The importance of preconception counseling and early pregnancy monitoring

Preconception counseling plays a key role in preparing for a pregnancy. In couples with a history of recurrent early pregnancy loss, counseling is of particular importance because women are invariably more distressed and require reassurance that everything possible is being done to avoid future pregnancy losses. Because their subsequent pregnancies are more likely to be planned and these patients may be more willing to adopt recommendations that have been offered to them, it becomes more important to identify which investigations and interventions are the most beneficial. Several interventions ranging from genetic testing to lifestyle changes and medications may have a positive effect on the chances of a successful pregnancy. Early pregnancy monitoring and support increases the chance of a live birth and helps to predict potential future pregnancy complications. Recent research suggests that events that occur in the uterine decidua, even before a woman knows she is pregnant, may have a significant impact on fetal growth and the outcome of pregnancy. With this in mind, shifting future research and clinical practice to focus on the periconceptual period and the very early stages of pregnancy should offer significant benefits to the health of both the mother and her infant. The overall aim should be to effectively use every pregnancy as the health-care opportunity of two lifetimes.