Interventions
The core components of preconception care (PCC) consist of risk assessment, health promotion, and intervention. PCC should be the earliest part of an interconnected chain of subsequent prenatal, neonatal, child, and youth care. Health authorities, non-governmental organizations (NGOs), and healthcare disciplines should be involved, such as general practitioners, midwives, obstetricians, clinical geneticists, and other maternal and child health professionals.
PCC is intended to improve the health of mother and child in various ways. Some approaches target the general population at large, some focus on both future parents individually, and others on all women of reproductive age.

Categories
PCC can be categorized into different forms:

• Collective measures are aimed at the general population to improve preconception health. Examples include rubella vaccination of children, iodization of salt, radiological protection of all women of reproductive age, cigarette package labelling to prevent low birth weight in singletons, and educational campaigns on the use of folic acid. Some of these measures are not primarily undertaken to improve preconception health (e.g., iodization of salt), but nonetheless benefit the health of mother and child.

• General individual PCC is provided by primary care workers (such as general practitioners, midwives, or community healthcare workers) to all couples planning pregnancy. Community healthcare workers can reach people through their networks with information promoting healthy behaviour and preventive actions (e.g., individual advice on smoking cessation). By informing people about the importance of PCC, they can stimulate demand for appropriate services. They can act as a link between the community or broader population and formal healthcare services.

• Specialized individual PCC is provided to:
  a) couples already known to be at risk for adverse pregnancy outcomes (e.g., due to prior pregnancy complications or chronic illness), or
  b) couples referred from general individual PCC after risk assessment (including medication use, genetic disorders in the family, or specific working conditions of women).

Depending on medical history, consultation by medical specialists may be required. In such cases, coordination by a single healthcare professional is essential. Recognizing the different forms of PCC is important for effective implementation. Worldwide, various professional organizations of nurses, midwives, gynecologists, and general practitioners have developed recommendations and guidelines for the provision of PCC to women in general and to targeted groups. For these guidelines to be implemented, greater consensus is needed on:

• standardized risk assessment tools;
• protocols to ensure uniform care;
• training of professionals in the provision of PCC;
• standardized communication tools and strategies adaptable to local contexts;
• clear distribution of tasks and responsibilities among professionals providing individual care;
• involvement of municipal public health institutions, schools, employers, etc.

One option to facilitate the implementation of PCC is through care pathways. Care pathways are multidisciplinary, organized, and efficient shared-care approaches based on evidence-based medicine. They can be used to refer individuals with (psycho)social and socio-economic risk factors to professionals in local authorities, social welfare services, and public health. These care pathways should be aligned with local guidelines, factors, and practices.