Preconception counseling: Rational, practice and challenges

Preconception counseling (PCC) is aimed at identifying and modifying risks related to maternal health and pregnancy outcome, prior to pregnancy. The main components of PCC include: maternal risk assessment, maternal education, and initiation of interventions. It is an opportunity to provide essential information regarding pregnancy, possible risks and available management options. At times, PCC provides a unique "time window" for an intervention, prior to the pregnancy, which may reduce maternal and fetal risks. Specific maternal populations may benefit from PCC more than others with regard to optimizing pregnancy outcome. Although PCC has been recommended for years as standard of care, most providers do not offer it and most consumers do not ask for it. The present review discusses the essence of preconception counseling and the evidence for its effectiveness. In addition, specific topics are reviewed in depth including folic acid supplementation, obesity, depression, seizure disorders, and drug therapy during pregnancy.