The Preconception Health Care Tool helps you assess the preconception health and risk factors for pregnancy of all patients of reproductive age. Use it over a series of visits to identify potential physical, genetic, psychosocial and environmental risk factors for adverse pregnancy outcomes. The Tool will guide you to help reduce those risks before conception through counselling, education and other interventions. You have a key role to play in ensuring the best start for infants and positive health outcomes for new mothers!

Question #1: How much folic acid should you recommend if there is positive history of a neural tube defect?

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Question #2: How much weekly physical activity is recommended to those considering/are pregnant?



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The Preconception Health Care Tool is designed to be used over a series of visits. Use it to:

  • Assess your patient’s preconception health.
  • Identify potential physical, genetic, psychosocial and environmental risk factors for pregnancy.
  • Address issues before patients become pregnant.
  • Consider the potential impact of conception and pregnancy when diagnosing and treating patients.
  • Counsel patients about current behaviours that might affect conception and pregnancy.

Code the time you spend implementing the tool with patients using the Ontario Health Insurance Plan (OHIP) billing code for individual care counselling (K013).

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Project Overview

Why is Preconception Health Care Important?

  • The critical period for fetal development often occurs before prenatal care begins.
  • Optimizing patients’ health and knowledge before conceiving improves maternal and
    infant outcomes.
  • Patients with chronic conditions may not be aware that their condition or treatment for their condition could have adverse effects on their infant.
  • Patients may not be aware of risks associated with delayed childbearing.
  • A woman’s health and weight before she becomes pregnant and her weight gain during pregnancy have a direct influence on her child’s health and weight.
  • Natural fertility and assisted reproductive technology success is significantly lower for women in their late 30-40s.
  • Prevention and screening for infectious diseases is important for those of reproductive age. All individuals of reproductive age should have their immunization status reviewed and updated.

Development Process

The Preconception Health Care Tool is one of several resources developed as part of the 2014 to 2017 Knowledge Translation in Primary Care Initiative. This multi-year initiative was a collaboration between the Centre for Effective Practice (CEP), Ontario College of Family Physicians (OCFP), and Nurse Practitioners’ Association of Ontario (NPAO). Funded by the Ministry of Health and Long-Term Care, this initiative supported primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.

The Preconception Health Care Tool was developed in response to recommendations in the Ministry of Health and Long Term Care’s No Time to Wait: The Healthy Kids Strategy and is based on well-documented evidence that healthy individuals have a much better chance of having babies who enjoy good health throughout their lives.

The Preconception Health Care Tool was developed using CEP’s integrated knowledge translation development methods. CEP ensures that health care providers are engaged throughout the tool development process, using a User Centered Design methodology to test the usability of tools from a provider perspective.

Meet the Team

The Preconception Health Care Tool was developed with input and review from clinical leads and a clinical working group. Health care providers and other stakeholders were also engaged throughout the development process.

Clinical Leads

Deanna Telner

Deanna Telner, MD, MEd, CCFP, FCFP 
Deanna Telner is a family physician at the community-based, academic teaching site, South East Toronto Family Health Team. She is involved in teaching medical students, residents and colleagues. She is an Assistant Professor and part-time researcher in the Department of Family and Community Medicine, University of Toronto. Her area of research interest is in postgraduate and continuing education. Dr. Telner has been extensively involved in the development of online clinical modules for primary care providers.

Rebekah Barrett

Rebekah Barrett, NP-PHC, MN
Rebekah is a Primary Health Care Nurse Practitioner, currently working with a diverse population at the Regent Park Community Health Centre in Toronto. She has a passion for Primary Care, where she has worked since 2009 in multiple roles. As an RN at the Taddle Creek Family Health Team, Rebekah worked within the Smoking Cessation Program, Methadone Maintenance Treatment Program, Hypertension Clinic, and brought her experience as a pediatric emergency nurse to develop the Group Well Child Care and Ouchless Immunization Programs. Rebekah has been involved in several Quality Improvement initiatives and has worked with the Centre for Effective Practice on CAN-ADAPTT projects. She has participated in research such as CAMH’s STOP study and the BETTER Project, and has been part-time faculty in the CAMH Nicotine Dependence Clinic’s TEACH Project. In 2013, she was awarded the Canadian Nurses Foundation Rx&D Nurse Practitioner Award and the Registered Nurses Foundation of Ontario Maternal Child Nurses’ Interest Group Nurse Practitioner Scholarship. Rebekah completed her Bachelor of Science in Nursing at Dalhousie University and her Master of Nursing at Athabasca University.


Thank you to the following individuals for their contribution to the development of the Preconception Health Care Tool:

  • Ontario Public Health Association (OPHA) Reproductive Health Workgroup chair, Catriona Mill, RN, MHSc, CCHN(c), and member Joanne Enders, RN, BScN;
  • Ontario’s Better Outcomes Registry and Network (BORN), Enhanced Record Working Group members, Stanley Lofsky, MD, CCFP, FCFP LM, and Debra Boyce, BSc, MD, FCFP;
  • Wendy McAllister, Manager, Best Start Resource Centre at Health Nexus;
  • Genetics Education Canada – Knowledge Organization (GEC-KO) co-director Dr. June Carroll, MD, CCFP, FCFP, and manager, Shawna Morrison, MS, CGC;
  • Rita Barbieri, RD; EatRight Ontario
  • Jackie Bellaire, MD, CCFP;
  • Christina Biancucci, MD, CCFP;
  • Lisa Graves, MD, CCFP, FCFP;
  • Anita Greig, MD, CCFP, FCFP;
  • Brandi Grozell, BScN, MSN, NP-PHC;
  • Michelle Lockyer, MD, CCFP; and
  • Patricia Mousmanis, MD, CCFP, FCFP.

Supporting Material

Below are some additional resources and sources of information. The supporting materials are hosted by external organizations, we cannot guarantee the accuracy and accessibility of their links. CEP will make every effort to keep these links up to date.

Our Preconception Health Care Tool is also available in Telus PS Suite EMR! Download the custom form here.

For instructions on how to import the form into your EMR, click here.

Please note: The Preconception Health Care Tool custom form and download instructions can also be accessed online via the TELUS Health Community Portal.

It is recommended that the tool be used on PS Suite EMR v5.2.702 or later to ensure full functionality of the form; use of the form on earlier versions of the EMR might result in a loss of some features and functionality.

Copyright & Disclaimer

CEP fully supports the use of the Preconception Health Care Tool by providers, educators, decision-makers and others. Please read the following information prior to use of the Tool to ensure appropriate permission is sought and appropriate citation is used.

Creative Commons License

Creative Commons The Preconception Health Care Tool is a product of the Centre for Effective Practice. Permission to use, copy, and distribute this material for all non-commercial and research purposes is granted, provided that all copies, modifications, and distributions contain full reproductions of this Creative Commons License and the following Disclaimer along with appropriate citations. Use of the Preconception Health Care Tool for commercial purposes or any modifications of the tool is subject to charge and use must be negotiated with the Centre for Effective Practice (Email:[email protected])

For statistical and bibliographic purposes, please notify the Centre for Effective Practice ([email protected]) of any use or reprinting of the tool.

Please use this citation when referencing the tool:

Reprinted with Permission from Centre for Effective Practice (November 2015). Preconception Health Care Tool. Toronto: Centre for Effective Practice


Preconception Health Care (the “Tool”) contains links to websites and other external resources (“Third Party Resources”) that are operated by and/or created by third party organizations. These third party organizations are solely responsible for the information contained in, and the operation of (as applicable), their respective Third Party Resource(s).

This Tool was developed for licensed health care professionals in Ontario as a guide only and does not constitute medical or other professional advice. Primary care providers and other health care professionals are required to exercise their own clinical judgment in using this Tool.

Neither the Centre for Effective Practice (“CEP”), Ontario College of Family Physicians, Government of Ontario, the contributors to this Tool, nor any of their respective agents, appointees, directors, officers, employees, contractors, members or volunteers: (i) are providing medical, diagnostic or treatment services through this Tool; (ii) to the extent permitted by applicable law, accept any responsibility for the use or misuse of this Tool by any individual including, but not limited to, primary care providers, or entity, including for any loss, damage or injury (including death) arising from or in connection with the use of this Tool, in whole or in part; or (iii) give or make any representation, warranty or endorsement of any of the Third Party Resources, that are owned or operated by third parties, including any information or advice contained therein.