- TUESDAY, July 22 (HealthDay News) — It's a good bet mom never
told you to speak to your doctor before getting pregnant. But these days,
that's exactly what women of childbearing age — and their male
partners — are being encouraged to do.

Experts say most physicians realize the importance of pre-pregnancy
counseling and measures, making sure, for example, that women take folic
acid during their reproductive years to prevent birth defects.

Yet surveys suggest that few doctors practice preconception care — or
even ask patients about their pregnancy plans.

“We're sort of waiting for women to come to us and say, 'I'm planning
to get pregnant. What should I do?'” said Dr. Anne L. Dunlop, an assistant
professor in the Department of Family and Preventive Medicine at Emory
University School of Medicine in Atlanta.

The term “preconception care” refers to the set of health interventions
that can improve the chances of getting pregnant, having a healthy
pregnancy, and delivering a healthy baby. These include quitting smoking
or drinking alcohol, as well as receiving nutrition counseling, and
undergoing early screening to detect and treat sexually transmitted
diseases.

The U.S. Centers for Disease Control and Prevention, with guidance from
groups like the March of Dimes and the American College of Obstetricians
and Gynecologists, issued recommendations in 2006 to improve preconception
care in the United States. Since that time, these organizations have been
working with leaders in the medical community to integrate the advice into
clinical practice.

The Georgia Academy of Family Physicians, for one, is conducting
“Quality Circles” to bring health-care providers up to speed with the
recommendations and identify ways to integrate pre-pregnancy services into
their practices, Dunlop noted.

In part, the CDC recommendations encourage every woman, man and couple
to have a reproductive plan, even if they do not intend to conceive. About
half of all pregnancies in the United States are unintended, the agency
noted, underscoring the need for contraception counseling.

In addition, the nation's primary-care providers are urged to take the
lead on providing preconception risk assessment services, patient
education and health promotion counseling to reduce reproductive risks and
improve pregnancy outcomes.

“Full implementation requires substantial support from a number of
sectors and will take some time,” said Samuel F. Posner, a co-author of
the preconception care report and associate director for science in the
CDC's Division of Reproductive Health. Part of the challenge, he conceded,
is overcoming numerous barriers, including the lack of a mechanism for
billing insurers and getting reimbursed.

Some insurers limit the use of billing codes for preventive services to
once a year, Dunlop explained, while others do not pay for these services
at all.

What's more, the notion of preconception care doesn't really resonate
with many women, she said. Take, for instance, a recently married
23-year-old who wants to hold off a couple of years before starting a
family. She may not even consider herself a candidate for preconception
care until she's ready to conceive.

All the more reason for doctors to ask patients about their
reproductive plan and schedule a follow-up visit if necessary. “Leave them
with the message that it's important you plan the pregnancy, not just in
general with yourself and your partner, but with me as your health-care
provider, because there's things we have to take care of ahead of time,”
Dunlop said.

When should women seek preconception care? While there are no
hard-and-fast recommendations, Dunlop believes most experts would advise
healthy women to see their doctor at least three months prior to planning
to conceive. Women with chronic conditions, including diabetes, obesity,
hypertension and seizure disorders, may need more time to get their
disease under optimal control and adjust their medications before trying
to conceive.

Until patients and providers begin taking a proactive approach to
pregnancy planning, there will likely be critical gaps in care.

Dr. Michael C. Lu, an associate professor of obstetrics/gynecology and
public health at the University of California, Los Angeles, cites one
survey in which roughly a third of obstetricians said that it's very
important to talk to their patients about folic acid supplementation
during a routine exam. Fewer than 20 percent said it's very important to
talk to their patients about environmental concerns during a routine
exam.

But exposure to toxins, including pesticides, lead and cigarette smoke,
may affect fertility, lead to miscarriage or cause birth defects,
according to the March of Dimes.

“Personally, I think we need to do better in terms of patient education
on nutrition, exercise, stress management, environmental toxicants, and
family planning,” Lu said. And not just for women. “We need to promote
preconception care for men as well.”

More information

The U.S. National Institute of Child Health and Human Development has
more on preconception care.