasing preconception coverage may reduce barriers to early prenatal care, which can lead to earlier identification and management of risk factors during pregnancy and improve outcomes. 6,7,15 Finally, increasing Medicaid generosity may reduce preconception and prenatal stress, which is associated with lower birth weights and preterm births, by reducing the potential for large medical bills. 16,17 Increasing insurance coverage for childless adults through state Medicaid programs may help to increase preconception insurance coverage and improve maternal outcomes.…”