PRECONCEPTION CARE AND FAMILY PLANNING SERVICES
While most women are seen in family planning clinics with the intent of avoiding pregnancy, there are distinct opportunities to provide education and counseling regarding a healthy pregnancy, if and when the client chooses to become pregnant in the future. Family PACT has adopted the following policies, which are based upon 2006 Centers for Disease Control and Prevention recommendations.
KEY POINTS
• The goals of preconception care are to optimize the woman’s health, to minimize risks during pregnancy to her and to her fetus, to improve pregnancy outcomes, and to provide information to make informed decisions about future reproduction.
• Unplanned pregnancies can pose a risk to the woman and/or fetus due to exposure to reversible and preventable risk factors.
QUESTIONS AND ANSWERS
What is preconception care?
There has been increased recognition that achieving a healthy pregnancy outcome is strongly influenced by a woman’s health status and lifestyle prior to conception. Preconception care is a set of interventions that focus on health promotion and disease prevention in women of childbearing age intended to improve the health status of a woman and that of her fetus/newborn. Why is birth spacing important?
A shortened inter-pregnancy interval is defined as less than 18 months from the last delivery to the next conception. There is a correlation between a shortened inter-pregnancy interval and increased medical risk to both the mother and her child. Therefore, a vital component of family planning care includes the effective use of a contraceptive method until the next pregnancy is intended.
What is a “reproductive life plan?”
It is a set of personal goals about having (or not having) children based on personal values and resources, and a plan to achieve those goals. Questions that should be asked during the initial comprehensive health history, and at subsequent updates, include:
• Do you hope to have any (more) children? How many children do you hope to have?
• How long do you plan to wait until you (next) become pregnant?
• How much space do you plan to have between your pregnancies?
• What do you plan to do until you are ready to become pregnant?
• What can I do today to help you achieve your plan?

What was discussed in preconception care?
review of current and past medical conditions and infectious diseases, prior immunizations, possible tetratogen exposure (including prescribed and non-prescription drugs and environmental toxins), genetic issues, nutrition, domestic violence, smoking and alcohol use, substance abuse, psychosocial issues, and financial planning were discussed with patient.
• Daily use of folic acid 0.4 mg tablets recommended at least three months prior to conception. While not a Family PACT benefit, it is inexpensive and can be purchased in any pharmacy without a prescription. Or, if the client is using a multi-vitamin, select one that includes folic acid.
• Women who smoke cigarettes should be advised to quit and offered appropriate referrals for smoking cessation programs.
• Advise women attempting pregnancy to stop (or at least minimize) consumption of alcoholic beverages.

• After a positive pregnancy test result, the client should be advised regarding the immediate initiation of folate and cessation of alcohol use and cigarette smoking. For women planning to continue their pregnancies, sexually transmitted infection (STI) screening, including human immunodeficiency virus (HIV) screening, should be deferred until initiation of prenatal care in order to avoid duplication of services.

• Women known to be Type I or Type II diabetics who are seen for family planning services should be reminded of the importance of blood sugar control before pregnancy, even if they are not currently attempting pregnancy.
• Confirm that a relationship exists with a primary care physician who is involved in the medical management diabetes, and if not, to refer for same.
• Unless performed recently, women with risk factors should be referred for screening for Type II diabetes before becoming pregnant, including clients with:
• Overweight or obesity (body mass index greater than 27)
• Polycystic ovarian syndrome (PCOS)
• A first degree relative with diabetes
• A history of gestational diabetes or a pregnancy outcome suspicious for Type II diabetes such as baby born greater than nine pounds or an unexplained stillbirth