The Resource Guide was developed by the Clinical Work Group of the National Preconception Health and Health Care Initiative, a public-private partnership working to advance preconception knowledge and care of all men and women of reproductive age in the US. Development was supported, in part, by funding from the W.K. Kellogg Foundation, the National Preconception Health and Health Care Initiative, and the Center for Maternal and Infant Health at the University of North Carolina at Chapel Hill.
Recommendations in the guide are evidence-based and echo national and professional recommendations for routine preventive care. Preconception recommendations are largely drawn from the publication, Preconception Health and Health Care: The Clinical Content of Preconception Care (eds: Jack B & Atrash HK, AJOG, 2008;199: 6B) which was an exhaustive review of the evidence to determine what strategies could be recommended for inclusion in preconception care. Using the USPSTF framework, the strength of the specific recommendations and the quality of the evidence were determined. This resource was enhanced by supplementary reviews of subsequent literature, a review of recommended practices by professional organizations and expert opinion.
The structure, framework and content of the guide were created by clinicians who included one or more representatives of American Academy of Family Physicians, the American College of OB/GYNs, the Association of Certified Nurse Midwives, the Association of Women’s Health, Obstetric and Neonatal Nurses and the Society for Maternal Fetal Medicine. The names and affiliations for each of the members of the team along with their principle areas of toolkit responsibility are provided in the authors section below.
During the creation process, the toolkit underwent field testing and revision. The Clinical Work Group thanks all of those clinicians who were so generous with their time and meticulous with their comments.
To ensure that providers understand how best to use this guide, we have developed a short power point presentation. To review the slides, please click here.
The guide is designed to build on a triaging approach whereby care is based on the likelihood of conception before the next routine primary care visit. This approach allows care to be efficiently targeted to the individual woman’s needs and risks. It is easily achievable by using a reproductive life plan (RLP). The RLP will identify if a specific woman:
- Desires pregnancy in the next year,
- Is unsure or ambivalent about her desires and, thus, at risk for an unintended conception in the next year, or
- Has no desire for pregnancy in the next year.
Based on the desires and likelihood of pregnancy in the next year, the guide offers specific clinical recommendations for ten components of routine primary care:
- Family Planning Guidance
- Infectious Diseases and Immunizations
- Chronic Diseases
- Medication Use
- Substance Use
- Previous Pregnancy Outcomes
- Genetic History
- Mental Health
- Intimate Partner Violence
Each of the ten components has been developed to provide:
- Background Information
- Clinical Guidance
- Clinical Tools
- Patient Resources
We appreciate the hard work and dedication of the following toolkit authors.
Eileen Beard, CNM, FNP, MS: Senior Practice Advisor, American College of Nurse-Midwives, Silver Spring, MD (over-all content reviewer).
Peter Bernstein, MD, MPH: Professor of Clinical Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, NY (chronic diseases).
Dean Coonrod, MD, MPH: Chair, Department of Obstetrics and Gynecology, Maricopa Integrated Health Care System; Phoenix, AZ (infectious diseases, previous pregnancy outcomes).
Anne Dunlop, MD, MPH: Associate Professor, Schools of Nursing, Medicine and Public Health, Robert W. Woodruff Health Sciences Center of Emory University, Atlanta, GA (nutrition, previous pregnancy outcomes).
Daniel J. Frayne, MD: Assistant Residency Director, MAHEC Family Medicine Residency Program, Asst. Clinical Professor, UNC Chapel Hill School of Medicine, Asheville, NC (chronic diseases).
Louise Floyd, DSN, RN: Associate Director of Program and Planning NCBDDD CDC, Atlanta, GA (substance use).
Jennifer Hosmer, MD, MPH: Chair Department of Obstetrics and Gynecology, The Providence Community Health Center, Providence, RI (infectious diseases) and Clinical Assistant Professor of Obstetrics and Gynecology, Brown Medical School, Providence, RI.
Merry-K. Moos, RN, (FNP-inactive), MPH, FAAN: Consultant, UNC Center for Maternal and Infant, Chapel Hill, NC (coordinator of initiative; family planning guidance, medication use, substance use, genetic history, interpersonal violence).
Catherine Ruhl, MS, CNM: Director of Women’s Health Programs, Association of Women’s Health, Obstetrical and Neonatal Nursing, Washington, DC (interpersonal violence).
Laurie Zephryn, MD: National Director for Women’s Health at Veteran’s Affairs, Washington, DC Affairs (mental health).