Family physicians are in a unique position to ensure that women receive preconception care. The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians recommend preconception care for all women, but particularly for women with comorbid conditions such as obesity, diabetes, and chronic hypertension. Family physicians should ask all women of reproductive age who are at risk of unintended pregnancy if they desire pregnancy within the next year and, based on this answer, provide counseling on contraception or preconception care. Given that more than half of all pregnancies in the United States are unplanned, all women of reproductive age should be prescribed at least 400 mcg/day of folic acid. They also should be counseled to modify risk factors such as smoking, alcohol use, overweight and obesity, and travel to countries where Zika virus infection is endemic. Women with significant chronic conditions should be counseled to achieve optimum control of their conditions before conception. Long-term treatment of such conditions with drugs should be reviewed and modified to prevent potentially teratogenic effects after the risks and benefits of continuing the drugs are considered.