What is preconception care, and should you care before you're even pregnant?

Cynthia Nypaver, PhD, APRN-CNM, WHNP-BC, FACNM, is an associate professor and the director of the Nurse-Midwifery Master of Science in Nursing (MSN) Program at the University of Cincinnati (UC) College of Nursing. She is a certified nurse-midwife and a fellow of the American College of Nurse-Midwives who spent nearly two decades in clinical midwifery practice before moving into full-time nursing education and research. Her research focuses specifically on closing the maternal healthcare gap for various populations, reducing infant mortality rates and examining community-based approaches to prenatal care, and preconception health.

Preconception care is often confused with prenatal care, but the two happen at different points and serve different purposes.

• Prenatal care is the medical care you receive after you're already pregnant: think ultrasounds, monitoring fetal growth, and preparing for delivery.
• Preconception care is the medical, nutritional, and lifestyle support you get before pregnancy, aimed at identifying and managing anything that could affect a future pregnancy, or your own health regardless of whether you ever become pregnant.

Because roughly 4 in 10 pregnancies in the U.S. are unintended, according to CDC data, many people find out they are pregnant only after key developmental windows have already begun. That is part of why Nypaver and other clinicians argue preconception care shouldn't be a special, opt-in visit, but simply a routine part of primary care for anyone of reproductive age, delivered by family doctors, nurse practitioners, and general OB-GYN visits alike, and not something reserved for fertility specialists.

Routine preconception care can include screening and counseling on:

• Chronic conditions, such as diabetes and high blood pressure, which are easier and safer to stabilize before pregnancy than during it
• Mental health, including depression and anxiety
• Intimate partner violence, which research shows can escalate during pregnancy
• Immunizations, such as making sure someone is protected against rubella, a virus that can cause serious birth defects if contracted during early pregnancy
• Nutrition and physical activity, including the well-known recommendation that anyone who could become pregnant get 400 micrograms of folic acid daily
• Environmental exposures, such as lead and mercury, which can affect fertility and fetal development
• Infectious diseases, including sexually transmitted infections
• Medications and their safety, since some common prescriptions aren't safe to continue during pregnancy and need to be adjusted in advance

A point Nypaver emphasizes is that preconception health isn’t solely a woman's responsibility. Sperm health, chronic conditions, medications, and environmental exposures on a partner's side can also affect fertility and pregnancy outcomes.

"Because factors affecting reproductive health can involve both partners, optimizing health before pregnancy should include all individuals of reproductive age," Nypaver says.

One of the more forward-looking parts of Nypaver's review is a rundown of the digital tools, from mobile health apps to wearable devices to personalized risk assessments, now being used to make preconception care easier to deliver and easier to stick with.

Preconception care isn't just about individual habits; it is tangled up with who can access health care at all. The numbers show well-documented concerns about ensuring fairness when examining maternal and infant health and making sure people in all communities receive proper care.

Nypaver suggests telehealth and other virtual approaches could help expand access to preconception care, particularly in rural communities. She also points to policy-level solutions, such as expanding health care coverage and directly addressing maternity care deserts, as ways to improve access to care before and between pregnancies.

Her biggest practical recommendation, however, is deceptively simple: stop treating preconception care as a special appointment and start folding it into every routine health care visit.

For health systems, that can mean building automatic prompts into electronic health records. For individual providers, including primary care doctors, it can mean simply adding a few questions to a routine health history: Are you planning a pregnancy, now or in the future? Are your chronic conditions well-managed? Are your immunizations up to date? How's your nutrition and activity level?

The need for more research done with communities into which preconception interventions actually move the needle is also emphasized by Nypaver.

"The community is the expert in designing interventions that actually fit local needs," she says, describing the value of a research approach where community members help shape the questions being studied, not just serve as subjects.

What is preconception care, in simple terms?

It's health care and health habits focused on preparing your body for a possible future pregnancy — managing chronic conditions, updating vaccines, improving nutrition, and reviewing medications — done before you conceive rather than after.

Who needs preconception care?

Anyone of reproductive age who could become pregnant, or who could get someone else pregnant, can benefit — not only people who are actively trying to conceive. Since a large share of pregnancies are unplanned, experts recommend treating preconception health as part of ordinary primary care.

Does preconception care only apply to women? No. Nypaver and other experts emphasize that both partners' health — including chronic conditions, medications, and environmental exposures — can affect fertility and pregnancy outcomes.

How is technology changing preconception care?

Mobile apps, wearable devices, EHR reminders, and AI-powered chatbots like Gabby are being used to deliver personalized reminders, education, and coaching, especially for people who face barriers to regular in-person care.

Why does preconception care matter for health equity?

Different populations in the U.S. face different maternal mortality rates and more than a third of U.S. counties lack basic maternity care access. Expanding preventive, preconception-stage care — including through telehealth — is one strategy experts point to for narrowing those gaps.

Where can I learn more or find tools?

Before, Between & Beyond Pregnancy is a national resource with preconception and interconception health information and toolkits for both patients and providers.

Prenatal care has long been the focus once someone is pregnant. Nypaver's message is that the months and years before pregnancy deserve just as much attention, not as a niche specialty service, but as a normal part of everyone's health care, supported by better technology, better research done in partnership with communities, and policy that closes access gaps.

"It's everybody's responsibility as providers," she says. "If we all work together and try to make preconception care part of every health care encounter, it can help improve health and outcomes for mothers and children."

Featured top image from iStock.