Among other things, this means all women between first menstrual period and menopause should take folic acid supplements, refrain from smoking, maintain a healthy weight and keep chronic conditions such as asthma and diabetes under control.

While most of these recommendations are well known to women who are pregnant or seeking to get pregnant, experts say it's important that women follow this advice throughout their reproductive lives, because about half of pregnancies are unplanned, and so much damage can be done to a fetus between conception and the time the pregnancy is confirmed.

The recommendations aim to "increase public awareness of the importance of preconception health" and emphasize the "importance of managing risk factors prior to pregnancy," said Samuel Posner, co-author of the guidelines and associate director for science in the division of reproductive health at the Centers for Disease Control and Prevention, which issued the report.

Other groups involved include the American College of Obstetricians and Gynecologists, the March of Dimes, Dartmouth Hitchcock Medical Center, the National Center for Chronic Disease Prevention's Division of Reproductive Health and the National Center on Birth Defects and Developmental Disabilities.

Preconception care

The idea of preconception care has been discussed for nearly 20 years, experts said, but it has drawn more attention recently. Progress toward further reducing the rate of unhealthy pregnancy results, including premature birth, low birthweight and infant mortality, has slowed in the United States since 1996 "in part because of inconsistent delivery and implementation of interventions before pregnancy to detect, treat and help women modify behaviors, health conditions and risk factors that contribute to adverse maternal and infant outcomes," according to the report.Preconception care should be delivered by any doctor a patient sees -- from her primary care physician to her gynecologist. It involves developing a "reproductive health plan" that details if and when children are planned, said Janis Biermann, a report co- author and vice president for education and health promotion at the March of Dimes.

"The recommendations say we need to be opportunistic," or deliver care and counseling when opportunities arise, said Merry-K. Moos, a professor in the University of North Carolina's maternal fetal medicine division in Chapel Hill who sat on the CDC advisory panel. "Healthier women have healthier pregnancies."

Women should also make sure all vaccinations are up-to-date and avoid contact with lead-based paints and cat feces, Biermann said.

The report recommends that women stop smoking and discuss with their doctor the danger alcohol poses to a developing fetus.

Issue of insurance

The CDC report also discusses disparities in care, noting that approximately 17 million women lack health insurance and are likely to postpone or forgo care. These disparities are more prominent among minority groups and those of lower socioeconomic status, the report states.

The National Center for Health Statistics data also reflect these disparities. Babies born to black mothers, for example, had the highest rate of infant death -- 13.5 per 1,000 live births. Infants born to white women had a death rate of 5.7 per 1,000.

Obstacles to preconception care include getting insurance companies to pay for visits and putting the concept into regular use by doctors and patients. Experts acknowledge that women with no plans to get pregnant in the near future may resist preconception care.

"We know that women -- unless you're actively planning (a pregnancy), ... she doesn't want to talk about it," Biermann said. So clinicians must find a "way to do this and not scare women," by promoting preconception care as part of standard women's health care, she said.

What This Means to You

The new Centers for Disease Control and Prevention report seeks to improve preconception health and health care. Steps recommended for women of child-bearing age:

• Develop a "reproductive health plan," which describes if and when you want to have children. (The same advice applies to men and couples.)

• Use your regular doctor visits as an opportunity to discuss your risks -- including chronic medical conditions and behaviors that might negatively impact a pregnancy -- and learn about how to reduce them and improve future pregnancy outcomes.

• If you have a chronic medical condition, such as diabetes, asthma or epilepsy, get it under control. Also, ask your doctor or pharmacist how to handle prescribed and over-the- counter medications should you become pregnant.

• Get a "prepregnancy checkup" just before attempting conception. This visit would advise a woman on what she should do and expect in the months to come.

• Aim to reach a healthy weight before getting pregnant.

• Don't smoke.

• Maintain a healthy diet, and take a daily folic acid supplement -- which has been shown to decrease the risk of neural tube defects. Talk with your doctor about which foods to eat and which to avoid. Fish consumption, for example, should be limited due to concerns about mercury contamination, according to the March of Dimes.