In the early part of the 20th century, women with medical problems were often unable to conceive or were advised not to. Discoveries such as insulin and the development of effective antihypertensive medications subsequently made it possible for many of these women to contemplate pregnancy. Obstetrical care of women with medical problems during this time dealt almost exclusively with protecting maternal health, as little was known about pathological influences on fetal development. In the 1960s, research began to focus on the pathophysiology of pregnancy and perinatal outcome. As a result, prenatal care was gradually extended to include fetal concerns, and interest in perinatal research increased dramatically. The etiologies of many maternal and fetal conditions were determined, and research also clarified the genetic origins of many diseases. At the same time, effective contraception was developed, allowing women to postpone pregnancy and limit family size while striving to optimize perinatal outcome. The focus of obstetrical care thus changed once again, from treating maternal and fetal diseases to predicting and preventing them.
In 2000, the Public Health Service released Healthy People 2010, a guide for the second nationwide preventive medicine program. The major goals are to increase the quality and years of healthy life and to eliminate health disparities between individuals. More specifically, it strives to improve the health and well-being of women, infants, children, and families.
Preconceptional counseling can play a major role in achieving these goals. As stated in the Department of Health and Human Services report on the program: “Preconceptional screening and counseling offer an opportunity to identify and mitigate maternal risk factors before pregnancy begins.” For example, the two leading causes of death in the first year of life—birth defects and disorders caused by preterm birth—can both be significantly reduced or eliminated by the preconceptional initiation of specific preventive strategies. Morbidity caused by a variety of factors, including uncontrolled maternal disease, environmental exposures, and nutritional deficiencies, also can be prevented by preconceptional care. Furthermore the intrauterine fetal environment has a tremendous impact on the health and well-being of the adult that fetus will become—the Barker hypothesis (Barker, 1994). Thus, optimizing pregnancy conditions and outcomes has long-term health impacts that are only beginning to be apparent. The 1989 Public Health Service Expert Panel on the Content of Prenatal Care rightfully concluded: “The preconceptional visit may be the single most important health care visit when viewed in the context of its effect on pregnancy.”