Expanded care in obstetrics for the 1980s: preconception and early postconception counseling.

This paper is an essay in which the suggestion is made to expand obstetric care during this decade to include preconception as well as early postconception counseling. The development of perinatal and neonatal medicine is traced and medical problems that might be improved by medical counseling before pregnancy occurs are tabulated. Diabetes is suggested as a prototype of a medical disorder for which preconception counseling would be helpful. The expansion of obstetric services into an area of preventive medicine might well begin in already established regional medical centers but should quickly expand to the offices of private obstetricians. In this broader interpretation of obstetric care, prevention of maternal and fetal or neonatal problems could decrease the cost of high-risk medical care.