Practitioners providing routine health maintenance for reproductive-aged women have the best opportunity to provide preventive counseling. Gynecologists, internists, family practitioners, and pediatricians can do so at the annual examination. The occasion of a negative pregnancy test is a good time for counseling. Jack and associates (1995) administered a comprehensive preconceptional risk survey to 136 women who had a negative pregnancy test in an ambulatory general practice clinic. Almost 95 percent of these women reported at least one problem that could affect a future pregnancy. These included medical or reproductive problems (52 percent), a family history of genetic diseases (50 percent), increased risk of contracting HIV (30 percent), increased risk of contracting hepatitis B and use of illegal substances (25 percent), alcohol use (17 percent), and nutritional risk (54 percent).
Basic preconceptional advice regarding diet, alcohol use, smoking, illicit drug use, vitamin intake, exercise, and other behaviors can be provided by the primary care provider, including the obstetrician-gynecologist. Medical records should be obtained and reviewed. Counselors should be knowledgeable about relevant medical diseases, prior surgery, reproductive disorders, or genetic conditions, and must be able to interpret data and recommendations provided by other specialists. The practitioner who is uncomfortable providing counseling should refer the woman or couple to a counselor with special expertise.