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, or 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 | Opportunities to raise it |
|---|---|
|
• Anyone with a chronic condition or its medication affecting pregnancy – diabetes, epilepsy, hypertension, thyroid, asthma, cardiac, renal or autoimmune disease |
• Requests to stop contraception, and routine contraception reviews |
|
• Anyone taking a known teratogen – sodium valproate, isotretinoin, methotrexate, ACE inhibitors/ARBs, warfarin or lithium |
• Chronic disease and medication reviews |
|
• A previous adverse pregnancy outcome – neural tube defect (NTD) or congenital anomaly, recurrent miscarriage, stillbirth, pre-eclampsia or gestational diabetes |
• Sexual health and cervical screening attendance |
|
• Smokers, high alcohol or recreational drug use, and a raised or low body mass index (BMI) |
• After a miscarriage, ectopic or termination |
|
• Family origin or family history suggesting a haemoglobinopathy or inheritable condition |
• Any consultation where a wish to conceive is mentioned |
Source: NICE NG247 · NICE NG3
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