Division of Maternal-Fetal Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Obstet Gynecol Surv. 2010 Feb;65(2):119-31. doi: 10.1097/OGX.0b013e3181d0c358.
Our objective was to provide the clinician with easy-to-use evidence-based guidelines, based on the best available literature, for offering effective preconception care, aimed at decreasing maternal and fetal/neonatal morbidity and mortality. We searched the Cochrane Library, MEDLINE, and PUBMED from 1966 until January 2009. We used the search terms "preconception," "preconception care," "prepregnancy," and "inter-pregnancy." We focused on level I publications, randomized studies, and meta-analyses of these studies in particular. We included non-English publications, if pertinent. We searched the reference lists of manuscripts identified, and selected those we judged relevant. Preconception care has been defined as a set of interventions that aim to identify and modify risks to a woman's health or pregnancy outcome through prevention and management. It should occur any time any healthcare provider sees a reproductive age woman. Personal and family history, physical exam, laboratory screening, reproductive plan, nutrition, supplements, weight, exercise, vaccinations, and injury prevention should be reviewed in all women. Folic acid 400 mcg per day, as well as proper diet and exercise should be encouraged. Women should receive the influenza vaccine if planning pregnancy during flu season; the rubella and varicella vaccines if there's no evidence of immunity to these viruses; and tetanus/diphtheria/pertussis if lacking adult vaccination. Specific interventions to reduce morbidity and mortality for both the woman and her baby should be offered to those identified with chronic diseases, or exposed to teratogens or illicit substances. There are several interventions that have been proven to effectively improve pregnancy outcome when provided as preconception care. These should be consistently provided to reproductive-age women.
Obstetricians & Gynecologists, Family Physicians. LEANING OBJECTIVES: After completion of this educational activity, the participant should be better able to assess potential benefits for women and their offspring that result from preconception care, translate specific evidence-based preconception strategies into clinical practice, and select resources for practitioners and patients that are print media or online related to preconception health.
为临床医生提供基于最佳现有文献的易于使用的循证指南，以提供有效的孕前保健，旨在降低母婴和胎儿/新生儿发病率和死亡率。我们检索了 Cochrane 图书馆、MEDLINE 和 PUBMED 从 1966 年到 2009 年 1 月。我们使用了“孕前”、“孕前保健”、“孕前”和“孕期”等术语。我们特别关注一级出版物、随机研究和这些研究的荟萃分析。如果相关，我们包括非英语出版物。我们检索了确定的手稿的参考文献列表，并选择了我们认为相关的。孕前保健已被定义为一组旨在通过预防和管理来识别和改变女性健康或妊娠结局风险的干预措施。任何时候任何医疗保健提供者看到育龄妇女都应进行孕前保健。应在所有妇女中审查个人和家族史、体格检查、实验室筛查、生殖计划、营养、补充剂、体重、运动、疫苗接种和伤害预防。应鼓励每天服用 400 mcg 叶酸以及适当的饮食和运动。如果计划在流感季节怀孕，应给妇女接种流感疫苗；如果没有针对这些病毒的免疫力，则应接种风疹和水痘疫苗；如果没有成人疫苗接种，则应接种破伤风、白喉和百日咳疫苗。应向患有慢性病或接触致畸剂或非法物质的妇女提供减少母婴发病率和死亡率的具体干预措施。已经证明，当作为孕前保健提供时，有几种干预措施可以有效地改善妊娠结局。这些应该持续提供给育龄妇女。
妇产科医生、家庭医生。学习目标：完成这项教育活动后，参与者应该能够更好地评估孕前保健为女性及其后代带来的潜在益处，将具体的基于证据的孕前策略转化为临床实践，并为从业者和患者选择与孕前健康相关的印刷媒体或在线资源。
