may decrease the likelihood of unfavorable pregnancy outcomes, such as the delivery of a premature or low-birth-weight infant. Several sources agree that nutritional services should be one of several components of preconceptional care.1–4 The publications ACOG Guide to Planning for Pregnancy, Birth, and Beyond5 and Caring for Our Future: The Content of Prenatal Care1 list nutrition-related topics to address at a preconception visit.
An increased emphasis on preconceptional care acknowledges that achieving substantial changes in diet and lifestyle often involves making incremental changes over time. It also recognizes that the primary prevention of nutrition-related fetal malformations or spontaneous abortions is possible only if risk reduction activities begin before conception; even an early prenatal visit would ordinarily be too late for effective intervention. Addressing behavioral change before conception can allow a woman to identify constructive actions and to delay conception until she has achieved a healthier physical state—one that will increase her chances for a successful pregnancy outcome.
Providing nutritional assessment, education, and interventions to encourage an optimal state of health may also benefit the many women who do not desire pregnancy. For these women, the provision of nutritional care as part of a periodic health assessment can be a mechanism for promoting their health over the short term, with the potential for preventing problems in the event of an unplanned pregnancy and for preventing or retarding the development of chronic diseases later in life.6
The objectives of nutritional care in the preconceptional period are to encourage women to achieve appropriate weight for height and healthful dietary habits. To this end, a periodic health visit for women of childbearing age should include assessment to identify indicators of possible nutrition problems, education relating to healthful dietary practices, and counseling, referral, or other interventions as needed to solve or reduce the adverse effects of such problems. Detailed information on these care activities is given in Nutrition During Pregnancy and Lactation: An Implementation Guide.7
The following section briefly discusses the nutrition-related health conditions that have been most closely linked to unfavorable pregnancy outcomes. There are also other health conditions occurring prior to conception that may increase the risk of nutrition problems during pregnancy, but data on such relationships are sparse. Data are also lacking on the relationship of multiple socioeconomic problems prior to conception and the risk of nutrition-related difficulties during pregnancy.