**Background:** Many factors contributing to perinatal morbidity and mortality are chronic conditions that begin before pregnancy. The CDC and ACOG recommend routine preconception health counseling, yet only 14% of ambulatory visits in the United States include any preconception or contraceptive counseling. Low-income women are more likely to receive reproductive health services in primary care rather than dedicated women's health settings and are disproportionately cared for in federally qualified health centers (FQHCs). Despite routine use of screening tools for other health needs such as depression, screening for preconception and interconception health needs is not widely adopted and there is a lack of consensus on the best approach. This systematic review aimed to identify and describe standardized interconception and preconception screening tools for reproductive health needs applicable in general outpatient clinical practice.
**Methods:** The authors conducted a structured search of PubMed, Web of Science, and CINAHL databases for standardized preconception and interconception health screening tools published in English between January 1, 2000 and March 1, 2022. Search terms included "preconception care," "interconception care," "family planning," "contraception," "reproductive health services," and "counseling." Studies with titles clearly indicating they were conducted outside the United States were removed. The search resulted in 15,399 studies. After removing 4,172 duplicates, 11,227 titles/abstracts were screened, and 207 advanced for full-text review. Inclusion criteria centered on standardized approaches or tools with potential for implementation within clinical settings in the United States. Studies focusing exclusively on contraceptive use, continuation, or method choice were excluded unless the tool had clear applicability for broader preconception care. Each title/abstract was reviewed by two study team members using the Covidence platform. The Mixed Methods Appraisal Tool (MMAT) was used to assess methodological quality. Of the 53 included studies, 5 were qualitative, 15 were randomized controlled trials, 16 were non-randomized, 11 were quantitative descriptive, 5 were mixed-methods studies, and 1 was a corrigendum.
**Key Results:** From the 53 eligible studies, the authors identified 22 distinct tools/standardized approaches, of which 10 had evidence from randomized clinical trials. The tools ranged widely in design, setting, and population. Seventeen specific tools were identified, including: One Key Question (OKQ), which prompts physicians to ask "Do you intend to become pregnant in the next year?" and was tested in multiple settings including FQHCs, primary care, and OB/GYN practices; Gabby, a web-based virtual animated health counselor tested in a national sample of 528 Black/African-American women aged 18–34 years, which showed that at 6 months, intervention women reached the action or maintenance stage of change for 50.0% of preconception risks compared with 42.7% in the control group (incidence rate ratio 1.16, 95% CI 1.07–1.26); MyFamilyPlan, a web-based preconception health education module that was significantly associated with increased discussion of reproductive health with providers (odds ratio: 1.97, 95% CI: 1.22–3.19); READY-Girls, a preconception counseling program for teens with type 1 diabetes that demonstrated sustained effects on knowledge and intentions at 12 months; and the IMPLICIT interconception care model for mothers at well-child visits, which showed mothers were more likely to report discussions with their child's doctor post-intervention for family planning (31% pre to 86% post; aOR 18.65), depression screening (63%–85%; aOR 5.22), and folic acid supplementation (53%–68%; aOR 2.54). The Computer-Assisted Motivational Intervention (CAMI) for adolescent mothers found that completing two or more sessions significantly reduced the risk of repeat birth (CAMI+: HR = 0.40; 95% CI, 0.16–0.98; CAMI-only: HR = 0.19; 95% CI, 0.05–0.69). The MMAT quality assessment found that most RCTs reported complete outcome data and had comparable groups at baseline, though 9 of 14 studies did not provide adequate information on blinding of outcome assessors. Only 3 of 16 non-randomized studies provided enough information to indicate the sample was representative of the target population.
**Clinical Implications:** Clinicians have a choice of tools when implementing standard reproductive screening services, with options ranging from single-question screening (OKQ) to comprehensive web-based platforms (Gabby, MyFamilyPlan) and condition-specific programs (READY-Girls for diabetes). For specific health conditions with strong evidence that preconception care improves pregnancy outcomes—such as glycemic control in diabetes reducing congenital anomalies and folic acid use reducing neural tube defects—validated tools should be used. The evidence indicates that implementing a standardized prompt or screening tool leads to higher rates of screening and counseling, but these have yet to demonstrate consistent changes in patient behavior or long-term clinical outcomes. Future research should follow patients longitudinally and track multiple outcomes including prevention of undesired pregnancy, better pre-pregnancy health, and improved perinatal outcomes. Limitations include the exclusion of non-English studies and studies conducted outside the United States, as well as the exclusion of studies focused solely on contraceptive use. Routine use of evidence-based preconception tools has the potential to help patients control the timing and conditions of future pregnancies and improve perinatal outcomes, especially for those with pre-pregnancy chronic conditions or other risk factors.