Preconception care: risk review, family history, supplements, vaccines and planning a pregnancy
- Safe practice
Before a planned pregnancy the nurse reviews risks, family history, habits, vaccines and tests, and prepares the woman to start it in the best health.
What it is
Preconception care gives women and couples health interventions before conception to improve their health and lower the risks for mother and baby (WHO). In Colombia, Resolución 3280 de 2018 asks every service to ask each woman about her plans to become pregnant. Women with that plan within a year get a preconception visit and at least one control. Without risk factors, a doctor or a nurse does the visit. Because about 4 in 10 pregnancies are unplanned (WHO), the visit also offers contraception until the woman decides.
What it requires
- Personal history to ask about includes diabetes, thyroid disease, epilepsy, hypertension, kidney, heart and autoimmune disease, thrombophilia, anaemia, asthma, tuberculosis, cancer and severe obesity.
- Family and genetic history, ideally three generations of both partners; maternal age over 35. Women with genetic history are referred to obstetrics.
- Tests in the route include hepatitis B surface antigen, cervical screening, fasting glucose, blood group, blood count, toxoplasma, rubella and varicella IgG, rapid syphilis test, urine culture and rapid HIV test with pre- and post-test counselling.
- WHO areas of preconception care include nutrition, tobacco, genetic conditions, vaccine-preventable disease, infertility, violence, STIs and HIV, mental health and substance use.
Components
- History: reproductive plans, personal, family, gynaecological and obstetric history, habits and psychosocial situation.
- Full physical examination with weight, height and nutritional status, and a gynaecological examination.
- Tests and their reading at the control visit.
- Plan of care: supplements, vaccines, referrals, health information and a contraceptive method until she decides.
How it is applied (and why)
- Ask about her plans and life project in every contact — the route starts from the reproductive intention.
- Take personal, family and obstetric history — chronic diseases and past complications change the plan.
- Ask about diet, activity, sleep, stress, medicines, tobacco, alcohol and other substances — detailed questions raise awareness of risk.
- Assess family support and exposure to gender or sexual violence — violence and isolation are risks too.
- Check the vaccination card and plan the missing vaccines at least three months before pregnancy — some vaccines are not given during pregnancy.
- Order the route's tests and read them at the control — the control visit closes the diagnosis.
- Ask the two depression questions when there is a history of postpartum depression — a positive answer goes to the mental health route.
- Teach folic acid before conception, spacing, early antenatal care and the right to IVE — she decides with full information.
- Provide a contraceptive method chosen by eligibility until she wants to conceive — planning needs time.
In nursing practice
- Previous preterm birth, stillbirth, two or more miscarriages or recurrent loss: refer for evaluation of causes before a new pregnancy.
- Previous postpartum haemorrhage: plan the next birth in an institution able to manage haemorrhage.
- Women with chronic disease are referred to the specialist to adjust treatment before conceiving, as the route sets out.
- Rh-negative women: blood group of the woman and her partner, with parity and past anti-D prophylaxis, to judge the risk of sensitisation.
Common mistakes
- Asking about pregnancy plans only in the gynaecology clinic.
- Leaving the visit without a method when the pregnancy is not planned yet.
- Forgetting to plan vaccines before the pregnancy.
- Not asking about violence and substance use.
Test yourself
Think of the answer, then tap the question to see it.
How long before a pregnancy should the vaccination schedule be complete, according to Res. 3280?
At least three months before the pregnancy.
What interval between pregnancies does the preconception visit advise?
At least 18 months, including after a caesarean section.
Why does the preconception visit also provide contraception?
So the woman can plan the pregnancy in the best conditions; she uses a method she chose until she decides to conceive.
Who may do the preconception visit for a woman without risk factors?
A medicine or nursing professional; obstetrics takes over when needed.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Resolución 3280 de 2018: Ruta Integral de Atención en Salud Materno Perinatal (section 4.1, preconception care) (Ministerio de Salud y Protección Social de Colombia, 2018); Preconception care: maximizing the gains for maternal and child health (policy brief) (World Health Organization, 2013).
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Representative model, for educational purposes only.