Gustavo F. Leguizamón

Preconception and antepartum care are excellent examples of effective primary prevention. Because more than 50% of pregnancies in the United States are unplanned, health care providers should advise every woman in her reproductive years to seek preconception care and counseling. This chapter offers an overview of the key components of effective preconception and antepartum care, and refers the reader to other chapters for more detailed descriptions of specific approaches and procedures.

Preconception care: Preconception care is a set of interventions that identify and modify biomedical, behavioral, and social risks to a woman’s health prior to her conceiving a child. It includes both prevention and management, emphasizing health issues that require action before conception, or very early in pregnancy, for maximal impact. The target population for preconception care is women of reproductive age, although men are also targeted by several components of preconception care.

Antepartum care: The antepartum period refers to events occurring or existing after conception and before birth. This is also known as the “prenatal” period. So, antepartum care has the dual goals of ensuring a healthy baby and a healthy mother. Antepartum care includes the evaluation of the health status of both mother and fetus, estimation of the gestational age of the baby, identification of the patient at risk for complications, anticipation of problems before they occur (and prevention, if possible), and patient education and communication.

Primary prevention consists of intervening before pathological changes have begun, to prevent the occurrence of disease. Preconception care is an excellent example of how primary prevention methods and the identification/ modification of risk factors can markedly improve pregnancy outcomes, particularly for women with chronic diseases such as diabetes, hypothyroidism, and substance abuse issues.

Because more than 50% of the pregnancies in the United States are unplanned, health care providers should advise every woman in her reproductive years to seek preconception care and counseling. Indeed, an overwhelming amount of evidence suggests the best time to evaluate, counsel, and potentially treat specific conditions affecting pregnancy is before conception.

There are four critical areas for determining risks and implementing interventions during the preconception period:

1. History and physical examination
   
2. Serology to evaluate mostly infectious diseases
   
3. Management of chronic disease
   
4. Preconception supplementation

History

The most relevant variables to determine are maternal age and life-style factors as well as the presence of previously existing conditions, such as infections or chronic disease. How these factors impact preconception care is described below.

Maternal Age

Timely education would most likely increase the opportunity to prevent teenage pregnancy and help women to make decisions regarding the age of conception. Finally, advanced paternal age is associated with increased genetic risk to the fetus and is considered when the father is older than 55 years.

Life-Style Factors

Tobacco: Smoking is a well-known, modifable risk factor. It has been associated with increase risk for spontaneous abortion, prematurity, intrauterine growth restriction (IUGR), premature rupture of membranes (PROM), abruptio placentae, and placenta previa. Of significant clinical importance is the fact that smoking discontinuation before or during early pregnancy reduces these tobacco-associated risks.

Alcohol: Drinking alcohol has been clearly identified as a risk factor for adverse pregnancy outcome. There is also strong evidence that harm can occur early in gestation, even before the patient is aware of her pregnancy.

The so-called “fetal alcohol syndrome” (FAS) is defined by the presence at least one of the following signs:

• growth restriction either before or after birth
  
• facial anomalies
  
• central nervous system dysfunction