CE/CME

Preconception Health: Screening and Intervention

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).

Credit Hours: 1.25 CE

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Overview
Appendix/Resources

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. For purposes of this module, the term “women” applies to adolescent girls of reproductive age as well as to adults, and the term “individuals” applies to all patients.

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 5/21/2027.

This module was released on 5/21/2024.

References

Featured

The American Academy of Family Physicians. (2022). Preconception Care (Position Paper).
The American Academy of Family Physicians. (2020). Striving for Birth Equity: Family Medicine's Role in Overcoming Disparities in Maternal Morbidity and Mortality.
American Academy of Pediatrics. Policy Statement. (2014, reaffirmed 2021). Contraception for Adolescents. Pediatrics. 134 (4): e1244–e1256.
The American College of Obstetricians and Gynecologists. (2023). Cervical Cancer Screening.
The American College of Obstetricians and Gynecologists. (2022). Practice Advisory. Clinical Guidance for the Integration of the Findings of the Chronic Hypertension and Pregnancy (CHAP) Study.
The American College of Obstetricians and Gynecologists. Committee Opinion No. 762. (2019, reaffirmed 2020). Prepregnancy Counseling.
The American College of Obstetricians and Gynecologists. Practice Bulletin No. 179. (2017, reaffirmed 2021). Breast Cancer Risk Assessment and Screening in Average-Risk Women.
The American College of Obstetricians and Gynecologists. Practice Bulletin No. 186. (2017, reaffirmed 2021). Long-Acting Reversible Contraception: Implants and Intrauterine Devices.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Association of State Public Health Nutritionists. An ASPHN Brief. (2017). Preconception Health: The Role of Nutrition.
Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. (2012). VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy. Chest. 2012 Feb;141(2 Suppl): e691S-e736S.
Centers for Disease Control and Prevention. (2022). CDC Fact Sheet: Information for Teens and Young Adults: Staying Healthy and Preventing STDs.
Centers for Disease Control and Prevention. (2022). Distracted Driving.
Centers for Disease Control and Prevention. (2022). Excessive Alcohol Use is a Risk to Women’s Health.
Centers for Disease Control and Prevention. High School Youth Risk Behavior Survey (YRBS). (2021). Youth Online.
Centers for Disease Control and Prevention. (2023). Planning for Pregnancy.
Centers for Disease Control and Prevention. (2023). Sexual Risk Behaviors.
Centers for Disease Control and Prevention. (2023). LGBTQ+ Youth: Addressing Health Disparities with a School-Based Approach.
Centers for Disease Control and Prevention. Reproductive Health. (2023). Contraception.
Centers for Disease Control and Prevention. Reproductive Health. (2018). Diabetes During Pregnancy.
Centers for Disease Control and Prevention. (2020). STD Testing.
Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021. (2021). Adolescents.
Clapp, M. A., & Bernstein, S. N. (2017). Preconception Counseling for Women With Cardiac Disease. Current Treatment Options in Cardiovascular Medicine. Sep;19(9):67.
Ferriera, S; Costa, R; Malveiro, D; Viera, F; Tuna, M. (2018). Warfarin embryopathy: Balancing maternal and fetal risks with anticoagulation therapy. Pediatrics and Neonatology. Volume 59, Issue 5, P534-535, October 2018.
Fleming-Dutra KE, Zauche LH, Roper LE, Ellington SR, Olson CK, Sharma AJ, Woodworth KR, Tepper N, Havers F, Oliver SE, Twentyman E, Jatlaoui TC. (2023). Safety and Effectiveness of Maternal COVID-19 Vaccines Among Pregnant People and Infants. Obstet Gynecol Clin North Am. 2023 Jun;50(2):279-297.
Grubb, L., & the AAP Committee on Adolescence. (2020). Barrier Protection Use by Adolescents During Sexual Activity. Pediatrics.146(2): e2020007245.
Hoyt-Austin AE, Phillipi CA, Lloyd-McLennan AM, King BA, Sipsma HL, Flaherman VJ, Kair LR. (2024). Physician personal breastfeeding experience and clinical care of the breastfeeding dyad. 2024 Mar;51(1):112-120.
Jenssen, BP; Walley, SC; Boykan, R; Caldwell, AL; Camenga, D. (2023). Section On Nicotine And Tobacco Prevention And Treatment, Committee On Substance Use And Prevention; Protecting Children and Adolescents From Tobacco and Nicotine. Pediatrics. 151(5): e2023061804.
Lim S, Harrison C, Callander E, Walker R, Teede H, Moran L. (2022). Addressing Obesity in Preconception, Pregnancy, and Postpartum: A Review of the Literature. Curr Obes. Rep. 11(4):405-414.
Machado, Vanessa, Madalena Ferreira, Luísa Lopes, José João Mendes, and João Botelho. (2023). Adverse Pregnancy Outcomes and Maternal Periodontal Disease: An Overview on Meta-Analytic and Methodological Quality. Journal of Clinical Medicine. 12(11), 3635.
Magdaleno AL, Venkataraman S, Dion M, Rochon M, Perilli G, Vengrove MA. (2019). Preconception Counseling in Women with Diabetes by Primary Care Providers and Perceived Barriers to Initiating this Discussion. Endocr Pract. 2020 Feb;26(2):226-234.
March of Dimes. (2020). Beyond Labels.
Masters C, Robinson D, Faulkner S, Patterson E, McIlraith T, Ansari A. (2019). Addressing Biases in Patient Care with The 5Rs of Cultural Humility, a Clinician Coaching Tool. J Gen Intern Med. Apr;34(4):627-630.
Mayo Clinic Health System. (2020). High blood pressure and pregnancy: Know the facts.
Mayo Clinic Health System. (2020). Hypothyroidism (underactive thyroid).
National Heart, Lung, and Blood Institute. (2020). What Is Anemia?
National Preconception Health + 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). Intimate Partner Violence Prevention: Resource for Action. Centers for Disease Control and Prevention.
Piolanti, Antonio; Waller, Franziska; Schmid, Iason E.; Foran, Heather M. (2023). Long-term Adverse Outcomes Associated With Teen Dating Violence: A Systematic Review. Pediatrics. 151(6): e2022059654.
Reproductive Health National Training Center. (2021). Client-Centered Reproductive Goals and Counseling Flow Chart.
Shebl, Eman; Chakraborty, Rebanta K. (2023). Asthma in Pregnancy. StatPearls.
Society of Hospital Medicine. (n.d.). The 5 Rs of Cultural Humility.
Talumaa, Britta; Brown, Adrian; Batterham, Rachel L.; Kalea, Anastasia Z.. (2022). Effective strategies in ending weight stigma in healthcare. Obesity Reviews. 23(10): e13494. First published: 07 August 2022.
Texas Department of State Health Services. (2023). Congenital Syphilis in Texas.
Texas Department of State Health Services. (2024). Healthy Texas Mothers and Babies.
Texas Department of State Health Services. (2019). Pregnancy Risk Assessment Monitoring System.
Texas Family Code, Chapter 32. Consent to Treatment of Child by Non-Parent or Child.
Texas Health and Human Services Commission. (2024). Healthy Texas Women.
Texas Health and Human Services Commission. Healthy Texas Women. (2024). Family Planning Program.
Texas Health and Human Services Commission. Texas Department of State Health Services. (2023). Maternal and Child Health Epidemiology: 2022/2023 Healthy Texas Mothers and Babies Data Book.
Texas Health and Human Services Commission. Texas Department of State Health Services. (2023). 2022 Texas Maternal Mortality and Morbidity Review Committee (MMMRC) Joint Biennial Report (2023 Addendum).
The University of North Carolina at Chapel Hill. Show Your Love Preconception Health. Before, Between and Beyond Pregnancy. (2020). Resource Guide for Clinicians.
Thompson, M; Kwong, J; Regan, A; Katz, M; Drews, S; Azziz-Baumgartner, E; Klein, N; Chung, H; Effler, P; Feldman, S; Simmonds, K; Wyant, B; Dawood, F; Jackson, M; Fell, D; Levy, A; Barda, N; Svenson, L; Fink, R; Ball, S; Naleway, A. (2019). Influenza Vaccine Effectiveness in Preventing Influenza-associated Hospitalizations During Pregnancy: A Multi-country Retrospective Test Negative Design Study, 2010–2016, Clinical Infectious Diseases. Volume 68, Issue 9, 1 May 2019, pages 1444–1453.
U.S. Department of Health and Human Services. U.S. Public Health Service. (2020). The Surgeon General’s Call to Action: To Improve Maternal Health.
U.S. Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans, 2nd Edition.

Definitions

The medical definitions in this module were obtained or adapted from the American Academy of Pediatric Dentistry, American College of Obstetricians and Gynecologists, 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.

Accreditation Statements

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

General Disclosure

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

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Health-Care Providers

Centers for Disease Control and Prevention. Immunization Schedules. (2024). For Healthcare Providers.
Centers for Disease Control and Prevention. (2020). STD Testing.
National LGBTQIA+ Health Education Center: A Program of the Fenway Institute. Learning Resources.
Reproductive Health National Training Center. (2021). Client-Centered Reproductive Goals and Counseling Flow Chart.
Research Recovery Institute. Behavioral Couples Therapy.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2022). NIDA-Modified ASSIST (NM ASSIST): Clinician's Screening Tool for Drug Use in General Medical Settings.
Texas Department of State Health Services. (2020). Yes Quit.
Texas Health and Human Services Commission. (2024). Family Planning.
Texas Health and Human Services Commission. (2024). Healthy Texas Women.
Texas Health Steps. (2024). Developmental and Mental Health Screening.
Texas Health and Human Services. (2024). Texas Health Steps Periodicity Schedule.
Texas Health and Human Services. (2023). Adolescent Health: A Guide for Providers.
Texas Health and Human Services. (2024). Anticipatory Guidance: A Guide for Providers.
The University of North Carolina at Chapel Hill. Show Your Love Preconception Health. Before, Between & Beyond Pregnancy.
U.S. Department of Health and Human Services, National Institute on Drug Abuse. (2023). Screening for Substance Use.
U.S. Department of Health and Human Services. Think Cultural Health.
U.S. Food and Drug Administration. (2022). Advice about Eating Fish For Those Who Might Become Pregnant or Are Pregnant or Breastfeeding and Children Ages 1-11 Years.
The Women's Preventive Services Initiative. "How I Practice" Videos.