Based on the premise that healthy women have healthy babies, preconception care is focused on the promotion of a healthy lifestyle and the prevention and/or management of harmful health conditions before pregnancy in all women of childbearing age. The goal of preconception care is to reduce the risk of adverse health effects for the woman and neonate by optimizing the woman's health before planning and conceiving a pregnancy. Since more than half of all pregnancies are unplanned and prenatal care visits often begin after the formation of vital organs in the fetus, physicians play a crucial role in initiating discussion about preconception care as part of regular visits.

Preconception care is an unfamiliar concept for patients. Providers don't often offer such a service and insurance companies don't often cover it. However, to reduce the incidence of low birth weight, preterm labor and birth outcome disparities nationwide, we must widen our focus to provide care before a woman becomes pregnant.

During every primary care visit, physicians are encouraged to provide risk assessment and counseling to all women in their reproductive years. Discussions should target three elements:

1. Providing protection against birth defects through vaccinations, multivitamin supplementation and testing for sexually transmitted diseases, including HIV/AIDS,

2. Managing chronic conditions, and

3. Avoiding teratogens such as alcohol, illegal drugs and smoking.

As part of this exchange, physicians should also encourage women to have a reproductive life plan and to seek medical guidance when they plan to get pregnant. A reproductive life plan reflects a set of personal goals of having (or not having) children based on personal values, objectives and resources. It includes planning the timing and number of children desired in the context of one's health, career objectives, financial status, marriage status/intentions, religious values and educational goals.

In partnership with the American College of Obstetrics and Gynecology, the American Academy of Pediatrics and the American Medical Association, the Centers for Disease Control and Prevention has released the following preconception care recommendations:

1. Individual Responsibility Across the Lifespan. Encourage each woman, man and couple to have a reproductive life plan.

2. Consumer Awareness. Increase public awareness about the importance of preconception health behaviors and preconception care services by using information and tools appropriate across various ages, health literacy levels, and cultural/linguistic contexts.

3. Preventive Visits. As part of primary care, provide risk assessment and educational counseling to all women of childbearing age to reduce reproductive risks.

4. Interventions for Identified Risks. Increase the proportion of women who receive interventions as follow-up to preconception risk screening.

5. Interconception Care. Use the interconception period to provide additional intensive interventions to women who have had a previous pregnancy that ended in an adverse birth outcome (i.e., infant death, fetal loss, birth defects, low birth weight or preterm birth).

6. Prepregnancy Checkup. Offer, as a component of maternity care, one prepregnancy visit for women or couples planning pregnancy.

7. Health Insurance Coverage for Women With Low Incomes. Increase public and private health insurance coverage for women with low incomes to improve access to preconception care.

8. Public Health Programs and Strategies. Integrate components of preconception health into existing local public health programs, including emphasis on interconception interventions for women with previous adverse outcomes.

9. Research. Increase evidence-based strategies and promote the use of the evidence to improve preconception health.

10. Improvements. Maximize public health surveillance and research mechanisms to monitor preconception health.

The full CDC recommendations can be found at www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm.

The Los Angeles County Maternal, Child and Adolescent Health Programs is collaborating with the Los Angeles Best Babies Network and the local chapter of the March of Dimes to develop preconception care as a standard of care accepted and implemented by physicians and healthcare providers. This collaborative is also establishing preconception care as a component of healthcare that should be requested by both men and women.

For more information, contact Cynthia Harding, director of the Los Angeles County Maternal, Child and Adolescent Health Programs, at 213/639-6400.

Elizabeth Gant is an MPH candidate at UCLA and an administrative aide for the Los Angeles County Maternal, Child and Adolescent Health Programs (MCAH). Diana Ramos, MD, MPH, is an obstetrician/gynecologist and the medical director of Maternal Health and Family Planning Programs for MCAH. Cynthia Harding, MPH, is the director of MCAH.