Overview of pre-conception counseling in the United States of America
Pre-conception counseling in the United States allows for optimization of US prenatal care. "Pre-conception counseling" is a meeting with a health-care professional (generally a physician or midwife) by a woman "before" attempting to become pregnant. It generally includes a "pre-conception risk assessment" for any potential complications of pregnancy.
Obstacles to pre-conception counseling in the United States.
Obstacles to pre-conception counseling in the United States include:
Screening and monitoring in the United States.
Screening and monitoring of women prior to conception is recommended to include the following:
However, the overall lack of evidence precludes a recommendation for universal screening for thyroid disease in pregnancy.
Rubella screening.
Screening for rubella susceptibility by history of vaccination or by serology is recommended in the US for all women of childbearing age at their first preconception counseling visit to reduce incidence of congenital rubella syndrome (CRS). It is recommended that all susceptible non-pregnant women of childbearing age should be offered rubella vaccination.
Varicella screening.
Immunity status of varicella should be performed at the pre-conception counseling session, in order to prevent the occurrence of congenital varicella syndrome and other adverse effects of varicella in pregnancy. Generally, a person with a positive medical history of varicella infection can be considered immune. Among adults in the United States having a negative or uncertain history of varicella, approximately 85%-90% will be immune. Therefore, an effective method is that people with a negative or uncertain history of varicella infection have a serology to check antibody production before receiving the vaccine. The CDC recommends that all adults be immunized if seronegative.
Domestic violence.
It is recommended to screen for domestic violence at a preconception visit, because domestic violence during pregnancy a risk factor for miscarriage, late entry into prenatal care, stillbirth, premature labor and birth, fetal injury and low birth weight, and detection can avail for specific counseling and intervention.
There is evidence that direct interview screening result in a higher rate of reporting prenatal domestic abuse than a written, self-report questionnaire method.
Education.
Education of women intending to be pregnant is recommended to include:
Vaccination and prophylaxis.
Vaccination and other prophylaxis of women intending to become pregnant is recommended to include: 
References.
 ;templatestyles src="Reflist/styles.css" / ;