Pre-pregnancy care is distinct from antenatal care. They are :-

Informed choice, which helps women and men to understand health issues that may affect conception and pregnancy.

Women and their partners being encouraged to prepare actively for pregnancy, and be as healthy as possible.

Identifying couples who are at increased risk of having babies with a genetic malformation.

Provide them with sufficient knowledge to make informed decisions.

A large number of pregnancies are unplanned .This and the haphazard seeking of pre-pregnancy advice by many patients, means that many opportunities for pre-pregnancy counseling are missed

By the first antenatal visit, organogenesis is well underway, and interventions to avoid malformations may be too late. For example, folic acid supplementation before conception and during the first trimester reduces the risk of a neural tube defect (NTD) by 50-70%.Similarly, control of glucose in women with diabetes appears to be most critical during the first 8-10 weeks of pregnancy in terms of preventing birth defects, so targeted care needs to occur before and early in pregnancy. Toxins such as alcohol can cause damage from the very early stages.

The goal of prenatal diagnosis is to help parents learn what theyneed to know about the health of their unborn child to help them make informed decisions for themselves and their family within the context of their own value system.

Women over the age of 35 should be counseled about the increased risks. The risk of fetal chromosomal abnormalities, particularly Down’s syndrome (trisomy 21), increases sharply with maternal age (1 in 1,500 risk at 20 years, 1 in 270 at 35 years, 1 in 100 at 40 years, 1 in 50 or more at over 45 years).
The current trend is for women to have babies later. Women should be supported in their choices, but should be aware that outcomes change with age. Older age is associated with increasing difficulty in conceiving, increasing risk of miscarriage, increased risk of adverse outcomes and complications of pregnancy

Assess pregnancy
Determine specific risks to fetus
Evaluate prenatal diagnostic options
Diagnosis fetus when desired and possible
Educate family about diagnosis, likely outcomes, potential and management options
Discuss risks, benefits, and uncertainties
Explore family concerns
Provide risk assessment for other family members
Provide psychosocial support and follow-up