Prepregnancy Care and Counseling to Improve Maternal and Neonatal Outcomes

This episode of JAMA Clinical Reviews features a detailed discussion on pre-pregnancy care and counseling, led by Dr. Karen Lasser and guests Dr. Kylie Cooper and Dr. Danielle Breitkopf from Mayo Clinic. The conversation emphasizes the critical role of pre-pregnancy interventions in improving maternal and neonatal outcomes by addressing modifiable risk factors such as diabetes, obesity, hypertension, substance use, and mental health. The experts highlight key strategies including optimizing hemoglobin A1c levels in women with diabetes, managing weight with lifestyle and pharmacologic approaches (while navigating the complexities of GLP-1 receptor agonists), controlling blood pressure with pregnancy-safe medications, and screening for intimate partner violence. They also stress the importance of medication review, folic acid supplementation, immunizations, and infectious disease screening—particularly for HIV, syphilis, rubella, varicella, and hepatitis B—as foundational components of preconception care. Specialized referrals to maternal-fetal medicine and genetic counseling are recommended for patients with complex medical or genetic conditions. The episode underscores that pre-pregnancy care is not only for those actively trying to conceive but should be a routine part of reproductive health for all individuals of reproductive age. It positions preconception counseling as a proactive, patient-centered opportunity to reduce morbidity and mortality, improve long-term health, and empower individuals with informed decision-making tools. The discussion concludes with a call for generalists to integrate these evidence-based practices into routine care, using validated screening tools and interdisciplinary collaboration to ensure equitable access to high-quality pre-pregnancy support.