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Prepregnancy counseling

ACOG and ASRM preparation for pregnancy through reproductive goals, condition and medication optimization, prevention and equitable risk review.

JurisdictionUnited States
Source check2026-08-20
Clinical reviewiatroX editorial team 路 Clinical editorial review 路 reviewed 2026-08-20 路 due 2027-08-20
AudienceUnited States healthcare professionals
This is an iatroX educational summary of named United States sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. Use the named authority, current FDA labeling, applicable state law, payer rules and local protocol where relevant.

Scope of this summary

Adolescents and adults who may become pregnant or are planning pregnancy, including those with chronic disease, prior pregnancy complications or fertility concerns. Counseling should be offered without assuming a patient wants pregnancy and must not condition care on body size, disability, immigration status or social circumstance.
sources for this section:ACOG/ASRM CO 762

The Bottom Line

  • Ask about reproductive goals routinely and offer either pregnancy preparation or effective contraception according to the patient鈥檚 preference, revisiting goals as circumstances change.
  • Optimize chronic medical and psychiatric conditions before conception when possible, balancing pregnancy risk against the harm of abruptly stopping an effective medicine.
  • Recommend folic-acid supplementation before conception, with higher-dose decisions reserved for recognized risk indications and checked against current US guidance.
  • Review immunization and infection status before pregnancy because live vaccines and some infection treatments have timing implications once pregnancy begins.
  • Address tobacco, alcohol and other substances, nutrition, physical activity, occupational exposure, intimate-partner violence, housing, food access and environmental risks through supportive rather than punitive counseling.
sources for this section:ACOG/ASRM CO 762

Practical clinical workflow

1
Elicit pregnancy timing, menstrual and obstetric history, infertility concerns, prior complications, genetic or family history, medical and mental-health conditions, medicines, supplements and substance exposure.
2
Check disease-specific control and pregnancy-compatible treatment with relevant specialists, prioritizing high-risk conditions such as diabetes, hypertension, epilepsy and significant cardiac, renal or autoimmune disease.
3
Review vaccines, cervical and sexually transmitted infection screening, oral health and immunity testing only where indicated, then provide folic acid and a plan for any needed preconception intervention.
4
Offer carrier screening or genetic counseling based on personal preference, family history, ancestry-independent recommendations and prior pregnancy information, with informed consent for possible results.
5
Document when to stop contraception, how to identify pregnancy, which medicines need immediate review and the route to early prenatal or maternal鈥揻etal-medicine care.
sources for this section:ACOG/ASRM CO 762

Safety boundaries and escalation

  • Do not abruptly discontinue antiseizure, psychiatric, antihypertensive, anticoagulant or other essential treatment solely because pregnancy is planned; coordinate a safer transition and disease-control plan.
  • Poorly controlled serious disease, a known teratogenic exposure or a prior severe pregnancy complication warrants specialist review before conception when feasible, but counseling must remain noncoercive.
  • Intimate-partner violence, reproductive coercion, trafficking, unsafe housing or acute mental-health risk requires confidential assessment and a patient-led safety and support pathway.
  • A late period, positive pregnancy test, bleeding or pelvic pain changes the task from preconception counseling to pregnancy assessment, including urgent ectopic evaluation when symptoms warrant.
sources for this section:ACOG/ASRM CO 762

Localization

This page follows the joint ACOG/ASRM US committee opinion. Medicaid eligibility, insurance, vaccine programs, genetic-testing access and state reproductive law vary; local referral pathways and updated condition-specific guidance must supplement this overview.
sources for this section:ACOG/ASRM CO 762

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. American College of Obstetricians and Gynecologists and American Society for Reproductive MedicinePrepregnancy CounselingCommittee Opinion No. 762; DOI 10.1097/AOG.0000000000003013 路 published 2019-01-01 路 accessed 2026-08-20
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