Preconception Health and Chronic Disease

Guidance for Health Care Providers

Key Messages for Providers

Optimizing chronic diseases before conception improves maternal, fetal, and intergenerational outcomes, reducing risks of complications and medication-related exposures. Preconception care allows time to adjust medications and coordinate multidisciplinary care.

Management of chronic disease should be integrated with mental health care, lifestyle counselling, and preventive care.

Shared decision-making and patient-centred counselling improve engagement and continuity of care.

Why Chronic Diseases Belong in Preconception Care

Chronic medical conditions are increasingly common among individuals of reproductive age and are associated with increased risks of infertility, pregnancy complications, and adverse neonatal outcomes.

Conditions such as diabetes, hypertension, thyroid disorders, and autoimmune disease can influence fertility, placental development, fetal growth, and maternal health during pregnancy.

Because many pregnancies are unplanned and early fetal development occurs before pregnancy recognition, identifying and stabilizing chronic illness prior to conception is critical.

Key rationale

Early embryogenesis occurs before pregnancy recognition
Medication exposure may occur before pregnancy is identified
Chronic disease complications can worsen during pregnancy
Stabilization prior to conception improves maternal and fetal outcomes
Chronic illness often co-occurs with mental health and social vulnerabilities
Preconception care shifts the focus from reactive management during pregnancy to anticipatory disease stabilization and prevention prior to conception.

Clinical Pearl: Stabilization Before Pregnancy Improves Outcomes

Achieving optimal disease control prior to conception significantly reduces risks of congenital anomalies, hypertensive disorders of pregnancy, preterm birth, and fetal growth restriction.

Index

Key Messages for Providers
Why Chronic Diseases Belong in Preconception Care
Core Clinical Principles
Routine Screening and Assessment
Common Chronic Diseases/Conditions in Preconception Care
Resources for Health Care Providers
Resources for Patients

Core Clinical Principles

Preconception chronic disease management should emphasize early identification, disease stabilization, coordinated care, and patient-centered counselling.

Key principles include:

Early identification of chronic conditions
Medication safety review
Disease stabilization prior to conception
Multidisciplinary care coordination
Shared decision-making regarding pregnancy timing

Providers play a key role in ensuring individuals with chronic illness receive coordinated care before pregnancy occurs.

Practice Tip: Ask About Reproductive Goals During Chronic Disease Visits

Individuals with chronic illness may not raise pregnancy intentions unless asked. Including a routine question such as “Would you like to become pregnant in the next year?” helps guide medication review and disease management planning.

Equity Alert: Chronic Disease and Structural Barriers

Individuals with chronic illness may face barriers to coordinated care, including financial constraints, geographic barriers, and limited access to specialty services. Addressing these barriers helps improve preconception health outcomes.

Routine Screening and Assessment

Chronic disease screening should be incorporated into routine care for individuals of reproductive age.

Screening should include:

Medical history and chronic conditions
Medication review
Metabolic and cardiovascular risk factors
Mental health screening
Lifestyle behaviours

Screening should be:

Routine
Non-judgmental
Repeated over time
Independent of pregnancy intention

Avoid assuming that individuals with chronic illness are not considering pregnancy.

Practice Tip: Medication Review Should Occur Regularly

Many medications used to manage chronic illness may require adjustment before pregnancy. Routine medication review helps prevent early fetal exposure before pregnancy recognition.

Common Chronic Diseases/Conditions in Preconception Care

Diabetes

Poor glycemic control prior to pregnancy increases risks of congenital anomalies, pregnancy loss, hypertensive disorders, and fetal growth abnormalities (See SOGC Guideline No. 393-Diabetes in Pregnancy and SOGC Guideline No. 464: Recurrent Pregnancy Loss for more information).

Clinical Approaches for Preconception Diabetes Management

Preconception Domain	Key Preconception Considerations	Why Preconception Timing Matters	Priority Action	Referral
Glycemic control	Hyperglycemia increases congenital anomaly risk	Organogenesis occurs early in pregnancy	Optimize glycemic control prior to conception	Endocrinology
Medication safety	Some medications require adjustment	Medication exposure may occur before pregnancy recognition	Review and adjust treatment regimens	Primary care
Diabetes complications	Retinopathy and nephropathy may worsen in pregnancy	Complications influence pregnancy risk	Screen for complications before conception	Specialists
Nutrition	Diet influences glycemic control	Stable metabolic control improves outcomes	Provide nutrition counselling	Dietitian
Postpartum risk	Diabetes persists postpartum	Ongoing management affects future pregnancies	Plan long-term care	Primary care

Clinical Pearl: Glycemic Control Before Conception Reduces Congenital Anomalies

Optimizing blood glucose prior to conception significantly reduces risks of neural tube defects, cardiac anomalies, and other congenital abnormalities.

Hypertension

Chronic hypertension increases the risks of preeclampsia, placental complications, and preterm birth (See SOGC Guideline No 426: Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management for more information).

Clinical Approaches for Preconception Hypertension Management

Preconception Domain	Key Preconception Considerations	Why Timing Matters	Priority Action	Referral
Blood pressure control	Poor control increases pregnancy complications	Placental development is sensitive to vascular health	Optimize BP prior to conception	Primary care
Medication safety	Some antihypertensives are contraindicated	Early exposure may occur before pregnancy recognition	Adjust medications	Primary care
Cardiovascular risk	Hypertension often coexists with metabolic conditions	Pregnancy increases cardiovascular demand	Assess cardiovascular risk	Cardiology
Lifestyle factors	Weight and diet affect BP control	Lifestyle changes require time	Encourage healthy behaviours	Primary care

Practice Tip: Review Antihypertensive Medications Early

Certain medications (e.g., ACE inhibitors and ARBs) may be contraindicated in pregnancy. Reviewing medications before conception helps prevent early exposure.

Thyroid disorders can affect fertility, pregnancy loss risk, and fetal neurodevelopment (See SOGC Committee Opinion No. 407: Thyroid Disease and Infertility and SOGC Guideline No. 464: Recurrent Pregnancy Loss for more information).

Clinical Approaches for Preconception Thyroid Management

Preconception Domain	Key Preconception Considerations	Why Timing Matters	Priority Action	Referral
Thyroid function	Abnormal thyroid hormone levels affect pregnancy	Early fetal brain development depends on maternal thyroid hormone	Achieve euthyroid status before conception	Endocrinology
Medication dosing	Thyroid medications may require adjustment	Hormonal changes occur early in pregnancy	Review dosing	Primary care
Monitoring	Thyroid disorders require ongoing monitoring	Pregnancy increases hormone requirements	Establish monitoring plan	Endocrinology

Clinical Pearl: Early Thyroid Hormone Support Is Critical

Adequate maternal thyroid hormone levels during early pregnancy support fetal brain development and reduce pregnancy complications.

Epilepsy and Seizure Disorders

Epilepsy affects many individuals of reproductive age. Both uncontrolled seizures and certain antiseizure medications can influence pregnancy outcomes.

Risks associated with poorly controlled epilepsy during pregnancy include:

Maternal injury from seizures
Congenital anomalies related to some antiseizure medications
Preterm birth
Fetal growth restriction

Because organ development occurs early in pregnancy, medication exposures and seizure control prior to pregnancy are important considerations.

Clinical Approaches for Preconception Epilepsy Management

Preconception Domain	Key Preconception Considerations	Why Timing Matters	Priority Action	Referral
Seizure control	Uncontrolled seizures increase maternal and fetal risk	Seizure frequency before pregnancy predicts seizure activity during pregnancy	Achieve stable seizure control prior to conception	Neurology
Medication safety	Some antiseizure medications carry teratogenic risk	Early fetal development occurs before pregnancy recognition	Review medication regimen and adjust where appropriate	Neurology
Folic acid supplementation	Higher folic acid doses may be recommended for patients taking antiseizure medications	Neural tube development occurs early in pregnancy	Initiate supplementation prior to conception	Primary care
Care coordination	Epilepsy often requires specialist input	Medication adjustments and monitoring may be required	Coordinate care with neurology	Neurology

Clinical Pearl: Optimize Seizure Control Before Pregnancy

Stable seizure control before conception is associated with improved maternal and neonatal outcomes.

Asthma and Chronic Respiratory Disease

Asthma is one of the most common chronic conditions affecting individuals of reproductive age. Poorly controlled asthma during pregnancy can increase the risk of adverse maternal and fetal outcomes.

Potential complications include:

Hypertensive disorders of pregnancy
Preterm birth
Low birth weight
Fetal growth restriction

Optimizing asthma control prior to pregnancy helps reduce these risks.

Clinical Approaches for Preconception Asthma Management

Preconception Domain	Key Preconception Considerations	Why Timing Matters	Priority Action	Referral
Asthma control	Poorly controlled asthma increases maternal and fetal risk	Respiratory status during pregnancy reflects pre-pregnancy control	Assess asthma severity and symptom control	Primary care
Medication safety	Patients may discontinue medications due to safety concerns	Medication interruption can worsen asthma control	Review inhaler medications and reassure regarding safety	Primary care
Trigger management	Environmental triggers worsen asthma symptoms	Trigger reduction improves disease stability	Address smoking, allergens, and air quality	Primary care
Self-management	Proper inhaler technique improves treatment effectiveness	Education supports long-term control	Review inhaler technique and action plan	Respiratory specialist

Clinical Pearl: Controlled Asthma Is Safer Than Untreated Disease

Maintaining asthma control during pregnancy is safer than discontinuing medications.

Autoimmune and Inflammatory Conditions

(e.g., systemic lupus erythematosus, inflammatory bowel disease, rheumatoid arthritis)

Autoimmune and inflammatory conditions frequently affect individuals during their reproductive years. Active disease at conception is associated with increased pregnancy complications.

Potential risks include:

Pregnancy loss
Preterm birth
Preeclampsia
Fetal growth restriction

Preconception care allows time to stabilize disease activity and review medications.

Clinical Approaches for Preconception Autoimmune Disease Management

Preconception Domain	Key Preconception Considerations	Why Timing Matters	Priority Action	Referral
Disease activity	Active disease increases pregnancy risk	Disease activity at conception predicts pregnancy outcomes	Aim for remission or low disease activity prior to conception	Specialist care
Medication safety	Some immunosuppressive medications are contraindicated in pregnancy	Medication exposure may occur before pregnancy recognition	Review medications and transition when needed	Specialist care
Organ involvement	Certain autoimmune conditions affect the kidneys or the cardiovascular system	Organ involvement influences pregnancy risk	Screen for disease complications	Specialist care
Multidisciplinary care	Complex conditions require coordinated care	Care planning improves maternal and fetal outcomes	Coordinate care across specialties	Multidisciplinary team

Clinical Pearl: Pregnancy Is Safest During Disease Remission

Planning pregnancy during stable disease activity reduces risks for both parent and baby.

Obesity and Metabolic Health

Why this matters

Obesity and metabolic disorders are increasingly common among individuals of reproductive age and are associated with a range of pregnancy complications.

Potential risks include:

Infertility and subfertility
Gestational diabetes
Hypertensive disorders of pregnancy
Cesarean birth
Long-term metabolic risk for offspring

Preconception care provides an opportunity to support metabolic health and reduce pregnancy risks (See SOGC Guideline No. 391: Pregnancy and Maternal Obesity Part 1: Pre-conception and Prenatal Care for more information).

Clinical Approaches for Preconception Metabolic Health

Preconception Domain	Key Preconception Considerations	Why Timing Matters	Priority Action	Referral
Metabolic risk	Obesity is associated with diabetes and hypertension	Metabolic health influences placental development	Assess BMI, blood pressure, and metabolic risk	Primary care
Lifestyle behaviours	Nutrition and physical activity affect metabolic health	Behaviour change requires time	Encourage gradual, sustainable lifestyle changes	Dietitian
Weight stigma	Stigma can affect engagement in care	Respectful counselling improves trust, engagement and adherence	Use non-judgmental, patient-centred communication	Primary care
Comorbid conditions	Metabolic disease often coexists with diabetes or hypertension	These conditions affect pregnancy outcomes	Screen and manage metabolic comorbidities	Primary care

Clinical Pearl: Focus on Metabolic Health, Not Weight Alone

Improving metabolic health before pregnancy can meaningfully reduce pregnancy risks.

Medication Safety

Medication review is a critical component of preconception care.

Providers should:

Review prescription medications
Review over-the-counter medications
Review supplements and herbal products
Identify potential teratogenic risks
Adjust medications when necessary

Pregnancy Timing and Contraception

For individuals with unstable chronic disease, pregnancy timing discussions may reduce risk.

Contraception counselling should:

Support patient autonomy
Avoid coercive framing
Align with reproductive goals
Emphasize health stabilization prior to conception

Clinical Pearl: Shared Decision-Making Improves Engagement

Discuss risks, benefits, and patient goals openly. Collaborative decision-making helps individuals make informed choices about pregnancy timing and disease management.

Practical Clinical Actions

Chronic disease management can be integrated into routine visits.

At routine visits, consider:

Asking about reproductive goals
Screening for chronic conditions
Reviewing medications
Assessing lifestyle and metabolic health
Optimizing disease management
Coordinating specialist referrals
Providing preconception counselling
Arranging follow-up care

Small, consistent interventions across visits can meaningfully reduce risk prior to conception.

Resources for Health Care Providers

To support clinical practice, the following resources provide evidence-based guidance, continuing education, and practical tools related to preconception and chronic disease care.

Canadian Resources

Public Health Agency of Canada – Preconception Health
National public health information and guidance to support health before pregnancy.

Diabetes Canada Clinical Practice Guidelines and Tools
Evidence-based recommendations and practical tools for diabetes prevention and management.

Heart & Stroke Foundation of Canada – Women’s Risk Factors
Information on cardiovascular risk factors affecting women’s health across the lifespan.

Healthy Pregnancy Hub
A central source of pregnancy-related health information and resources for care providers and the public.

SOGC Clinical Guidelines

No 391: Pregnancy and Maternal Obesity Part 1: Pre-conception and Prenatal Care
Guidance on preconception and prenatal care considerations for people living with obesity.

No 393: Diabetes in Pregnancy
Recommendations for the management of diabetes before and during pregnancy.

Committee Opinion No 407: Thyroid Disease and Infertility
Clinical guidance on the relationship between thyroid disorders and fertility.

No 426: Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management
A comprehensive overview of hypertensive disorders in pregnancy, including prevention and management strategies.

No 464: Recurrent Pregnancy Loss
Guidance on the assessment and management of recurrent pregnancy loss.

Quick Reference Guides

Clinical Quick Read by Condition
A concise summary of key preconception care considerations organized by condition.

Clinical Quick Reference Table
A practical, at-a-glance table to support clinical decision-making during preconception care.

Webinar

Preconception Planning for People with Diabetes and Prediabetes
A Stanford Health Care video that provides guidance on preconception planning for people with diabetes and prediabetes to support a healthy pregnancy and optimal outcomes.

SOGC Resource

Condition-Specific Preconception Care Packs
A set of condition-specific preconception care packs that bring together aligned information for clinicians and patients to support shared understanding, timely care, and informed decision-making before pregnancy.

Chronic Disease in Preconception Care – Clinical Quick Reference Table for Providers
This quick reference table outlines key considerations for managing chronic conditions before pregnancy, including risks, preconception actions, medication considerations, and referral guidance.

Chronic Disease in Preconception Care – Clinical Quick-Read for Health Care Providers
A concise provider-facing overview on screening, medication review, and preconception management of common chronic conditions to improve maternal and fetal outcomes. 

Resources for Patients

Medication Safety Before and During Pregnancy
An SOGC and Canadian Pharmacists Association resource that outlines general medication safety considerations before and during pregnancy, including the importance of reviewing prescriptions, over-the-counter medications, and supplements with a health care provider.

Patient Handouts on Preconception Health
These SOGC patient handouts are designed to provide clear, supportive, and easy-to-understand information about how health before pregnancy can affect future outcomes.

The Society of Obstetricians and Gynaecologists of Canada (SOGC)

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