Background:
During the last few decades perinatal mortality rates has not decreased substantially and maternal mortality even increased. The first trimester of the pregnancy is essential concerning the etiology of birth defects as well as disturbances in early placental development resulting in subsequent pregnancy complications like fetal growth restriction and preeclampsia.
Initiating care before conception, preconception care, could therefore be the most effective strategy to improve the outcome of the pregnancy. Identification of risk factors is a main component of preconception care. In the Netherlands there is no history in preconception care and no practical tools were available. Self-administered questionnaires have been proven to be accurate screening tools.

Objectives:
We have developed www.zwangerwijzer.nl to provide a practical instrument, for national use, to identify risk factors. Www.zwangerwijzer.nl is a checklist on Internet. It is easy to access and to understand. Www.zwangerwijzer focuses on identifying risk factors, supplies information about health promotion and provides advise for additional preconception counselling if necessary. It is used by parents to be for their own information. It is also used as a screening tool for professionals in a clinical setting, facilitating the implementation of programs of preconception care in The Netherlands.


Methods:
Self-administered questionnaires were adapted into an automated electronic checklist on a national website, www.zwangerwijzer.nl. It is online since January 2004.

Results:
Zwangerwijzer had 129.558 unique visitors in 2006. The number of visitors is growing each year. Anonymous data are recorded after informed consent. 47% of visitors completed the whole questionnaires. Among female participants, 66% of them took folic acid supplements, 22% smoked and 17% took medication. Zwangerwijzer will make it possible to acquire risk profiles of subpopulations such as ethnic minorities. Although Internet has limitations as a scientific tool, we have found similar data as in other surveys.

Conclusion and implications for practice:
Zwangerwijzer is a well-established national instrument for preconception care and will, as a simple screening instrument for risk factors, play an important role in the implementation of preconception care in the whole of The Netherlands.