In this country, the first prenatal visit is traditionally not scheduled until at least 8 weeks after conception. By that time, many irreversible problems may have already developed because most of the body's vital organs are formed within the first few weeks of pregnancy.
"By the time women see a doctor, the horse is already out of the barn," says Dr. Peter Bernstein, a maternal and fetal medicine specialist at Montefiore Medical Center in New York. "Pregnancy planning and care should begin months before a couple tries to conceive."
Many experts believe that this late start might explain why poor pregnancy outcomes continue to be a problem in the U.S. despite dramatic improvements in prenatal care over the last two decades. Each year, close to 500,000 babies are delivered prematurely and 120,000 are born with major birth defects.
Last year, the Centers for Disease Control and Prevention (CDC) convened a panel of experts in maternal and fetal medicine to formulate recommendations for preconception health and care. The results, published in the CDC's journal Morbidity and Mortality Weekly Report in April, provide some general guidelines for women and their medical care providers to follow.
The panel's recommendations stress the importance of individual responsibility, encouraging every woman, man and couple to have a "reproductive life plan" and noting that unintended pregnancies allow no opportunity for preconception care. Unfortunately, in the U.S., approximately half of all pregnancies are unplanned. "Every pregnancy should be a planned pregnancy," says Bernstein, who was a member of the panel.
Bernstein adds that pregnancies should not only be planned, they should be planned with a doctor or other healthcare provider. That way, an appropriate action plan can be developed.
Many problems can be avoided by simply ensuring that women and couples are in better health before they get pregnant and have established healthier lifestyles, the panel concluded. Later this month, it will reconvene to identify specific strategies to achieve this. But some interventions are so logical -- and already so well-supported by science -- that there is no reason to wait for the panel's go-ahead to begin implementing them.
