Welcome to the training on Preconception Health: Screening and Intervention provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Goal
The goal of this module is to equip Texas Health Steps providers and other health-care professionals to integrate preconception health screening, intervention and counseling into routine clinical practice.
Target Audience
Primary care providers and other health professionals, including Texas Health Steps providers, who treat adolescent girls and women who may become pregnant.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Summarize the role of preconception health care in promoting good health for all patients, regardless of whether they become pregnant.
- Interpret health risks and conditions that can adversely affect maternal and infant health before and during pregnancy.
- Integrate preconception health care and counseling into routine clinical encounters for individuals of reproductive age, including at preventive medical checkups.
Note: Preconception care is appropriate for all patients of reproductive age, regardless of their gender or gender identity. For purposes of this module, the term “women” applies to adolescent girls of reproductive age as well as to adults. The term “individuals” applies to all patients, including non-binary and transgender youth and adults.
Note: A companion module, Prenatal Health: Screening and Intervention, identifies and addresses prenatal factors that affect maternal health and safety. Texas Health Steps provides regular preventive medical checkups and other services to young women through 20 years of age. Where appropriate, this module highlights Texas Health Steps required screenings and other preventive services that can contribute to preconception health and safety.
Please note this module expires on 5/6/2024.
This module was released on 5/6/2021.
Accreditation Statement
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) of Continuing Nursing Education.
Certified Health Education Specialists
Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES®) and/or Master Certified Health Education Specialists (MCHES®) to receive up to 1.25 total Category I contact education contact hours. Maximum advanced-level continuing education contact hours available are 1.25.
Licensed Marriage and Family Therapists
The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is related to the practice of marriage and family therapy; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 hours of credit.
Licensed Professional Counselors
Up to 1.25 LPC hours may be earned at this event.
Social Workers
The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 hours of credit.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.25 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
Disclosures
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support. - Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose. - Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center. - Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
Browser Requirements
Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.
- American Academy of Pediatrics. (2020). Bright Futures: Developmental, Behavioral, Psychosocial, Screening, and Assessment Forms (including the PHQ-2).
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Major Depressive Disorder. (From University of Iowa Health Care.)
- Before, Between and Beyond Pregnancy. (2020). Preconception Care Clinical Toolkit. National Preconception Health and Health Care Initiative.
- Centers for Disease Control and Prevention. (2020). Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2020.
- Centers for Disease Control and Prevention. (2020). Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2020.
- Centers for Disease Control and Prevention. (2020). STD Testing: Information for Parents of Adolescents.
- Centers for Disease Control and Prevention. (2019). Human Papillomavirus (HPV): HPV Vaccine Schedule and Dosing.
- Centers for Disease Control and Prevention. (2015). 2015 Sexually Transmitted Diseases Treatment Guidelines: Special Populations.
- Commit to Inclusion. (2017). 9 Guidelines for Disability Inclusion.
- Delaware Health and Social Services. (n.d.). Set Your Mind. Set Your Goals.
- Environmental Protection Agency & Food and Drug Administration. (2019). Advice About Eating Fish, with a chart showing “best choices” and “good choices” of fish to eat and other information.
- Family Planning National Training Center (FPNTC). (n.d.). Client-Centered Reproductive Goals and Counseling Flow Chart.
- March of Dimes. (2020). Beyond Labels.
- National Institute on Drug Abuse. (2012). Resource Guide: Screening for Drug Use in General Medical Settings.
- National LGBTQIA+ Health Education Center.
- National Preconception Health and Health Care Initiative (NPHHCI). (2020). Women’s Health Practice Bulletin, 2020.
- Niolon, P. H., Kearns, M., Dills, J., Rambo, K., Irving, S., Armstead, T., & Gilbert, L. (2017). Preventing Intimate Partner Violence Across the Lifespan: A Technical Package of Programs, Policies, and Practices. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
- Power to Decide. (2018). One Key Question.
- Texas Department of State Health Services. (2020). Yes Quit.
- Texas Health and Human Services Commission. (2021). Family Planning.
- Texas Health and Human Services Commission. (2021). Healthy Texas Women.
- Texas Health and Human Services Commission. (2019). Healthy Texas Babies: Prepregnancy Health.
- Texas Health Steps. (2021). Texas Health Steps Checkup Components.
- Texas Health Steps. (2021). Seven validated, standardized mental health screening tools.
- Texas Health Steps. Periodicity Schedule.
- Texas Health Steps. Adolescent Health: A Guide for Providers.
- Texas Health Steps. Anticipatory Guidance—A Guide for Providers.
- Texas Medicaid Provider Procedures Manual (TMPPM). (2021). Screening, Brief Intervention, and Referral to Treatment, page 64.
- The Lancet. (2018). Preconception Health series. “Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health,” “Origins of lifetime health around the time of conception: causes and consequences,” and “Intervention strategies to improve nutrition and health behaviours before conception.” 391(10132).
- U.S. Department of Health and Human Services, National Institute on Drug Abuse. (2012). Resource Guide: Screening for Drug Use in General Medical Settings.
- Alkalay, A. (2009). Guidance for Preconception Care of Women with Thyroid Disease. Before, Between & Beyond Pregnancy. The National Preconception Curriculum and Resources Guide for Clinicians.
- Allen, V. M., Armson, B. A., Genetics Committee, & Maternal Fetal Medicine Committee. (2007). Teratogenicity associated with pre-existing and gestational diabetes. Journal of Obstetrics and Gynaecology Canada, 29(11), 927–934.
- American Academy of Family Physicians. (2020). Take Care of Yourself Before Pregnancy.
- American Academy of Pediatrics. (2020). Adolescent Sexual Health: Sexual Violence.
- American Academy of Pediatrics. (2020). Bright Futures: Developmental, Behavioral, Psychosocial, Screening, and Assessment Forms (including the PHQ-2).
- American College of Obstetricians and Gynecologists. (2019). Prepregnancy Counseling. Committee Opinion No. 762.
- American College of Obstetricians and Gynecologists. (2016). Reproductive Life Planning to Reduce Unintended Pregnancy. Committee Opinion No. 654.
- American College of Obstetricians and Gynecologists. (2017). Oral Health Care During Pregnancy and Through the Lifespan. Committee Opinion No. 569.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Major Depressive Disorder. (From University of Iowa Health Care.)
- Association of State Public Health Nutritionists. (2015). Preconception Health: The Role of Nutrition. An ASPHN Brief.
- Basile, K. C., Hertz, M. F., & Back, S. E. (2007). Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
- Before, Between and Beyond Pregnancy. (2020). Preconception Care Clinical Toolkit. National Preconception Health and Health Care Initiative.
- Brakman, A., Ellsworth, T. R., & Gold, M. (2015). “Gay, lesbian, and bisexual youth grouped, show increased risk for unintended pregnancy.” Relias (formerly AHC Media), September 2015.
- Centers for Disease Control and Prevention. (2020). Before Pregnancy: Information for Men.
- Centers for Disease Control and Prevention. (2020). Before Pregnancy: Overview.
- Centers for Disease Control and Prevention. (2020). Distracted Driving.
- Centers for Disease Control and Prevention. (2020). Prevalence of Obesity and Severe Obesity Among Adults: United States 2017-2018. National Center for Health Statistics (NCHS) Data Brief No. 360, February 2020.
- Centers for Disease Control and Prevention. (2020). Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2020.
- Centers for Disease Control and Prevention. (2020). Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2020.
- Centers for Disease Control and Prevention. (2020). Reproductive Health: Depression Among Women.
- Centers for Disease Control and Prevention. (2020). Sexual Risk Behaviors Can Lead to HIV, STD, and Teen Pregnancy.
- Centers for Disease Control and Prevention. (2020). Youth Risk Behavior Survey, Texas 2019 Results.
- Centers for Disease Control and Prevention. (2019). Adolescent and School Health: Health Risks among Sexual Minority Youth.
- Centers for Disease Control and Prevention. (2019). Alcohol and Public Health. Fact Sheets–Excessive Alcohol Use and Risks to Women’s Health.
- Centers for Disease Control and Prevention. (2019). Childhood Obesity Facts: Prevalence of Childhood Obesity in the United States.
- Centers for Disease Control and Prevention. (2019). Facts about Sickle Cell Disease.
- Centers for Disease Control and Prevention. (2019). HIV Risk Among Persons Who Exchange Sex for Money or Nonmonetary Items.
- Centers for Disease Control and Prevention. (2019). Human Papillomavirus (HPV): HPV Vaccine Schedule and Dosing.
- Centers for Disease Control and Prevention. (2019). Reproductive Health: Unintended Pregnancy.
- Centers for Disease Control and Prevention. (2019). Youth Risk Behavior Surveillance–United States, 2019.
- Centers for Disease Control and Prevention. (2018). Disparities in Preconception Health Indicators — Behavioral Risk Factor Surveillance System, 2013–2015, and Pregnancy Risk Assessment Monitoring System, 2013–2014. MMWR Surveillance Summaries, 67(No. SS-01):1–16.
- Centers for Disease Control and Prevention. (2017). Lesbian, Gay, Bisexual, and Transgender Health: LGBT Youth.
- Centers for Disease Control and Prevention. (2015). 2015 Sexually Transmitted Diseases Treatment Guidelines: Special Populations.
- Centers for Disease Control and Prevention. (n.d.). Overweight and Obesity Among People with Disabilities.
- Chang, T., Choi, H, Richardson, C. R., & Davis, M. M. (2013). Implications of teen birth for overweight and obesity in adulthood. American Journal of Obstetrics & Gynecology, 209(2):110.e1-7.
- Charlton, B. M., Roberts, A. L., Rosario, M., Katz-Wise, S. L., Calzo, J. P., Spiegelman, D., & Austin, S. B. (2018). Teen Pregnancy Risk Factors Among Young Women of Diverse Sexual Orientations. Pediatrics, 141(4), e20172278.
- Clapp, M. A., & Bernstein, S. N. (2017). Preconception Counseling for Women With Cardiac Disease. Current Treatment Options in Cardiovascular Medicine, 19(9), 67.
- Commit to Inclusion. (2017). 9 Guidelines for Disability Inclusion.
- Dean, S. V., Lassi, Z. S., Imam, A. M., & Bhutta, Z. A. (2014). Preconception care: nutritional risks and interventions. Reproductive Health, 11(S3).
- Dicola, D., & Spaar, E. (2016). Intimate Partner Violence. American Family Physician, 94(8), 646–651.
- Environmental Protection Agency & Food and Drug Administration. (2019). Advice About Eating Fish.
- Farahi, N., & Zolotor, A., (2013). Recommendations for Preconception Counseling and Care. American Family Physician, 88(8):499-506.
- Grubb, L., & the AAP Committee on Adolescence. (2020). Barrier Protection Use by Adolescents During Sexual Activity. Pediatrics, 146(2), e2020007245.
- Guttmacher Institute. (2020). An Overview of Minors’ Consent Law.
- Guttmacher Institute. (2019). Unintended Pregnancy in the U.S.
- Johns, M. M., Lowry, R., Andrzejewski, J., Barrios, L. C., Demissie, Z., McManus, T, . . . Underwood, J. M. (2019). Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Among High School Students—19 States and Large Urban School Districts, 2017. MMWR Morbidity and Mortality Weekly Report (MMWR), 68:67-71.
- Kovar, C. L. (2018). Reproductive Coercion: Baby, If You Love Me. MCN. The American Journal of Maternal Child Nursing, 43(4), 213–217.
- Marcell, A. V., Burstein, G. R., & the AAP Committee on Adolescence. (2017). Clinical Report: Sexual and Reproductive Health Care Services in the Pediatric Setting. Pediatrics, 140(5), e20172858.
- March of Dimes. (2020). Beyond Labels.
- March of Dimes Peristats. (2020). Obesity among Women of Childbearing Age, Texas 2008-2018. Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention.
- Maurer, D. M., Raymond, T. J., & Davis, B. N. (2018). Depression: Screening and Diagnosis. American Family Physician, 98(8):508-515.
- Mayo Clinic Health System. (2020). High Blood Pressure and Pregnancy: Know the Facts.
- Mayo Clinic Health System. (2020). Hypothyroidism (Underactive Thyroid).
- MGH Center for Women’s Health. (2020). Pregnancy Outcomes in Women with Anorexia Nervosa.
- M’hamdi, H. I., van Voorst, S. F., Pinxten, W., M. T. Hilhorst, & Steegers, E. A. P. (2017). Barriers in the Uptake and Delivery of Preconception Care: Exploring the Views of Care Providers. Maternal and Child Health Journal, 21(1): 21–28.
- National Preconception Health and Health Care Initiative (NPHHCI). (2020). Women’s Health Practice Bulletin, 2020.
- Niolon, P. H., Kearns, M., Dills, J., Rambo, K., Irving, S., Armstead, T., & Gilbert, L. (2017). Preventing Intimate Partner Violence Across the Lifespan: A Technical Package of Programs, Policies, and Practices. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
- Okosieme, O. E., Khan, I., & Taylor, P. N. (2018). Preconception management of thyroid dysfunction. Clinical Endocrinology.
- Power to Decide. (2020). Texas Data.
- Pregnancy Risk Assessment Monitoring System (PRAMS). (2016-2017). Prevalence of Selected Maternal and Child Health Indicators for Texas.
- Smith, S. G., Zhang, X., Basile, K. C., Merrick, M. T., Wang, J., Kresnow, M., & Chen, J. (2018). The National Intimate Partner and Sexual Violence Survey (NISVS): 2015 Data Brief – Updated Release. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
- Smoke Free Women.
- Texas Department of State Health Services. (2020). Healthy Texas Babies.
- Texas Family Code, Chapter 32.
- Texas Health and Human Services Commission. (2020). Healthy Texas Women.
- Texas Health and Human Services Commission. (2017). Policy and Procedure Manual for Healthy Texas Women (HTW), 2017.
- Texas Health and Human Services Commission. (2021). Family Planning.
- Texas Medicaid Provider Procedures Manual (TMPPM). (2021). Substance Use Disorder (SUD) Services. Page 68
- The Lancet series: Preconception Health series. (2018).
“Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health.”
“Origins of lifetime health around the time of conception: causes and consequences.”
“Intervention strategies to improve nutrition and health behaviours before conception.” - The Lancet, 391(10132).
- U.S. Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans, 2nd Edition.
- U.S. Department of Health and Human Services, National Institute on Drug Abuse. (2012). Resource Guide: Screening for Drug Use in General Medical Settings.
- U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2020). Healthy People 2020, Maternal, Infant, and Child Health.
- U.S. Department of Health and Human Services, Office of Population Affairs. (2018). Contraceptive Care Measures.
- U.S. Department of Health and Human Services, Office on Women’s Health. (2018). Preconception Health.
- U.S. Department of Health and Human Services, President’s Council on Sports, Fitness & Nutrition. (2017). Facts & Statistics.
- U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2017). Underage Binge Drinking Varies within and across States.
- U.S. Preventive Services Task Force. (2018). Final Recommendation Statement: Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Screening
- Women’s Preventive Services Initiative, American College of Obstetricians and Gynecologists. (2018). Counseling for Sexually Transmitted Infections.
- Yehuda, I. (2016). Implementation of Preconception Care for Women With Diabetes. Diabetes Spectrum: A publication of the American Diabetes Association, 29(2), 105–114.
- Zöllner, J., Curry, R., & Johnson, M. (2013). The contribution of heart disease to maternal mortality. Current Opinion in Obstetrics & Gynecology, 25(2):91-7.
The medical definitions in this module were obtained or adapted from the American Academy of Pediatric Dentistry, Archives of Sexual Behavior, Centers for Disease Control and Prevention, Journal of Medical Research and Innovation, Mayo Clinic, Medscape, Merriam-Webster, National Institute of Neurological Disorders and Stroke, Preeclampsia Foundation and U.S. National Library of Medicine and WebMD.
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