Background:
Preconception counselling is a form of preventive medicine that consists of three main components: risk assessment, health promotion and intervention. Ideally all reproductive-age women should be considered at risk for pregnancy and be advised about anticipatory activities that are important in the periconception period.

Objectives:
Our aim was to survey the attitudes of Israeli gynaecologists regarding preconception counselling during an office visit for other clinical problems (in women who either want or might get pregnant) and compare it to prenatal care visit.

Methods:
Anonymous questionnaires were sent by e-mail to all registered gynaecologists in an Israeli gynaecology network. Respondents were asked about their opinion and conduct in different aspects of preconception counselling and prenatal care. The questionnaire included two identical sets of 6 questions; the first was regarding the care of reproductive aged women who visit their gynaecologist for various reasons and the second was regarding the care of women in their first prenatal visit. The questionnaire also included basic demographic data. Answers were scored (from 3-always to 0-never), summed (max total score 18) and compared using Chi-square and paired t tests. We also calculated the percent of physicians who recommended an intervention to most (either always or usually) of their patients.

Results:
100 questionnaires were returned. Most of the respondents were specialists with more than 10 years experience and seventy-five percent were male. Mean score for the preconception set was significantly lower than the prenatal set 11.3 (62.7%) versus 16.9 (93.7%) respectively, p<0.001. Folic acid supplementation and rubella vaccine were recommended to most women in only 42% and 41% of preconception visits, compared to 99% and 92% of first prenatal care visits (p<0.001). Similarly, 94% offered genetic screening tests prenatally to most women, compared to 62% who offered the same tests to women with infertility problems (p<0.001). There were no significant differences in the scores between the physicians whose main interest was obstetrics (39) and the rest of the gynaecologists.

Conclusion and implications for practice:
Preconception counselling is still a neglected area. Gynaecologists fail to recognize proper opportunities for preconception care. Increased awareness and concrete guidelines concerning the timing and content of preconception counselling might be helpful.