Table 2.

Preconception Interventions With Evidence of Improving Pregnancy Outcomes

Intervention	Proven health effect
Folic acid supplementation	Reduces occurrence of neural tube defects by two-thirds
Rubella vaccination	Provides protection against congenital rubella syndrome
Diabetes mellitus management	Substantially reduces the 3-fold increase in birth defects among infants of diabetic women
Hypothyroidism management	Adjusting levothyroxine dosage early in pregnancy protects proper neurologic development
Hepatitis B virus vaccination for at-risk women	Prevents transmission of infection to infant and eliminates risk to woman of hepatic failure, liver carcinoma, cirrhosis, and death due to hepatitis B virus infection
HIV and AIDS screening and treatment	Allows for timely treatment and provides women (or couples) with additional information that can influence the timing of pregnancy
STD screening and treatment	Reduces the risk of ectopic pregnancy, infertility, and chronic pelvic pain associated with Chlamydia trachomatis and Neisseria gonorrhoeae and also reduces the possible risk to the fetus of fetal death and physical and developmental disabilities, including mental retardation and blindness
Maternal PKU management	Prevents babies from being born with PKU-related mental retardation
Oral anticoagulant use management	Switching women’s medication from teratogenic anticoagulants (i.e., warfarin) before pregnancy avoids harmful exposure
Antiepileptic drug use management	Changing to a less teratogenic treatment regimen reduces harmful exposure
Isotretinoin use management	Preventing pregnancy in women who use isotretinoin, or ceasing its use before conception, eliminates harmful exposure
Smoking cessation counseling	Completing smoking cessation before pregnancy can prevent smoking-associated preterm birth, low birth weight, or other adverse perinatal outcomes
Eliminating alcohol use	Controlling alcohol binge drinking or frequent drinking before pregnancy prevents fetal alcohol syndrome and other alcohol-related birth defects
Obesity control	Reaching a healthy weight before pregnancy reduces the risks of neural tube defects, preterm delivery, diabetes mellitus, cesarean section, and hypertensive and thromboembolic disease associated with obesity

AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus; PKU, phenylketonuria; STD, sexually transmitted disease

Modified from Dunlop AL, Jack B, Frey K. National recommendations for preconception care: the essential role of the family physician. J Am Board Fam Med. 2007;20:81–4. Used with permission