In 1990, the United States Public Health Service published Healthy People 2000: National Health Promotion and Disease Prevention Objectives. One of the objectives included in the family planning priority area and repeated in the maternal and infant health priority area is the following: "Increase to at least 60 percent the proportion of primary care providers who provide age-appropriate preconception care and counseling." Drawing on the guidelines proposed by the Public Health Service Expert Panel on the Content of Prenatal Care, this article describes the components of preconception care: 1) appropriate and ongoing risk assessment, 2) health promotion, and 3) medical and psychological interventions and follow-up. The organization of this article is based on a preconception class outline developed by the authors; recommendations included in the article are consistent with those of the Expert Panel. After discussing opportunities for providing preconception care, this article addresses: 1) helping women evaluate their psychological readiness; 2) evaluating physical readiness; 3) the examination and concerns of the father; 4) evaluating the need for genetic counseling; 5) creating a positive environment for conception; 6) discontinuing family planning methods and timing conception; and 7) choosing a provider and birth place.

PIP: There is an increased attention to preconception care and counseling (PCC) in the US. Midwives should include it into their practice. Even though the PCC concept is new, many midwives already know and/or practice its components, including risk assessment, health promotion, psychological and medical interventions, and follow-up. Opportunities for PCC are gynecology visits, postpartum visits, school-based programs, occupational health centers, and local health departments. Midwives can help women decide whether they are psychologically prepared for motherhood through group discussions and family-timing scenarios. They should refer women to substance abuse counseling and address physical abuse. A medical history and physical exam followed by an evaluation of any medical problems are also important. Preconception screening should include laboratory tests for hemoglobin or hematocrit, Rh factor, rubella titer, urine dipstick (protein and sugar), Pap smear, gonococcal culture, syphilis ...... and hepatitis B test. Midwives should offer women an illicit drug screen and an HIV serodiagnostic test. Additional tests recommended for some women include a tuberculosis screen, chlamydia culture or rapid screen, toxoplasmosis, herpes simplex, cytomegalovirus, varicella, hemoglobinopathies, Tay-Sachs, and karyotype. Factors which may affect sperm morphology are cigarette smoking, alcohol drinking, vitamins A and E, linoleic acid, and zinc. Other male factors which may affect pregnancy outcome are advanced age, sexually transmitted diseases, HIV, and exposure to drugs and chemicals. Midwives should determine the need to refer women for genetic counseling. They can help establish a positive environment for conception by conducting a nutritional history and counseling; promoting vitamin supplementation; by counseling about dangers of cigarette smoking, alcohol drinking, and drugs; and by keeping up to date on reproductive toxicology, environmental pollutants, and occupational hazards. Midwives should take a menstrual, contraceptive, and sexual history. Menstrual charting can help detect ovulation. Other issues needing to be addressed are infertility and choosing a care provider and birth place.