Very few patients schedule a preconception visit prior to attempting to conceive. While not all pregnancies are planned in a deliberate way, many are. Most patients move mountains to ensure that they don’t miss a prenatal visit, but almost no one has heard of a “preconception visit.” And, though not widely discussed, these visits can offer significant health benefits for patients and their families.
Preconception visits are just that: a medical appointment with a healthcare professional (usually an OB-GYN or a midwife) to ensure maternal health is optimized before attempting to conceive. These visits are widely mandated by reproductive endocrinologists in the setting of patients with health issues undergoing in-vitro fertilization, but are not routinely used by other women, despite the potential benefits.
Information and knowledge can be relayed effectively during these visits. For example, reviewing the recommendation to take prenatal vitamins (or folic acid alone) for the three months prior to conception can be a powerful tool in the prevention of neural tube defects in developing pregnancies. Neural tube abnormalities can range from the purely cosmetic skin “dimple” to catastrophic morbidity. And though there have been many advances in intra-fetal repair of these anomalies, prevention is easier, less expensive, and has far fewer complications. Yet many mothers believe they should only start taking prenatal vitamins after a positive pregnancy test—despite the fact that the neural tube is often already partially formed by that time.
There is also the opportunity for patients to learn more about the physiology of reproduction during preconception visits. For example, many couples erroneously believe that abstaining from sex for long lengths of time prior to ovulation can improve sperm count and conception. In fact, evidence shows that this actually decreases conception rates. Sperm are produced continuously, largely irrespective of ejaculation frequency. Although abstaining for just a few days improves sperm count, sperm “saved” for longer than this are more likely to be abnormal and are less likely to produce a pregnancy.
During a preconception visit, emerging or chronic maternal health issues can be identified and addressed. For example, waning immunity to chicken pox (more common now that more of the population is vaccinated rather than previously infected) can be easily corrected with simple vaccination. And though we think of chicken pox as a minor infection in children, it can have disastrous effects on a developing pregnancy. Unfortunately, the chicken pox vaccination should not be given to pregnant women for potential safety concerns. The window for vaccination is prior to conception, not after.
Perhaps the most compelling rationale for the preconception visit is the opportunity to discuss genetic carrier screening. Much of the population is aware that parents can be “silent carriers” for potentially harmful genetic conditions. If two parents are both carriers of the same condition, they have a roughly 25% chance of having a pregnancy with that condition. Of course, some conditions are less severe than others, but many are dangerous and potentially life-ending. Most of the Jewish community is well-aware of Tay-Sachs disease, but few are aware of the hundreds of other similar and significant diseases that exist. Armed with this knowledge prior to conception, families can better choose which plan of care is best for them. Some families will decide to do IVF, and only select embryos not affected by the disease that the parents carry. Some families would prefer not to do IVF, but instead opt for early diagnostic testing, which gives them the option to end an affected pregnancy early, when it is comparatively safer and less complex. And still other families will choose to conceive spontaneously and not test, but will alert their pediatrician to the possibility of disease and have a low threshold for screening and intervention in their newborn children. For some conditions, early identification and lifestyle modification can be the difference between a normal life and profound degenerative disability.
Skipping a preconception consultation can be a missed opportunity to make a pregnancy safer. Things as simple as taking a vitamin, getting a blood test and seeing a doctor can have enormous influence over the health of a woman and her pregnancy, and ultimately, the shape of her family. Do we not owe it to ourselves and our families to do what we can to stay safe and healthy, especially when it can be as simple as a conversation?
Special thanks to Dr. Nicole Feigenblum, who provided the inspiration for this piece.
Amanda Resnikoff, MD is a skilled, determined and compassionate OB-GYN who grew up in the Hudson Valley. She attended Columbia University and graduated with a bachelor’s degree in neuroscience. Dr. Resnikoff then earned her medical degree from Sackler School of Medicine and later completed her residency at Rutgers NJMS (formerly UMDNJ). Dr. Resnikoff worked as an OB-GYN at Hackensack University Medical Center for five years before joining the team at Maternal Resources in 2017.
