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The time to deal with unwanted risks is not during the second trimester of pregnancy, as is so often the case in practice. Preconception counseling will identify specific risks and attendant options, which include the following:

 Knowledge of family history

 Attention to maternal health (e.g. diabetes control,⁷⁰¹, ⁷⁰² confirm cardiac and vascular normality)

 Decision not to have children (includes consideration of vasectomy or tubal ligation)

 Adoption

 In vitro fertilization

 Gamete intrafallopian tube transfer or allied techniques

 Artificial insemination by donor

 Ovum donation (includes surrogacy)

 Intracytoplasmic sperm injection

 Carrier detection tests

 Noninvasive prenatal screening by fetal DNA in the maternal circulation

 Naternal serum α‐fetoprotein screening for NTDs

 Prenatal diagnosis (CVS, amniocentesis, cordocentesis, ultrasound, MRI)

 Preimplantation genetic testing

 Fetal treatment or surgery for selected disorders

 Folic acid supplementation in periconceptional period (see Chapter 10)

 Noninvasive prenatal testing (aneuploidy; monogenic disorders)

 Selective abortion