Table 1.

Listing of some of the clues from a pedigree that can help anticipate a patient's psychosocial needs in preconception counseling (adapted from Bennett 2010)

Family history clue	Anticipatory guidance
Patient is approaching the age of relatives in the family who have developed disease or had life-threatening complications	May be reason that patient is seeking medical care at this time
	Patient may have escalating anxiety about developing condition in family
	Patient may be experiencing chronic sorrow
Patient is only a relative affected with the condition in immediate or extended family	Patient may have feelings of anger, disbelief and bewilderment, asking “Why me?”
	Patient may have misconceptions about patterns of inheritance given perception of pattern of disease in family
Patient is only an unaffected relative in immediate or extended family	Patient may experience survivor guilt
	Patient may have hard time believing that risk for disease is “average”
	Patient may have misconceptions about patterns of inheritance given perception of pattern of disease in family
Patient/couple is experiencing infertility and another close relative is pregnant or has recently given birth	Patient may have emotional conflicts regarding simultaneous family experience
Degree that medical interventions have been successful or well tolerated by relative(s)	If relatives have had successful medical interventions or screening the patient may be more trustful of the medical system, or the converse maybe true if the relatives have done poorly or screening has not detected disease early
Family history of depression or suicide	This could be a clue to risk factor for antepartum depression or need for extra assistance in coping with disease in family or outcome of test results
What is the structure of the family history? (e.g., are there relatives to turn to for support)	Are there siblings, adult children, parents or a step-parent who are available for support?