PRECONCEPTION CARE

HISTORY TAKING, PHYSICAL

ASSESSMENT &
INTERVENTIONS
 LIFE-COURSE CONTINUUM:
Priority interventions for mothers, newborns and children.

When
to intervene?

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PRECONCEPTION
CARE
Preconception care is the provision of biomedical,
behavioral and social health interventions to
women and couples before conception occurs.

It aims at improving their health status, and

reducing behaviors, individual and environmental
factors that contribute to poor maternal and child
health outcomes.

Its ultimate aim is to improve maternal and child

health, in both the short and long term. ˡ

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 IMPORTANCE
OF
PRECONCEPTION CARE
Preconception care has a positive effect on a range of health outcomes³:

Maternal outcomes Neonatal outcomes

Maternal mortality Neonatal mortality
Unintended pregnancies Abortions, stillbirths, preterm birth
Complications during pregnancy Low birth weight, underweight and
and delivery stunting
Diarrhoea, Vertical transmission of Birth defects
HIV/ STD
Risk of type 2 diabetes and Neonatal infections
cardiovascular disease
Breast feeding Childhood cancers

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 Risk factors that
contribute to maternal
and childhood mortality
and morbidity
 Contribution to
Risk factors during the
Contribution to maternal childhood
preconception period
morbidity and mortality morbidity and
and pregnancy
mortality

• Infertility
• Conception delay • Preterm birth
• Spontaneous abortion • Stillbirth
• Smoking/ smokeless
• Ectopic pregnancy • Low birth weight
tobacco/ Exposure to
• Placenta praevia • Birth defects
second hand smoke
• Placental abruption • Sudden infant death
• Premature rupture of Syndrome
membranes

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Risk factors during the
Contribution to maternal Contribution to childhood
preconception period
morbidity and mortality morbidity and mortality
and pregnancy

• Fetal alcohol spectrum

• Unwanted pregnancy
disorders
• Risk of sexually transmitted
• Mild intellectual
infections (STIs)/ HIV
• Alcohol and drug disability
• Alcohol and drug -related
use • Miscarriage &
health conditions
Prematurity
• Social, legal and financial
• Child neglect
problems

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Risk factors during
Contribution to
the preconception Contribution to childhood
maternal morbidity and
period and morbidity and mortality
mortality
pregnancy

• Recurrent miscarriage
• Intrauterine Death
• Preterm labour
• Hydrops Fetalis
• Premature rupture of
• Fetal Growth Retardation
• Genetic disorders membranes
• Preterm Birth
• Pregnancy
• Complications Of delivery
complications
• Neonatal complications
• Disability

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Risk factors during
the preconception Contribution to maternal Contribution to childhood
period and morbidity and mortality morbidity and mortality
pregnancy

• Perinatal • Preterm birth

depression, • Underweight and stunting
• Complications during
including • Reduced breastfeeding
pregnancy
antenatal and • Increased episodes of diarrhoea
• Postpartum bipolar
postpartum • Lower compliance with
event
depression immunization schedules
• Postpartum psychosis
• Bipolar disorder/ • Delayed psychosocial
Psychosis. development

• Neurodevelopmental
• Epilepsy • Perinatal complications
impairments
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Risk factors during the Contribution to
Contribution to childhood
preconception period and maternal morbidity
morbidity and mortality
pregnancy and mortality
• Neural tube defects,
• Folic acid and multivitamin
• Other birth defects,
insufficiency
• Multiple congenital anomalies
• Child mortality
• Maternal
• Low birth weight
• Iron-deficiency anaemia morbidities and
• Preterm birth
mortality
• Low child cognition
• Abortion and stillbirth
• Mental retardation
• Iodine • Cretinism, goiter
• Increased infant mortality
• Hypothyroidism

• Maternaleclampsia
• Calcium
• Preeclampsia
Risk factors during the
Contribution to maternal Contribution to childhood
preconception period
morbidity and mortality morbidity and mortality
and pregnancy
• Preterm birth
• Maternal • Low birth weight
• Complications during
underweight, often • Stillbirth
pregnancy and delivery
combined with low • Type 2 diabetes
• Nutrient deficiencies
stature • Cardiovascular disease
in later life
• Birth defects
• Maternal overweight
• Type 2 diabetes • Neural tube defects
and obesity
• Hypertensive disease of • Preterm delivery
• Untreated diabetes
pregnancy • Stillbirth
mellitus
• Gestational diabetes • Macrosomia
(type 2 diabetes
• Complications during • Hypoglycaemia after
mellitus and
pregnancy and delivery birth
gestational diabetes
• Shoulder dystocia • Type 2 diabetes in later
mellitus)
life
Risk factors during
the preconception Contribution to maternal Contribution to childhood
period and morbidity and mortality morbidity and mortality
pregnancy
• Morbidity related to
complications of unsafe
• Unintended • Adverse effects on infant and
Abortion
pregnancy child health
• Psychosocial
Consequences

• Prematurity or fetal death,

• Too-early
• Complications during • Low birth weight
pregnancy
pregnancy • Preterm birth
• Short birth
• Increased likelihood of • Increased risk of neonatal
intervals (<24
depression and postneonatal (one
months)
month to one year) death

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Risk factors during
Contribution to
the preconception Contribution to childhood
maternal morbidity
period and morbidity and mortality
and mortality
pregnancy

• Spontaneous or • Stillbirth,
• Rubella
therapeutic abortion • congenital rubella syndrome

• Maternal infection • Neonatal infection

• Tetanus
• Death • Death

• Chronic liver disease

• Hepatitis B • Neonatal hepatitis B infection
• Premature death

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 History taking in
Preconception Care
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 Reproductive History Taking for
Preconception Care
1. Menstrual History 2. Contraceptive History
• Age of menarche • Current and past contraceptive
methods used
• Menstrual cycle regularity (length,
flow, and symptoms) • Duration and side effects
• History of dysmenorrhea, • Previous discontinuation and
menorrhagia, or oligomenorrhea reasons
• Last menstrual period (LMP)

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3. Pregnancy History (Gravida, Para, 4. History of Infertility and Assisted
Abortus – GPA System) Reproductive Technology (ART)
• Number of pregnancies, live births,
miscarriages, stillbirths, and elective • Duration of infertility (if applicable)
abortions • Previous fertility treatments (e.g.,
• History of pregnancy complications (e.g., IVF, IUI)
preeclampsia, gestational diabetes,
preterm labor) • Hormonal or surgical interventions
• Mode of delivery (vaginal, C-section,
instrumental)
• Birth outcomes (birth weight, gestational
age, neonatal complications)

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5. History of Sexually Transmitted 6. Gynecological History
Infections (STIs) and Pelvic • History of ovarian cysts, fibroids,
Inflammatory Disease (PID) endometriosis, or polycystic ovary
• Past or current STIs (chlamydia, syndrome (PCOS)
gonorrhea, syphilis, HIV, HPV, etc.) • Previous pelvic surgeries (e.g.,
• History of PID or any reproductive myomectomy, ovarian cystectomy)
tract infections • Cervical screening results (Pap
• Treatment received and follow-up smear, HPV test)
status
 Genetic and family History Taking for
Preconception Care
1. Chromosomal Abnormalities in 2. Consanguinity and Its Impact
the Family • Close blood relation between
• Down Syndrome (Trisomy 21) partners increases the risk of
• Turner Syndrome (45,X) autosomal recessive disorders
(e.g., congenital metabolic
• Klinefelter Syndrome (47,XXY) disorders, hearing loss, certain
• Balanced translocations or cardiac defects).
inversions in parents

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3. Family History of Pregnancy and Birth 4. Genetic Risks in the Partner
Outcomes
• Recurrent Miscarriages or Stillbirths: Could • Male partner should also provide
indicate chromosomal abnormalities, a family and genetic history to
thrombophilia, or structural uterine anomalies.
identify risks for X-linked and
• Preterm Birth or Intrauterine Growth Restriction autosomal recessive disorders.
(IUGR): May suggest inherited clotting disorders,
maternal genetic conditions, or familial trends. • Carrier Screening for Both
• Congenital Anomalies: Neural tube defects, cleft Partners: If one partner is a carrier,
lip/palate, heart defects, limb abnormalities.
the other should be tested to
• Multiple Pregnancies (Twins or More): Familial
tendency towards hyperovulation.
assess the risk to offspring.
Psychosocial, environment & lifestyle history
taking
1. Lifestyle and Environmental 2. Psychosocial and Mental
Exposures Health History
• Smoking, alcohol, drug use • History of depression, anxiety,
• Exposure to toxins, radiation, or other psychiatric disorders
or hazardous chemicals • Experience with previous
• Work-related reproductive pregnancy loss or traumatic
hazards birth experiences
• Support system and
relationship stability
3. Immunization and Infection
History
• Immunization status (Rubella,
Hepatitis B, HPV, Tetanus)
• History of infections affecting
pregnancy (TORCH:
Toxoplasmosis, Other
[syphilis], Rubella,
Cytomegalovirus, Herpes)
Physical Assessment in
Preconception Care
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 For appropriate preconception care,
women can be divided into 2 groups

Inter pregnancy
Newly married group
interval group

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 General Assessment
• Vital Signs:
• Blood Pressure: ____ / ____ mmHg
• Heart Rate: ____ bpm
• Respiratory Rate: ____ breaths/min
• Temperature: ____ °C
• BMI: ____ kg/m² (Weight: ____ kg, Height: ____ cm)
• Oxygen Saturation (if indicated): ____%
• General Appearance:
• ☐ Well-nourished ☐ Underweight ☐ Overweight ☐ Obese
• ☐ Alert & Oriented ☐ Pale ☐ Fatigued ☐ Other: ___________

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Head, Neck & Skin Examination
• Head & Face:☐ Normal ☐ Skull deformities ☐ Facial asymmetry
• Eyes:Sclera: ☐ White ☐ Icteric (Jaundice)
• Pupils: ☐ Normal ☐ Abnormal (Specify: ___________)
• Thyroid Palpation:☐ Normal ☐ Goiter ☐ Nodules ☐ Tenderness
• Skin & Hair:Pigmentation changes (e.g., Acanthosis Nigricans –
PCOS risk): ☐ Yes ☐ No
• Excessive Hair Growth (Hirsutism – Endocrine Disorders): ☐
Yes ☐ No
• Skin Lesions/Moles: ☐ Normal ☐ Abnormal (Describe:
___________)
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Breast Examination
• Breast Inspection:☐
Symmetrical ☐ Asymmetrical
• ☐ Nipple Inversion ☐ Discharge
☐ Masses
• Palpation:☐ No lumps
detected
• ☐ Masses detected (Location:
___________)
Cardiovascular, Respiratory and abdomen
Examination
• Heart Sounds: ☐ Normal ☐ Murmurs ☐ Irregular Rhythm
• Lung Sounds: ☐ Clear Bilaterally ☐ Crackles ☐ Wheezing
• Abdominal Inspection: ☐ Normal ☐ Distension ☐ Scars (Previous
Surgeries?)
• Palpation:
• ☐ Soft, Non-Tender
• ☐ Tenderness (Location: ___________)
• ☐ Masses (Specify: ___________)
• Liver & Spleen Enlargement: ☐ Yes ☐ No
Pelvic Examination (If Indicated & Consented)
• (For identifying gynecological abnormalities, cervical health, or
infections.)
• External Genitalia: ☐ Normal ☐ Lesions ☐ Discharge ☐ Pain
• Speculum Exam: ☐ Normal ☐ Abnormal (Cervical Erosion,
Polyps, etc.)
• Bimanual Examination:
• Uterus: ☐ Normal Size ☐ Enlarged ☐ Retroverted
• Ovaries: ☐ Normal ☐ Enlarged ☐ Cysts Palpable
Neurological & Musculoskeletal Examination
• Neurological:Reflexes: ☐ Normal ☐ Hyperreflexia ☐ Hyporeflexia
• Motor & Sensory: ☐ Normal ☐ Deficits (Specify: ___________)
• Musculoskeletal & Posture: ☐ Normal ☐ Scoliosis ☐ Joint
Abnormalities
 Interventions in
Preconception Care
 Areas addressed by the
Evidence-based interventions
preconception care package
Nutritional conditions
•Screening and management for anemia
and diabetes
•Supplementing folic acid, nutrition
dense food
•Monitoring nutritional status
•Promoting exercise
•Salt iodization

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 Areas addressed by the
Evidence-based interventions
preconception care package
Tobacco use

•Screening for tobacco use

•Pharmacotherapy and intensive behavioural
counselling services
•Harmful effects of second-hand smoke on
pregnant women and unborn children

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 Areas addressed by the
preconception care package Evidence-based interventions

Genetic conditions

•Family planning
•Genetic counselling and treatment for
genetic conditions
•Carrier screening and testing
•Screening among populations at high risks

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Areas addressed by the
preconception care Evidence-based interventions
package
Environmental health
•Providing information on environmental hazards and
prevention
•Protecting from unnecessary exposure to radiation,
lead and pesticides
•Informing women of childbearing age about levels of
methyl mercury in fish
•Promoting use of improved stoves and cleaner fuels
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 Areas addressed by the
Evidence-based interventions
preconception care package
Infertility
•Awareness -preventable and unpreventable
causes of infertility
•Management of underlying causes of infertility,
including past STIs
•Counselling for individuals/couples diagnosed
with unpreventable causes of infertility/sub-
fertility.

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 Areas addressed by the
Evidence-based interventions
preconception care package
Interpersonal violence

•Sex education
•Recognizing signs of violence against women
•Providing health care services
•Screening, counselling and treating of people who are
problem drinkers and have alcohol use disorders

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 Areas addressed by the
Evidence-based interventions
preconception care package
Too-early, unwanted and rapid •Education of girls
successive pregnancies
•Influencing cultural norms that support early
marriage
•Contraceptives
•Engaging men and boys to assess norms and
practices regarding gender-based violence and
coerced sex
•Educating regarding pregnancy with short birth
intervals
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Areas addressed by the
preconception care Evidence-based interventions
package

Sexually transmitted
infections (STIs)
•Promoting safe sex practices
•Promoting barrier methods
•Screening for STIs
•Increasing access to treatment and other relevant
health services

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Areas addressed by the
preconception care Evidence-based interventions
package
HIV
•Family planning
•Promoting safe sex practices
•HIV counselling and testing, including male
partner testing
•Antiretroviral therapy
•Providing male circumcision

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Areas addressed by the
preconception care Evidence-based interventions
package
Mental health
•Assessing psychosocial problems
•Psychosocial counselling
•Managing depression
•Improving access to education for women of
childbearing age
•Strengthening community networks and promoting
women’s empowerment

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 Areas addressed by the
Evidence-based interventions
preconception care package

Psychoactive substance use

•Screening and treatment for substance use
•Providing family planning assistance for
families with substance use disorders
•Establishing prevention programmes to reduce
substance use in adolescents

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 Areas addressed by the
Evidence-based interventions
preconception care package

Vaccine-preventable
diseases

•Vaccination against rubella, tetanus,

diphtheria and Hepatitis B

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REFERENCES

• Meeting to develop a global consensus on preconception care to reduce

maternal and childhood mortality and morbidity. Geneva, World Health
Organization, 2013.
• Liu et al, “Global, regional, and national causes of child mortality: an updated
systematic analysis for 2010 with time trends since 2000”. The Lancet 2012, 379:
2151–61.
• World Health Organization. (2013). Preconception Care Policy Brief . 1–8.
Website url: https://doi.org/10.1016/S1002-0721(09)60023-5
• Govt. of lndia (2014),India Newborn Action Plan (INAP), Sept.2014, Ministry of
Health and Family Welfare, New Delhi.

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