Maternal & Newborn · Topic 41 of 58
Preconception Care
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Preconception Care
The visit before pregnancy: folic acid, vaccines, medication review and chronic disease control, all before conception. Alcohol can affect the fetus before the pregnancy is known.
Folic acid
400–800 mcg daily, starting at least 1 month before conception
A client needing extra folic acid takes a separate folic acid supplement, not extra prenatal vitamins, because of the risk of vitamin A toxicity. ACOG also counsels clients with seizure disorders to take 4 mg daily; the 2024 AAN guideline sets at least 0.4 mg daily and says the optimal dose is unclear.
Vaccines
Live vaccines before conception, never during pregnancy
Varicella vaccine takes 2 doses, so a nonimmune client who wants pregnancy starts about 2 months before trying to conceive.
Medication review
Review every medication, and teach not to stop one alone
Teach: if pregnancy occurs on isotretinoin, stop it at once and call the provider; ACE inhibitors and ARBs are also discontinued as soon as pregnancy is detected. Isotretinoin requires contraception until 1 month after the last dose; methotrexate requires effective contraception until 6 months after the final dose. Warfarin is contraindicated in pregnancy except in some clients with mechanical heart valves at high risk of thromboembolism. Teach reliable contraception while on a teratogenic drug.
Chronic conditions
Control them before conception
Teach reliable contraception until diabetes treatment and A1C are ready for pregnancy.
Alcohol, nicotine and drugs
No amount of alcohol is known to be safe
Moderate caffeine, under 200 mg a day, does not appear to be a major factor in miscarriage or preterm birth.
Weight
Encourage a normal BMI before conception
After bariatric surgery, pregnancy is less desirable during rapid weight loss, typically the first 12–24 months.
Birth spacing
Birth to next conception: avoid under 6 months
After a prior cesarean, a client considering a trial of labor has a higher risk of uterine rupture with an interpregnancy interval of 18–24 months or less.
Teach: exposures to avoid
Toxoplasmosis, high-mercury fish and lead
Screening at the visit
Nursing priorities
Folic acid and live vaccines come at least 1 month before conception. Review every medication, and teach the client not to stop one alone.
Sources · USPSTF 2023 folic acid recommendation, clinical summary (Am Fam Physician) · CDC: About Folic Acid · CDC: Guidelines for Vaccinating Pregnant Women · ACOG Committee Opinion 762: Prepregnancy Counseling (2019) · Divalproex sodium delayed-release tablets label, boxed warning: fetal risk (DailyMed) · Lisinopril tablet label, boxed warning: fetal toxicity (DailyMed) · Isotretinoin capsules label, boxed warning and iPLEDGE REMS (DailyMed) · Methotrexate tablets label, boxed warning: embryo-fetal toxicity (DailyMed) · ADA Standards of Care in Diabetes 2026, Section 15: Management of Diabetes in Pregnancy · CDC: About Alcohol Use During Pregnancy · CDC: Vaccines Recommended Before and During Pregnancy · Managing Chronic Hypertension in Pregnant Women: ACOG Practice Bulletin 203 summary (Am Fam Physician 2019) · AAN/AES/SMFM 2024 guideline: epilepsy and pregnancy (AAN press release) · CDC: Preventing Toxoplasmosis · CDC: People at Increased Risk for Toxoplasmosis · FDA: Advice About Eating Fish · CDC NIOSH: About Lead and Other Heavy Metals and Reproductive Health · USPSTF 2025: Intimate Partner Violence and Caregiver Abuse, Screening · Interpregnancy Care: Guidelines from ACOG and SMFM (Am Fam Physician 2019) · Warfarin sodium tablet label (DailyMed) · Follow your facility's protocol for preconception screening.
Preconception Care
Preconception care is the visit before pregnancy that prepares a client for conception through folic acid, vaccines, medication review, chronic disease control and risk screening. Folic acid 400 to 800 mcg daily, started at least 1 month before conception, prevents neural tube defects, and after a prior affected pregnancy the prescribed dose is 4 mg daily. Live vaccines such as MMR and varicella are given at least 1 month before conception and never during pregnancy, so the nurse checks rubella and varicella immunity first. Every medication is reviewed, and the client is taught not to stop one alone: isotretinoin, warfarin, valproate, ACE inhibitors, ARBs and methotrexate need a plan with the provider. Diabetes, hypertension, seizure disorders and thyroid disease are controlled first, with an A1C goal below 6.5% when that is safe. No amount of alcohol is known to be safe. The visit also covers weight, toxoplasmosis, high-mercury fish, lead, partner violence, STIs, mood disorders and birth spacing, avoiding an interval under 6 months.
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