Practice Guidelines

Interpregnancy Care: Guidelines from ACOG and SMFM


Am Fam Physician. 2019 Jul 15;100(2):121-123.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Clinicians should review women's prescription and nonprescription medications and environmental exposures for potential teratogens before the next pregnancy.

• During the interpregnancy period, all women should be asked about their use of tobacco, alcohol, and drugs.

• Women should be advised to avoid interpregnancy intervals shorter than six months and counseled about the risks and benefits of intervals shorter than 18 months.

From the AFP Editors

Interpregnancy care is the care provided to women of childbearing age who are between pregnancies. The interpregnancy period provides an opportunity to address complications or medical issues that developed during pregnancy, to assess women's mental and physical well-being, and to optimize long-term health. The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) have published guidelines focusing on interpregnancy care to improve outcomes of future pregnancies and the overall health of women, regardless of their future pregnancy plans.

Anticipatory guidance should begin during pregnancy and include the development of a postpartum care plan that addresses the transition to parenthood and interpregnancy or well-woman care. Family planning counseling should also begin during the prenatal period, with conversations about the woman's desire to have more children. In women with chronic medical conditions, the interpregnancy period is an opportune time to optimize health before a subsequent pregnancy and to promote future health.

Breastfeeding and Maternal Health


Clinicians should routinely provide guidance and support to enable women to breastfeed. Multiple studies have shown that longer duration of breastfeeding is associated with improved maternal health. Benefits include a lower risk of diabetes mellitus, hypertension, myocardial infarction, ovarian cancer, and breast cancer. Although exclusive breastfeeding is recommended for the first six months of life, clinicians should support each woman's informed decision about whether to initiate or continue breastfeeding.

Congenital Abnormalities


Women who are planning to become pregnant or are capable of becoming pregnant should take 400 mcg of folic acid daily, beginning at least one month before fertilization and continuing through the first 12 weeks of pregnancy. Those who have had a child with a neural tube defect should take 4 mg of folic acid daily, beginning at least three months before

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at



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