to the editor: I read with great interest the article on preconception care by Dr. Lu, which emphasized the importance of optimizing maternal health before pregnancy. This concept is most necessary and long overdue considering the high neonatal morbidity and mortality rates in the United States relative to those rates in other industrialized nations.

I would like to make two additional points on this topic. First, Dr. Lu addressed the importance of women of reproductive age avoiding teratogenic agents because of their potential effects on the fetus. However, many women currently work under potentially hazardous conditions but are afraid to voice their complaints. Primary care physicians must advocate for them. Some medical offices with radiography equipment are not checking Geiger counters or making staff aware of radiation exposure.¹ We must screen our patients for these workplace hazards and violations, and also help them to reduce the risks by contacting the Occupational Safety and Health Administration and other authorities.

Second, I disagree with the author's assertion that the components of preconception care for men are not as well defined. This appears to be based on the Centers for Disease Control and Prevention's definition of preconception care as “a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management.”² It would be a mistake to believe that these risk factors affect only women. The man should be viewed as half of the equation. Men contribute financial resources and psychosocial support, and should be educated about the negative effects of sexually transmitted diseases on the health of his spouse and the fetus.³ It is also important for men to understand the potential impact of stress and anxiety on pregnancy outcomes.^4,5 Finally, getting potential fathers involved in preconception care may encourage them to take more responsibility for the health and well–being of their partners and children.

in reply: I appreciate Dr. Harding-Marin's response, which calls attention to two important issues in preconception care. First, I agree wholeheartedly that “we must screen our patients for these workplace hazards and violations, and also help them to reduce the risks.” However, we must first educate ourselves. Many physicians are not aware of worker rights under the Occupational Safety and Health (OSH) Act.¹ Workers have the right to a safe workplace free from recognized reproductive hazards. Under the OSH Act's Hazard Communication Standard, employees have the right to know what they are being exposed to by requesting a Material Safety Data Sheet (MSDS). An employer who does not provide MSDSs when asked or retaliates against an employee for requesting an MSDS is breaking the law. Physicians need to review the MSDSs with their patients, or refer them to their local Teratogen Information Service for counseling.² I agree with Dr. Harding-Marin that physicians have a moral responsibility to report workplace hazards and violations by contacting the Occupational Safety and Health Administration (OSHA) and other authorities.

Second, I also concur that preconception care should be a vital issue for both sexes. Men contribute about one half of the baby's genetic materials. Their sperm DNA can get damaged in many ways,³ including exposures to tobacco, alcohol, drugs (e.g., anabolic steroids), caffeine, poor diet, radiation and chemotherapy, and testicular hyperthermia. Medical conditions such as diabetes mellitus, varicoceles, and epididymitis, if left untreated, can also reduce sperm count and quality. A growing number of xenobiotics, including 1,2-dibromo-3-chloropropane, nonylphenol, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), dioxins, phthalates and acrylamide, have been shown to cause oxidative stress and DNA damage to the sperm. Such damage can result in infertility and subfertility, spontaneous abortions, birth defects, or even childhood cancers. Men also contribute financial resources and psychosocial support, and their preparation for fatherhood should begin with preconception care.

Unfortunately, the content of preconception care for men is still much less defined than that for women. This is why my colleagues and I wrote a concept paper on clinical content of preconception care for men for the American Journal of Obstetrics and Gynecology.⁴ We identified 10 major components for risk screening, health promotion, and clinical and psychosocial interventions: (1) reproductive life plan and history; (2) medical history, including current medication use; (3) infections, inflammation, and immunizations; (4) family history and genetic risks; (5) behavioral and psychosocial risks; (6) mental health and stress resilience; (7) healthy weight and nutrition; (8) avoidance of harmful exposures; (9) partner and parenting support; and (10) physical assessment including laboratory testing. It was not our intention to propose a complete and final model, but rather to start a much needed dialogue on the content of preconception care for men. Given family physicians' unique relationships with the whole family, your voices need to be heard in this dialogue. Let the dialogue begin.