Table 1 Recommendations for preconception counselling and care

Family planning: ask women of reproductive age about intention to become pregnant. Provide contraceptive counselling tailored to patients’ intentions

Nutrition and physical activity: advise adequate fruit and vegetable intake, folic acid supplementation (400 mcg daily) to reduce the risk of neural tube defects, exercise/physical activity

Body Mass Index: assess body mass index, and counsel women who are overweight, obese, or underweight about achieving a healthy body weight before becoming pregnant

Substance use:

  - screen for alcohol use, and provide referral for women with alcohol dependence

  - screen for tobacco use, and provide smoking cessation treatment when needed; counsel patients about the effect of smoking on pregnancies and child health

  - provide brief behavioural interventions to reduce tobacco, alcohol, and drug use

Chronic diseases: counsel women with diabetes mellitus about the importance of glycemic control before conception

Medications: assess for the use of teratogenic medications; for women with chronic diseases, switch to safer medications when possible, and use the fewest medications at the lowest dosages needed to control the disease

Communicable diseases: screen patients who wish to become pregnant for sexually transmitted infections and other communicable diseases

Immunizations: update hepatitis B, influenza, measles, mumps, rubella, tetanus, diphtheria, pertussis, varicella immunizations as needed in patients who wish to become pregnant

Family genetic history: screen for personal or family history of congenital anomalies or genetic disorders; refer couples for genetic counselling when risk factors are identified, and provide carrier testing when appropriate to determine risk to future pregnancy

Mental health: screen for depression and anxiety disorders; counsel patients about the risks of untreated depression during pregnancy, as well as the risks of treatment

Psychosocial factors: screen for intimate partner violence; evaluate the patient’s safety, and provide referral to appropriate resources

Infertility-subfertility: promote awareness and understanding of fertility and infertility and their preventable and unpreventable causes; screen couples for infertility-subfertility causes

Environmental exposures:

  - assess for workplace exposures to toxicants; industries that are known to use toxic chemicals include clinical and laboratory health care, dry cleaning, printing, manufacturing, and agriculture

  - assess for household exposure to potentially harmful agents such as heavy metals, solvents, and pesticides

  - counsel patients about avoiding mercury exposure by not consuming large fish and limiting other fish intake

Men’s preconception counselling and care: similar to PC for women, it consists of: a reproductive life plan, nutritional and physical activity, a healthy body weight, tobacco, alcohol, drug use, exposures to teratogens, a complete medical history that includes medications, medical conditions, sexually transmitted infections screening, immunizations, family history for genetic conditions, mental health and environmental exposures