GPAtlas🧭 When to offer pre-conception care
Pre-conception care is not a diagnosis but a proactive consultation, offered to anyone of reproductive age who:
• Is planning a pregnancy.
• Wishes to stop contraception.
• Has a long-term condition or medication that could affect pregnancy.
The aim is to optimise health before conception to improve outcomes for parent and baby.
Two facts make this consultation matter:
• First, the neural tube closes by around 28 days – often before a pregnancy is recognised – so folic acid and a medication review must happen before conception, not at booking.
• Second, around two-thirds of maternal deaths in the UK now occur in women with pre-existing medical conditions, so the people who benefit most are often those already under your care for chronic disease.
The two highest-value actions are simple: start folic acid, and review every medication for teratogenicity before contraception is stopped. Be proactive – raise pre-conception health opportunistically rather than waiting to be asked.
| Especially important to offer to |
|---|
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• Anyone with a chronic condition or its medication affecting pregnancy – diabetes, epilepsy, hypertension, thyroid, asthma, cardiac, renal or autoimmune disease |
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• Anyone taking a known teratogen – sodium valproate, isotretinoin, methotrexate, ACE inhibitors/ARBs, warfarin or lithium |
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• A previous adverse pregnancy outcome – neural tube defect (NTD) or congenital anomaly, recurrent miscarriage, stillbirth, pre-eclampsia or gestational diabetes |
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• Smokers, high alcohol or recreational drug use, and a raised or low body mass index (BMI) |
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• Family origin or family history suggesting a haemoglobinopathy or inheritable condition |
| Opportunities to raise it |
|---|
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• Requests to stop contraception, and routine contraception reviews |
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• Chronic disease and medication reviews |
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• Sexual health and cervical screening attendance |
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• After a miscarriage, ectopic or termination |
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• Any consultation where a wish to conceive is mentioned |
Source: NICE NG247 · NICE NG3
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