Preconception Conditions Affecting Pregnancy
Key Points
- High-risk pregnancy often begins before conception through medical, nutritional, and social risk factors.
- Preconception optimization can reduce maternal-fetal morbidity and mortality.
- Risk factors include age extremes, chronic disease, substance exposure, nutrition imbalance, and social determinants.
- Nursing care centers on early identification, education, coordination, and adherence support.
Pathophysiology
Preexisting conditions alter maternal reserve and placental adaptation, increasing risk for hypertensive disease, growth restriction, preterm birth, stillbirth, hemorrhage, and neonatal complications. Hyperglycemia, uncontrolled hypertension, thyroid dysfunction, and cardiac disease are major contributors.
Nutritional excess/deficiency and social instability (poverty, unstable housing, limited access, discrimination barriers) amplify physiologic risk and delay care. Substance use and teratogenic medication exposure increase embryofetal vulnerability during critical development windows.
Classification
- Medical-risk domain: Chronic hypertension, diabetes, thyroid/cardiac/renal/immune disorders, HIV, and other comorbidities.
- Nutritional-risk domain: Overnutrition/obesity and micronutrient deficiencies.
- Population-risk domain: Adolescents, advanced maternal age, and marginalized groups with care barriers.
- Behavioral/social domain: Substance use, low access, stress burden, and inadequate support systems.
Nursing Assessment
NCLEX Focus
Prioritize conditions that require preconception control targets before attempting pregnancy.
- Assess chronic disease history, medication profile, and teratogen exposure risk.
- Screen nutrition pattern, BMI trends, and micronutrient risk factors.
- Evaluate social determinants, insurance/access barriers, and support availability.
- Assess substance use with nonjudgmental, harm-reduction focused inquiry.
- Determine need for specialist co-management before and during pregnancy.
Nursing Interventions
- Provide preconception counseling on disease control targets and medication safety.
- Support contraception planning until health optimization goals are reached.
- Coordinate multidisciplinary referrals (MFM, cardiology, endocrinology, nutrition, social work).
- Connect patients with community resources for food, housing, transport, and behavioral support.
- Reinforce frequent monitoring plans once pregnancy begins.
Conception-Before-Stabilization Risk
Entering pregnancy with uncontrolled chronic disease increases preventable severe maternal and fetal outcomes.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| insulin-therapy | Pregestational diabetes management contexts | Tight glucose control before conception reduces congenital and obstetric risk. |
| antihypertensives-in-pregnancy | Chronic hypertension transition contexts | Ensure pregnancy-compatible regimens and avoid contraindicated agents. |
Clinical Judgment Application
Clinical Scenario
A patient planning pregnancy has uncontrolled type 2 diabetes, BMI 36, and inconsistent access to medications.
Recognize Cues: Multiple high-risk preconception factors are present. Analyze Cues: Current status elevates risk of congenital anomalies and maternal complications. Prioritize Hypotheses: Priority is delaying conception while optimizing medical and social stability. Generate Solutions: Initiate multidisciplinary optimization, resource linkage, and preconception targets. Take Action: Implement plan with close follow-up and contraception support. Evaluate Outcomes: Glycemic and access control improve before conception attempt.
Related Concepts
- preconceptual-care - Core preventive framework for risk reduction before pregnancy.
- conditions-limited-to-pregnancy - Preexisting risk often predicts pregnancy-specific complications.
- first-prenatal-visit - Baseline screening identifies unresolved preconception risk.
- fetal-growth-and-development - Preconception status influences developmental outcomes.
- person-and-family-centered-care - Effective risk reduction requires individualized planning.
Self-Check
- Which preconception risk factors most strongly warrant specialist co-management?
- Why is medication review critical before conception, not after?
- How can nurses reduce social-barrier effects on high-risk pregnancy outcomes?