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WHAT, WHY, and HOW
Preconception Care
© Copyright 2010, Saskatchewan Prevention Institute
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This presentation has been developed for use by physicians,
nurses, midwives and other health care workers as an
educational tool. The intent of this tool is to inform these
professionals of the role and significance of women’s
preconception health promotion to better inform work with
this population.
Teacher’s Notes
If using this presentation to inform colleagues or other health
care workers, the teacher’s notes provided are intended to
provide more detailed information that the speakers can use at
their convenience.
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Preconception care is promoting the health of
women of childbearing age before conception to
improve pregnancy-related outcomes.
Planning for a Healthy Baby Starts before Pregnancy
• The health of a baby is highly related to the health
of parents
• The most critical time for development occurs right
after conception; often before mothers know they
are pregnant
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Preconception planning includes lifestyle and
behaviour changes that optimize the early fetal
environment by:
 protecting fetal development:
e.g., Taking folic acid and keeping up to date with
immunizations
 managing maternal health conditions:
e.g., Sexually Transmitted Infections (STIs), diabetes, obesity
 preparing for pregnancy
 modifying risk factors:
e.g., Medication use, alcohol and tobacco use
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Over half of all pregnancies are unplanned
• That means, a woman’s body needs to be ready for an unexpected
pregnancy in order to support the healthy development of the fetus
Waiting until the pregnancy is confirmed may be too late to
prevent exposure to risk factors
• The first few weeks of pregnancy are the most sensitive for a developing
fetus
 Between day 17 and 45 after conception,
or 4 to 10 weeks from the last menstrual period
Many health outcomes for the baby may have already been
decided, even before a woman realizes she is pregnant.
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Moore, K.L., & Persaud, T.V.N. (1973). The Developing Human: Clinically Oriented Embryology. Philadelphia: W.B. Saunders; 98.
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Definition: MI is “a collaborative, person-centred form of guiding
to elicit and strengthen motivation for change” (Miller et al., 2008, pg.
137).
A refined form of guiding and part of everyday conversations
about change, MI is conducted with a spirit of collaboration,
evocation (drawing out patient’s thoughts and ideas) and respect
of autonomy.
Clinicians should work collaboratively with patients to set the
agenda and develop a personal plan for change.
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MI helps clinicians to:
R–
Resist the Righting Reflex: (i.e. avoid the natural desire to
set things right)
U – Have a better understanding of your patient’s motivation
L–
Listen using Reflective Listening Skills: (i.e. decrease questions
and increase the proportion and accuracy of statement)
E–
Empower your patients to make healthier choices for
themselves
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(Rollnick, 2008, pg. 10)
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The following four skills are used strategically throughout MI
conversations:
1. Open ended questions:
i.e. , “What would be your top two reasons for making the change?”
2.
Affirmations:
i.e. “You have made some big changes, such as better nutrition and exercise, to get
your body ready for having a baby.”
3.
Reflective listening (used predominantly in MI conversations):
i.e. Patient: “I am trying so hard to make the changes we talked about, but it is just
so hard.” Clinician: “It is really important to you to have a healthy pregnancy and
that you don't give up.”
4.
Summarizing:
i.e. “What I have heard you say so far is that you know there are some important
reasons to make the changes - at the same time it has been a struggle and you have
very little support in your life. What have I missed?”
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• It is important that women are informed of what
they can do before they become pregnant to ensure
that their baby has an optimal chance of healthy
prenatal development
• Promote the following simple steps that women can
take now to change their health behaviours and
reduce their risk factors before becoming pregnant
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• Taking a multivitamin daily has been shown to reduce the risk
of certain birth defects
• Women planning a pregnancy or who could become pregnant
should take a daily multivitamin containing 0.4-1.0mg of folic
acid
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• If all women of childbearing age consume enough folic acid, it
is estimated that as many as half of certain birth defects can
be prevented, such as:
 Neural tube defects
 Heart defects
 Limb defects
• Folic acid promotes the development of the baby’s brain stem
• It is recommended that all woman of childbearing age
regardless of pregnancy intentions, be informed about the
benefits of taking a multivitamin containing folic acid
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• Gaining too much weight during pregnancy or being
overweight before pregnancy puts women at risk of:
 High blood pressure
 Gestational Diabetes
 Increased risk of Type 2 Diabetes and obesity later on in life for
both mother and child
 Stillbirth, miscarriage and preeclampsia
 Increased risk of birth defects (i.e. neural tube defects)
 High birth weight baby
 Complications during labour and delivery
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Maintaining a healthy weight
before pregnancy is important
to help women achieve
optimal health benefits
during their pregnancy.
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• The benefits of regular exercise before, during, and after
conception include:

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
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Healthier pregnancy
Faster and easier labour; less need for induction
Returning to pre-pregnancy weight faster
Improved mood and sleep
Reduced weight gain during pregnancy
Fewer pregnancy discomforts such as backaches and swelling
Decreased depression and anxiety
Control of gestational diabetes
Appropriate weight management
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Regular exercise, including jogging and
impact aerobics, will not lower the
chances of getting pregnant, nor
will it increase the risks for
miscarriage. This is especially
true if a regular fitness plan
has been followed prior
to conception.
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• The following immunizations are recommended to be up to
date prior to conception:
 Rubella
 Chickenpox
 Hepatitis B
After getting immunized a woman should wait
at least one month before becoming pregnant.
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Screen for and Treat Sexually Transmitted Infections (STIs)
• STIs during pregnancy can lead to fetal death, physical, and
developmental disabilities:
 Early screening and treatment can prevent these adverse birth
outcomes
• Women and their partners should be encouraged to be tested for
STIs regularly, including HIV, and if positive, receive treatment for
the benefit of their own health and that of future pregnancies
• Some STIs can be treated and some cannot. Steps can be taken to
reduce the chance of passing on an infection from mom to baby
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Sexually Transmitted Infections Include:
Chlamydia and Gonorrhea (Treatable with antibiotics)
• Left untreated, these infections are associated with infertility,
chronic pelvic pain, ectopic pregnancy and eye problems in
the person infected
HIV
• Treatment during pregnancy, labour and the first six weeks of
a baby’s life can improve protection from transmission to 99%
• Risk of transmission increases from 1% to 25% if left
untreated
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Herpes
• If herpes is transmitted to the baby, infection may lead to
developmental delays and even death
• There is no cure for herpes, but medications can be used to
drastically reduce the risk of transmitting the infection
• Pregnant women who have had herpes in the past present a low
risk for infecting their baby, even if an outbreak occurs during
labour, as the mother will have developed antibodies to transmit
to the baby
• The trimester in which a woman is initially infected directly
affects the health outcomes of the baby
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Screen for and Treat Hepatitis B and Hepatitis C
• These diseases are transmitted through blood or body fluids
and infected mothers can pass it on to their babies
• If Hepatitis B is detected before pregnancy, the mother can be
treated to ensure the baby will not be infected
• If Hepatitis B is detected during pregnancy, treatment should
begin to protect any babies becoming infected should she
become pregnant in the future
• Treatment should start for the baby to reduce the baby’s chance of
getting Hepatitis B, beginning within two days of birth
• There is no vaccine for Hepatitis C
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• There is no known safe time to drink alcohol during pregnancy


Everything that the mother eats and/or drinks goes to the baby
through the placenta and umbilical cord
Harm to a baby from alcohol can happen early on in pregnancy, before
a pregnancy is even known or realized by the woman
 Alcohol can harm the baby’s development throughout the entire
pregnancy, while fetal outcomes differ based on trimester of exposure
• When pregnancy is a possibility, it is safest to stop alcohol
consumption during this time
• When working with women who are unable to stop, then
counselling to reduce consumption may help to reduce the
risk to the baby
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• Smoking is linked to infertility
• Smoking heavily during pregnancy increases the risk of:
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Miscarriage
Babies being born too small and too early
Sudden Infant Death Syndrome (SIDS)
Asthma and other respiratory problems later in child’s life
• Quitting smoking before deciding to get pregnant ensures
optimal health benefits for the baby
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Some medications may not be safe to take during pregnancy
• Talk to women about any medications they may be taking, or
may begin taking including:
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Prescription drugs
Herbal and traditional remedies – don’t assume that natural means
safe
Non-prescription drugs (Over-the-counter)
 i.e. cough syrup, cold medications, vitamins, aspirins
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Using drugs at anytime during pregnancy can cause damage to a
growing baby
• As a baby develops, different organs are sensitive to drug
exposure at different times
• To reduce all developmental risks, it is best to avoid using
recreational or street drugs throughout pregnancy
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• Sometimes medication use may be necessary during
pregnancy
 If a woman is currently taking antidepressant or mood stabilizing
medication, she should not stop without talking to her doctor. It may
be most beneficial for a woman to continue to take medication
through the pregnancy
• The most common treatments for maternal depression are
counseling, support groups, and medications, often used in
combination
• You should always speak with patients to discuss their options
 Women should understand that your office is a safe place to discuss
mental health issues and treatment options
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• It is important that certain health conditions are well
managed before pregnancy to help promote and begin a
healthy pregnancy
• These include:
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Asthma
Diabetes
Heart Disease
High Blood Pressure
Hypothyroidism
Epilepsy
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• Before conceiving, try to ensure the patient reduces high
stress levels:
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Ask the woman how she is feeling
Encourage her to learn about pregnancy and birth
Encourage exercise
Promote a healthy diet
Emphasize the importance of rest and relaxation
Spend time discussing the supports she has in her life and who will be
there for her throughout the pregnancy and after her baby is born
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• Oral disease is the most common chronic disease and can
contribute to systemic health problems including heart
disease, stroke, respiratory disease, and diabetes
• During pregnancy, oral disease can contribute to adverse birth
outcomes, such as a baby born preterm/low birth weight
• Improve oral health by:
 brushing and flossing regularly
 limiting simple carbohydrates
 using fluoride (e.g., drink fluoridated water, if available)
• Visiting a dentist regularly can help to reduce these risks
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• Eating well before becoming pregnant will help women meet
the nutritional needs of a growing baby during pregnancy
• Healthy fetal development requires certain vitamins, minerals,
and nutrients
 Take a daily multivitamin to help get your folic acid and other vitamins
you will need during pregnancy
• Follow Canada’s Food Guide:
www.healthcanada.gc.cafoodguide
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Although most pregnancies in Canada result in a healthy baby, it
is important to know about pre-disposed genetic risks

Some health problems can be passed through the genes of a mother
or father to a baby
Genetic Counseling: may help to reassure and help with making
informed decisions about getting pregnant by determining the
probability of certain conditions
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Counseling could be suggested for families with:
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A history of genetic disorders due to family history or ethnicity
Women with a personal risk of disease due to occupational exposure
Women with a history of multiple miscarriages
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Workplace Exposure
Certain workplace toxins have been associated with reduced
fertility, still birth, miscarriage, low birth weight, and birth defects
 Women should remove the chemicals used in their workplaces to
determine their risks
Environmental Exposure
Certain contaminants in the air, soil, water, food, and consumer
products may put a developing fetus at risk
For more information about exposure risks, please visit MotherRisk online at www.motherrisk.org
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Under The Saskatchewan Human
Rights Code, women are protected
against discrimination because of
pregnancy, pregnancy-related
illness, childbirth, or any
circumstances related to
pregnancy or childbirth
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• Abuse often starts or escalates during pregnancy
• Maternal abuse can cause a baby to be born too small or too
early
 Babies can die or be injured during abuse
• Make sure women know that your office is a safe place to
discuss domestic violence
• For more information on domestic violence, visit
www.abusehelplines.org
www.hotpeachpages.com
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• Scheduling a check up before conceiving will help ensure that a
woman is in good health to support a healthy pregnancy and baby
• It is an excellent opportunity to identify any potential risks to the
pregnancy and the mother
• Encourage preconception health questions
• May also be a good time to suggest getting a full blood panel ,
including tests for HIV, STIs, Hepatitis B and Hepatitis C
• Explore the woman’s concerns, medical history, lifestyle, and
behaviours to facilitate discussion on how to help her have the
healthiest baby possible
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