The most common question asked of expectant couples is usually “Do you want a boy or a girl?”

And the standard answer is “It doesn’t matter. Just so he or she is healthy.”While that may be routine dialogue, there’s a lot a couple can do before conception to help get the results they’re want.“Healthy parents lead to healthy babies, thus promoting healthy families,” says Dr. David O’Gurek, a member of the American Academy of Family Physicians.The Summit Hill native chaired a group of prominent family physicians from across the country who recently concluded a position paper that calls for universal delivery of preconception care.An ounce of preventionWhile the paper provided family physicians with an evidenced-based statement on what factors should be taken into consideration in caring for men and women during their childbearing years, it is underscored in O’Gurek’s quote of Ben Franklin: “An ounce of prevention is worth a pound of cure.”During his study of preconception care as a member of the Commission on Health of the Public and Science, O’Gurek says he was often reminded that “Health care is often sought, delivered and provided as a reaction to a specific illness, symptom and crisis; however, the value of preventive medicine, well understood by primary care physicians, is highly apparent in preconception care.”In simple language, this means it’s important to include preconception care in routine clinical practice.“While there is often so much to discuss regarding wellness during a patient’s visit, many of these concepts are not unique to promotion of a healthy pregnancy and/or family, but they are also important to promotion of health of the individual and therefore isn’t additive to the visit, but an integral part of it.”O’Gurek said his familiarity with preconception care evolved during his residency training.“I was delighted to see the notion of preconception care expanded to include preventive aspects of men’s health.”He says that the position paper notes that most family planning and preconception care programs, research and clinical practice guidelines have focused almost exclusively on women.“This not only promotes men’s health, but also makes the needed effort to facilitate a healthy pregnancy not the sole burden of the woman,” O’Gurek says.Risk factorsFifty percent of the pregnancies in the U.S. are reported as unintended. That, plus the reality that many of the risk factors that affect pregnancy outcome are present before conception and can be modified, suggests the importance of preconception care for men and women of childbearing ages.With preconception care, these modifiable risk factors can be addressed and discussed, says O’Gurek.“Additionally, an important part of preconception care is an open discussion about a reproductive plan. If a woman does not desire pregnancy, she can clearly be counseled on contraceptive options and receive assistance in selecting the safest and most appropriate option for her.”He stresses that access to contraceptive options that are nonjudgmental and respects the individual must be available.“Despite data demonstrating that access to and availability of birth control options does not increase sexual activity or promiscuity, there are still those who, for some reason or another, fear such access. For those women wishing to respect and follow certain religious traditions, natural family planning methods are also available for prevention of pregnancy.”He says it is critical that individuals also receive appropriate counseling regarding prevention of sexually transmitted infections.Prenatal care neededO’Gurek says young people typically utilize the medical system only for acute illness.“Women are often not showing up at the doctor’s office until a missed period or with a positive home pregnancy test,” says O’Gurek. “In practice, I have seen this happen early in the pregnancy, but have also seen women presenting for their first visit to a doctor almost nine months pregnant.”He says that while most women are aware of the need for prenatal vitamins during pregnancy, in reality, most of them start taking them too late.“The benefit of prenatal vitamins comes largely with folic acid supplementation which prevents against potentially devastating neurological issues like neural tube defects. The formation of organs occurs early in pregnancy, and, therefore, folic acid supplementation before even planning on having a baby ensures that this is in place for when pregnancy occurs with mom and the baby reaping the greatest benefit.”He says this also assumes that the woman had a review of her current health status and discussion regarding other modifiable risk factors during a visit where the prenatal vitamins were ordered by the physician.O’Gurek says the U.S. ranks “quite poorly” compared to developed nations in infant mortality, which is attributed in many cases to prematurity and birth defects, but also being the result of the lack of preconception care.“Much of the research on modifiable risk factors addressed with preconception care looks specifically at their effects on reducing prematurity and birth defects.”Those promoted in the paper demonstrate areas where addressing the risk factor before pregnancy significantly reduces the rates of prematurity and/or birth defects.“It is critical that evidence-based health care be provided and women receive appropriate counseling and care in these areas,” says O’Gurek.“While pregnancy can be one of the most exciting and joyful experiences for a young couple, it can also be one of the most challenging and stressful times.“It is our duty as health care providers and even more so as a society to promote development of healthy families through access to readily available services to ensure such care can be provided.”O’Gurek insists that preconception care is synonymous with primary care for men and women of childbearing age.He says it is important for individuals to have a primary care physician to ensure that evidence-based health maintenance care (i.e., appropriate cancer screenings, infection screenings, immunizations) is provided.People should be their own health advocates.“Just as physicians should be proactive in discussing these health issues, individuals should bring up these issues before, during, or after visits,” says O’Gurek.“As reproductive plans change over time, preconception care is an ongoing discussion between a patient, his/her partner, and his/her health care provider to meet a person’s personal needs.”The AAFP position paper on preconception can be found at aafp.org/about/policies/all/preconception-care.html.