Prepregnancy care for women with social needs should enable women to protect and control their fertility and to ensure any pregnancies are intended and optimally timed for good medical and social outcomes. In 2006, the USA published recommendations and guidelines on preconception care for all women, but these guidelines do not specifically address the needs of socially disadvantaged women. All reproductive healthcare professionals must be trained and must be able to take a full social history in both the prepregnancy and maternity setting. Provision of reproductive health care, including prepregnancy care, for women with social problems should be incorporated into strategic planning and reflected in staffing levels and skill mix. Complementary services including information, education and social and health care should be provided for socially disadvantaged men and partners of socially disadvantaged women. Development of routine service provision is a priority and such services should be subject to audit.

The Royal College of Obstetricians and Gynaecologists (RCOG) published its document Standards in Maternity Care in 2008 which is being used widely by commissioners, providers and policy makers. The document sets out the principles of quality-assured maternity services. This chapter identifies some key indicators as exemplars, although it is recommended to make use of the whole document. Prepregnancy care for women with social needs is essential. Prepregnancy care can improve outcomes in high-risk pregnancies regardless of whether the high-risk status is of medical or social aetiology. From a public health perspective, the identification of anomalies can improve perinatal morbidity and mortality, as conditions may be identified early in pregnancy and managed accordingly. Current approaches for the prevention of hypoxic ischaemic encephalopathy include antenatal identification and monitoring of fetal growth restriction and electronic fetal monitoring accompanied by intrapartum fetal blood sampling.