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Considering or Seeking Pregnancy

If pregnancy is desired, provide preconception counseling and education in response to the client’s identified goals and preferences.

Once a client indicates they are considering or seeking pregnancy, introduce preconception or interconception health counseling. To ensure a person-centered approach to transitioning into this counseling, ask the client:

Would you like to talk about ways to be prepared for a healthy pregnancy?”

Preconception & Interconception Counseling

Preconception and interconception counseling create an opportunity to improve pregnancy health outcomes for clients considering pregnancy. This counseling applies to any client with reproductive potential as it promotes health and wellbeing for all clients. Providers of all stripes should “take the opportunity to ask about and address reproductive health risks and needs whenever possible—when patients or clients are in front of us for whatever reason.”

A client’s engagement in preconception health is vital for them to achieve a healthy pregnancy and have a healthy baby. According to ACOG’s 2019 Committee Opinion, “the goal of pre-pregnancy care is to reduce the risk of adverse health effects…by working with the [client] to optimize health, address modifiable risk factors, and provide education about healthy pregnancy.” This opinion notes that all people who may become pregnant receive preconception counseling, including lesbian, gay, bisexual, transgender, queer, intersex, asexual, and gender-nonconforming individuals.

In addition to ACOG, the American Academy of Family Physicians and the Healthy People 2030 goals from U.S. Department of Health and Human Services highlight the importance of preconception care to improve birth outcomes noting that “strategies to help [clients] adopt healthy habits and get health care before and during pregnancy can help prevent pregnancy complications.” These strategies become especially important considering that, according to a Commonwealth Fund issue brief, people who can become pregnant in the US are more likely to die from complications related to pregnancy or childbirth than those in other high-income counties. While the brief notes that the US’s rate is more than double that of the other countries, it also notes that the rate of maternal death among black women was double that of white women.

Elements of Preconception or Interconception Counseling

Below are recommendations and resources for appropriate health assessment and screening of clients who are considering pregnancy. Keep in mind that clients may be exploring pregnancy in varying degrees and while all of the below information is important for a client who is considering pregnancy, not all elements may be necessary for clients at varying degrees of their pregnancy seeking journey.

ACOG offers clinical recommendations for providing prepregnancy counseling. The RHNTC’s Preconception Counseling Checklist also outlines the following assessment and screening areas and can be used as a tool by clinic staff to ensure important elements of preconception health are discussed during the client visit. Additionally, the RHNTC offers a Preconception Health Toolkit to assist clinics in reviewing and strengthening the quality of preconception health services.

Health Assessment

For providers in healthcare settings where clients may receive preconception or interconception care and/or pregnancy testing and counseling but do not offer or refer for prenatal care, staff should assess and counsel clients who are considering pregnancy on the topics listed below.

Click the + to expand the sections below to read more.
  • Folic Acid Supplementation

    According to ACOG, pre-pregnancy folic acid supplementation should be encouraged to reduce the risk of neural tube defects (NTDs). People who can become pregnant should take 400 mcg of folic acid everyday.

    Healthy People 2030 also has an objective to increase the proportion of people who can become pregnant getting enough folic acid. For more information, including clinical recommendations, research/data and client resources, check out the CDC’s Folic Acid page. March of Dimes also hosts helpful information for clients on their website.

  • Nutrition, Physical Activity, and a Healthy BMI

    According to Healthy People 2030, only 42.1 % of people who gave birth in 2018 had a healthy weight prior to pregnancy. ACOG recommends clients be encouraged to try to attain a BMI in the normal range before attempting pregnancy because abnormally high or low BMI is associated with infertility and maternal and fetal pregnancy complications.

    Providers should encourage clients to eat a diet rich in fruits, vegetables, protein and whole grains and to engage in at least 30 min of moderate physical activity per day.

    Eating Healthy During Pregnancy and Exercise During Pregnancy from the March of Dimes are good clients resources

  • Exposure to Environmental Toxins

    According to recommendations published in the American Journal of Obstetrics and Genecology, “three sectors of a [client’s] environment—the home, the community, and the workplace—should be asked about to identify hazards to the pregnancy outcome.” 

    Hazards may include:

    • mercury through fish consumption

    • plastics with bisphenol-A (BPA)

    • lead paint

    • soil and water hazards

    • asbestos

    • pesticides

    • organic solvents and heavy metals used in manufacturing

    • solvents used in dry cleaning

    • organics and radiation utilized in health care for treatment

    ACOG also issued a Committee Opinion on Reducing Prenatal Exposure to Toxic Environmental Agents.

    ACOG and March of Dimes recognize that communities of color are disparately impacted by exposure to environmental toxins. Environmental justice is a framework and component of reproductive justice that seeks to ensure all people live healthy, safe lives.

  • Fertility Awareness

    Tracking fertility can be used to both prevent and achieve pregnancy. Helping clients understand and track their fertility can help them identify when they are most fertile and most able to become pregnant. The RHNTC’s Fertility Awareness-Based Methods: Fertility Indicator Concepts and Counseling Points job aid can assist providers in educating clients. The Office of Women’s Health also hosts a client resource page on Trying to Conceive that shares information on fertility tracking.

  • Pregnancy Support Services

    Having support during pregnancy can alleviate stress that could lead to poor pregnancy outcomes. During pregnancy, stress, including serious types of stress such as negative life events, catastrophic events, and racism can increase chances of having a premature baby or a low-birthweight baby.

    Providers should discuss the importance of a support system as the client considers becoming pregnant and offer resources in the community that provide various types of support such as financial assistance and other resources such as diapers or other items needed to prepare for birth and parenting.

    Additionally, doula services and prenatal care groups have been shown to improve pregnancy outcomes.

    Doula Services

    Doulas are trained, non-medical professionals who provide continuous physical, emotional and informational support to a pregnant person before, during and after pregnancy. ACOG and March of Dimes acknowledge the important role doulas can play in supporting people during pregnancy and that this support can improve pregnancy outcomes.

    A 2013 study in the Journal for Perinatal Education found that doula-assisted mothers were four times less likely to have a low birth weight baby, two times less likely to experience a birth complication, and significantly more likely to initiate breastfeeding.

    A Commonwealth Fund Issue Brief notes that evidence suggests doulas are beneficial particularly for women of color, low-income women, and other communities that have been historically marginalized. The brief also mentions “that doulas have the potential to provide a “buffer” against racism in health care for pregnant women of color by providing patient-centered, tailored, and culturally appropriate care.” The Advancing Birth Justice report is a great resource to learn more about how doulas can help solve health inequities in the birthing space.

    Very few states currently cover doula services under Medicaid, despite growing calls for coverage to be extended for these services. However, this is slowly shifting. In April 2022, HRSA announced the use of funds for Community Health Centers to hire, train, and compensate community-based doulas.

    DONA International and Doula Training International are both great resources for learning more about doula services and for finding a doula in your area.

    Prenatal Care Groups

    Prenatal care groups have been around for many years. Different models exist and may go under different names – like Centering Pregnancy or Supportive Pregnancy Care – at core these are supportive groups that provide a peer learning and support environment for pregnant people.

    The care model typically consists of a cohort of 8 to 10 pregnant people of similar gestational age who participate in multiple 90 to 120 minute interactive group prenatal care visits. The visits consist of discussions covering medical and non-medical aspects of pregnancy. These include:

    • Nutrition

    • Common discomforts

    • Stress management

    • Labor and birth

    • Breastfeeding

    • Infant care

    While they are more widely available than doula services, prenatal care groups are still not a commonly provided service among healthcare providers. Similar to doula services, very few states offer Medicaid coverage and reimbursement for pregnancy centering programs beyond the main prenatal care visit.

    Group prenatal care visits are endorsed by ACOG and the March of Dimes. Research suggests that these group models hold promise for supporting improved birth outcomes for pregnant Black people and their babies, particularly reducing the risk of preterm birth.

    The Centering Healthcare Institute and the March of Dimes provide training and support to providers who wish to implement prenatal care groups


While the areas below are typically screened for during most clinical visits, they are particularly important for clients considering pregnancy.

Click the + to expand the sections below to read more.

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The content on this page was last reviewed and updated in October 2023.

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