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Some women plan when to conceive and come to their providers for advice and counseling and guidance. It can also be a part of counseling at a well-woman visit. Preconception counseling can identify genetic or chronic diseases that need counseling before becoming pregnant. Most women of childbearing age will conceive within a year of trying to conceive (TTC). Most women should be counseled to try for that long before considering an appointment with an infertility specialist for assisted reproductive technologies (ART). For those who are over 35 years of age, ART should be considered after six months of TTC. Women who are over 40 years old or have a condition that causes irregular menstrual cycles can be sent sooner if desired. Semen analysis can also be considered for those who are having difficulty with TTC.
Education on when ovulation occurs is important to women becoming pregnant. This entails careful tracking of menses using a calendar (and, yes, there are apps for that too). Ovulation occurs 14 days before the next menstrual cycle. With a normal 28-day cycle, that will occur on day 14, but if the woman’s cycle is longer or shorter, that time would be adjusted accordingly. Once the timing of ovulation is determined, women should try to conceive a few days before, throughout, and a few days after ovulation with the frequency being every or every other day. Other signs of ovulation such as cervical mucus and a slight increase in basal body temperature can help to confirm ovulation is occurring. For those who would like to have more confirmation, ovulation predictor tests can be used to confirm ovulation by testing for the surge of follicle stimulating hormone (FSH) that occurs during
Identification of risks:
When possible, women who have health conditions such as diabetes, hypertension, thyroid disorders, seizure disorders, mental health disorders, or autoimmune conditions should be advised to visit their specialist before TTC.
A complete list of medications (including over-the-counter) that a woman is taking should be reviewed and adjusted to make sure they are safe for pregnancy. Those who work in professions that expose them to potentially harmful or teratogenic agents such as chemicals, irradiation, or infectious diseases should be counseled on ways to avoid exposure. Women should also be screened for abuse and the risk of sexually transmitted infections.
Two particular infections that can be screened for prior to pregnancy are rubella and varicella. Those who are non-immune can be vaccinated prior to pregnancy as neither can be done during pregnancy, and they should avoid pregnancy within three months of immunization.
Genetic counseling and testing can be done to identify a woman’s personal or family history of conditions that would influence the outcome of the pregnancy. Described as “carrier testing,” decisions on what testing should be done depends on the ethnicity and identification of inherited problems. Carrier testing can be brief or extensive; sending patients to a genetic counselor helps with determining which testing should be done.
Association of Professors of Gynecology and Obstetrics (2015, September 3). Topic 9: Preconception Care: https://www.youtube.com/watch?v=k9GJEvPnmlQ
Health Promotion prior to conceiving:
Begin taking a prenatal vitamin.
Begin folic acid 0.4 mg supplementation to prevent neural tube defects (NTD) (1 mg for those with a family history of NTD or a pregnancy with multiples).
Achieve a healthy weight; counsel for any eating disorders.
Screen for anemia.
Screen and counsel for illicit drugs, smoking, or alcohol use.
Discuss ways to increase protein and calcium for those with a vegetarian diet.
Discuss food safety: Avoid raw meat or fish. Avoid unpasteurized cheese, milk, or juices.
Identification of Risks
Limit fish intake to about three servings per week (total of 12 ounces)
Counseling after a pregnancy test:
After a woman discovers she is pregnant, it is important to explore how she is feeling; it could be elation, disappointment, or relief. If the pregnancy test is positive, it is important to assess any immediate health concerns, explore her current life circumstances, and help her identify support systems. Any counseling should be provided in a nonjudgmental, nondirective way. If she has not been counseled before pregnancy, the same counseling should be done at the time the pregnancy is discovered.
For information on termination of pregnancy, click below
Other Resources
Other Resources
Fowler, J.R., Mahdy, H. & Jack, B.W. (2022, September 6). Preconception Counseling. https://www.ncbi.nlm.nih.gov/books/NBK441880/
Government of Canada (2021, April 26). Family Centered Maternity and Newborn Care: National Guidelines: Chapter 2: Preconception Care: https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-2.html
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