Preconceptual obstetric risk assessment and health promotion.

Preconceptual risk assessment is an increasingly important part of obstetric care in the era of fetal therapeutics, invasive diagnostic techniques and "premium" pregnancies. The constant rates of the two greatest contributors to infant morbidity and mortality--congenital malformations and low birth weight--suggest that our basic approach to obstetric care is not sufficiently preventive. Preconceptual obstetric risk assessment, along with health promotion, education and therapeutic intervention, can reduce risk and improve outcome. A medical and psychosocial emphasis on preconceptual and early pregnancy care, along with promotion of the health of the pregnant woman, the fetus, the infant and the family up to one year after birth, may prove to be a way of decreasing infant morbidity and mortality. The identification of important risks associated with demographics, systemic disease, infection, environment, genetics and lifestyle will assist the family physician in promoting health strategies in obstetric care.