-J. Whitridge Williams (1903) he Centers for Disease Control and Prevention (CDC) (2015) defines preconceptional care as "a set of interventions that aim to identiy and modiy biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management." To achieve this goal, the CDC has developed an action plan for preconceptional health care in the United States Qohnson, 2006). The American College of Obstetricians and Gynecologists (2017 e) and the Society for Maternal-Fetali1vIedicine (2014) also reairm the importance of preconceptional care, and the following objectives have been established for advancing it: 1. Improve knowledge, attitudes, and behaviors of men and women related to preconceptional health 2.
Assure that all childbearing-aged women receive preconceptional care services-including evidence-based risk screening, health promotion, and interventions-that will enable them to enter pregnancy in optimal health 3.
Reduce risks indicated by a previous adverse pregnancy outcome through interconceptional interventions to prevent or minimize recurrent adverse outcomes 4.
Reduce the disparities in adverse pregnancy outcomes
To illustrate potentilly modifiable conditions, data that describe the health status of women who delivered liveborn neonates in the United States in 2004 are reviewed. Table 8-1 demonstrates the high prevalence of many conditions that may be amenable to intervention during the preconceptional and interpregnancy periods. To be successul, however, strategies that mitigate these potential pregnancy risks must be provided before conception. By the time most women realize they are pregnantusually 1 to 2 weeks ater the first missed period-the embryo has already begun to form. hus, many preventive steps-for example, folic acid to avoid neural-tube defects-will be inefective if initiated at this time. Importantly, up to half of all pregnancies in the United States in 2008 were unplanned according to the Guttmacher Institute (2015), and oten these are at greatest risk.
Few randomized trials evaluate preconceptional counseling eicacy, in part because withholding such counseling would be unethical. Also, pregnancy outcomes are dependent on the interaction of various maternal, fetal, and environmental factors. hus, ascribing a salutary outcome to a specific intervention is diicult (Moos, 2004; Temel, 2014). However, prospective observational and case-control studies have demonstrated the successes of preconceptional counseling (American College of Obstetrics and Gynecologists, 2016b). \100s and coworkers (1996) assessed the efectiveness of a preconceptional counseling program administered during routine health care provision to reduce unintended pregnancies. he 456 counseled women had a 50-percent greater likelihood of subsequent pregnancies that they considered "intended" compared with 309 uncounseled
TABLE 8-1. Prevalence of Prepregnancy Maternal Behaviors, Experiences, Health Conditions, and Previous Poor Birth Outcomesa aln the United States in 2004.
bAmong women who were not trying to become pregnant.
Data from D'Angelo D, Williams L, Morrow 8, et al: Precon ception and interconception health status of women who recently gave birth to a live-born infant-Pregnancy Risk
Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004. MMWR 56(1l0):1,l2007.
women. Moreover, compared with another group of women who had no health care before pregnancy, the counseled group had a 65-percent higher rate of intended pregnancy. Interesting ethical aspects of paternal lifestyle modification were reviewed by van der Zee and associates (2013).