Although most pregnancies result in good maternal and fetal outcomes, some pregnancies may result in adverse health effects for the woman, fetus, or neonate. Although some of these outcomes cannot be prevented, optimizing a woman's health and knowledge before planning and conceiving a pregnancy—also referred to as preconception care or pre-pregnancy care—may eliminate or reduce the risk.
For example, initiation of folic acid supplementation at least 1 month before pregnancy reduces the incidence of neural tube defects such as spina bifida and anencephaly. Similarly, adequate glucose control in a woman with diabetes before conception and throughout pregnancy can decrease maternal morbidity, spontaneous abortion, fetal malformation, fetal macrosomia, intrauterine fetal death, and neonatal morbidity.
Nearly half of all pregnancies in South Africa are unintended. Therefore, the challenge of preconception care lies not only in addressing pregnancy planning for women who seek medical care and consultation specifically in anticipation of a planned pregnancy but also in educating and screening all reproductively capable women on an ongoing basis to identify potential maternal and fetal risks and hazards to pregnancy before and between pregnancies.
Several national and international medical organizations and advocacy groups have focused on the optimization of health before conception. Core preconception care provided by Dr. Dheshni Naidoo address and include the following factors:
As medical care rapidly advances, the list of issues to consider when planning a pregnancy continues to grow.
Dr Dheshni Naidoo encourages women to formulate a reproductive health plan and discusses it in a nondirective way at each visit. Such a plan would address the individual's or couple's desire for a child or children (or desire not to have children); the optimal number, spacing, and timing of children in the family; and age-related changes in fertility. Because many women's plans change over time, creating a reproductive health plan requires an ongoing conscientious assessment of the desirability of a future pregnancy, determination of steps that need to be taken either to prevent or to plan for and optimize a pregnancy, and evaluation of current health status and other issues relevant to the health of a pregnancy.