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Preconception health care for the primary care practitioner.

There will always be birth defects and pregnancy complications due to factors beyond our control. However, we are rapidly discovering many interventions women can use to optimize their chances of having a healthy pregnancy and baby. Most of these, such as immunization and normalization of a diabetic woman's glycosylated hemoglobin level, are most effective when begun before conception. Since the discovery of the congenital rubella syndrome in 1941, there has been a steady accumulation of information on the prevention of birth defects through preconception health. In just the last few years, we have learned that folic acid can decrease neural tube defects, angiotensin converting enzyme inhibitors are teratogenic, and zidovudine can decrease the vertical transmission rate of human immunodeficiency virus. The Varivax vaccine released last year is expected to decrease the perinatal morbidity from varicella. By using the time before conception, we may be able to fully maximize the benefits of good nutrition, exercise, medical screening, and avoidance of environmental toxins.