Preconception counseling: Make it part of the annual exam

Think ahead: Address immunization status

When a pregnant woman contracts an infectious disease, her developing fetus can be affected. Making sure the immunization status of all your reproductive-age patients is up to date will go a long way toward protecting their offspring from harm.²⁹

Rubella. Also known as German measles, rubella can cause fetal anomalies and spontaneous abortion if contracted during the first half of pregnancy. Because the measles, mumps, and rubella (MMR) vaccine contains live attenuated viruses, susceptible patients should be immunized at least 1 month before they conceive.³

Hepatitis B. Preventing hepatitis B is an important public health issue. Screen patients at risk for hepatitis B infection—health care workers, sex workers, intravenous drug abusers, and nonmonogamous women who do not use barrier protection—with a hepatitis B surface antigen level. Vaccination is safe up to 1 month before conception.³

Varicella. Maternal varicella (chicken pox) can cause fetal harm, particularly if symptoms appear just before or during delivery. Women of reproductive age who have not already had the disease or been vaccinated should be immunized. This is a live virus vaccine and must, therefore, be administered at least 1 month before conception.³

Influenza. Administering influenza vaccine is not contraindicated during pregnancy, although most experts advise waiting until the second trimester. Certainly it is appropriate to administer the vaccine during influenza season or when risk factors such as chronic lung disease are present. Avoid live attenuated vaccine (FluMist) in pregnant women.

Tdap vaccination. The CDC’s Advisory Committee on Immunization Practices recommended in 2008 that susceptible pregnant women receive Tdap during the postpartum period to protect vulnerable infants against pertussis. Tdap is thought to be safe during pregnancy, but it would make sense to administer this vaccine when indicated prior to conception as part of a vaccination screening program.

Screen for genetic conditions prepregnancy

Part of a comprehensive preconception visit includes screening for communicable diseases and genetic conditions.

Communicable diseases. Consider screening all women prior to pregnancy for HIV infection, gonorrhea, chlamydia, hepatitis B, hepatitis C (for health care workers), and syphilis.

Diabetes. Screening guidelines for diabetes are available from the American Association of Clinical Endocrinologists.²⁰ Consider preconception screening for patients who, during a previous pregnancy, had gestational diabetes or who delivered a baby weighing more than 9 pounds.

Genetic screening. Patients from certain ethnic groups are more susceptible to specific genetic mutations. Genetic disorders associated with particular ethnic origins are listed in TABLE 3 . Consider a preconception referral to a genetic counselor or perinatologist when the patient’s family history suggests inherited disorders.

TABLE 3
Genetic disorders: Who to screen, tests to use³⁴

Correspondence
D. Ashley Hill, MD, Associate Director, Department of Obstetrics and Gynecology, Loch Haven OB/Gyn Group, Florida Hospital Orlando, 235 Princeton Street, Suite 200, Orlando, FL 32804; d.ashley.hill.md@flhosp.org