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Lancet (London, England) May 2018A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data... (Review)
Review
A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from low-income, middle-income, and high-income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high-income and low-income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Several studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little effect on maternal and newborn health outcomes. Comparatively few interventions have been made for preconception diet and lifestyle. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that it is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and actions at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases. Alongside continued efforts to reduce smoking, alcohol consumption, and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly, health professionals should be alerted to ways of identifying women who are planning a pregnancy.
Topics: Diet, Healthy; Female; Health Behavior; Humans; Life Style; Nutritional Status; Preconception Care; Pregnancy; Pregnancy Complications
PubMed: 29673873
DOI: 10.1016/S0140-6736(18)30311-8 -
Reproductive Health Sep 2014There is increasingly a double burden of under-nutrition and obesity in women of reproductive age. Preconception underweight or overweight, short stature and... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
There is increasingly a double burden of under-nutrition and obesity in women of reproductive age. Preconception underweight or overweight, short stature and micronutrient deficiencies all contribute to excess maternal and fetal complications during pregnancy.
METHODS
A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on maternal, newborn and child health (MNCH) outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.
RESULTS
Maternal pre-pregnancy weight is a significant factor in the preconception period with underweight contributing to a 32% higher risk of preterm birth, and obesity more than doubling the risk for preeclampsia, gestational diabetes. Overweight women are more likely to undergo a Cesarean delivery, and their newborns have higher chances of being born with a neural tube or congenital heart defect. Among nutrition-specific interventions, preconception folic acid supplementation has the strongest evidence of effect, preventing 69% of recurrent neural tube defects. Multiple micronutrient supplementation shows promise to reduce the rates of congenital anomalies and risk of preeclampsia. Although over 40% of women worldwide are anemic in the preconception period, only one study has shown a risk for low birth weight.
CONCLUSION
All women, but especially those who become pregnant in adolescence or have closely-spaced pregnancies (inter-pregnancy interval less than six months), require nutritional assessment and appropriate intervention in the preconception period with an emphasis on optimizing maternal body mass index and micronutrient reserves. Increasing coverage of nutrition-specific and nutrition-sensitive strategies (such as food fortification; integration of nutrition initiatives with other maternal and child health interventions; and community based platforms) is necessary among adolescent girls and women of reproductive age. The effectiveness of interventions will need to be simultaneously monitored, and form the basis for the development of improved delivery strategies and new nutritional interventions.
Topics: Body Weight; Congenital Abnormalities; Dietary Supplements; Female; Folic Acid; Humans; Infant, Newborn; Preconception Care; Pregnancy; Pregnancy Complications; Prenatal Nutritional Physiological Phenomena
PubMed: 25415364
DOI: 10.1186/1742-4755-11-S3-S3 -
European Heart Journal Oct 2014
2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC).
Topics: Ablation Techniques; Adult; Angina Pectoris; Arrhythmias, Cardiac; Cardiac Imaging Techniques; Cardiac Pacing, Artificial; Cardiomyopathy, Hypertrophic; Child; Clinical Laboratory Techniques; Death, Sudden, Cardiac; Delivery of Health Care; Diagnosis, Differential; Electrocardiography; Female; Genetic Counseling; Genetic Testing; Heart Failure; Heart Valve Diseases; Humans; Medical History Taking; Pedigree; Physical Examination; Preconception Care; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Care; Risk Factors; Sports Medicine; Syncope; Thoracic Surgical Procedures; Ventricular Outflow Obstruction
PubMed: 25173338
DOI: 10.1093/eurheartj/ehu284 -
Clinical Obstetrics and Gynecology Jun 2018Significant racial and ethnic disparities in maternal morbidity and mortality exist in the United States. Black women are 3 to 4 times more likely to die a...
Significant racial and ethnic disparities in maternal morbidity and mortality exist in the United States. Black women are 3 to 4 times more likely to die a pregnancy-related death as compared with white women. Growing research indicates that quality of health care, from preconception through postpartum care, may be a critical lever for improving outcomes for racial and ethnic minority women. This article reviews racial and ethnic disparities in severe maternal morbidities and mortality, underlying drivers of these disparities, and potential levers to reduce their occurrence.
Topics: Communication; Cultural Competency; Decision Making; Delivery, Obstetric; Female; Healthcare Disparities; Humans; Maternal Mortality; Obstetrics; Postnatal Care; Preconception Care; Pregnancy; Pregnancy Complications; Prenatal Care; Quality Improvement; Quality of Health Care; Racial Groups; United States
PubMed: 29346121
DOI: 10.1097/GRF.0000000000000349 -
Minerva Ginecologica Feb 2018There is a growing realization that efforts to optimize the health of women and reduce the risk of adverse maternal, perinatal and neonatal outcomes during pregnancy... (Review)
Review
There is a growing realization that efforts to optimize the health of women and reduce the risk of adverse maternal, perinatal and neonatal outcomes during pregnancy should commence in the preconception period. The preconception period (prior to or between pregnancies) provides an opportune time to address reproductive intentions and promote and support wellbeing and healthy behavior change regardless of pregnancy intention. Research over the last 30 years has explored the influence of a range of preconception risk factors and determinants of health on pregnancy and maternal and neonatal outcomes including: pregnancy planning, diet and micronutrient supplementation, physical activity, weight, smoking, recreational drug and alcohol use, mental health, oral hygiene, and chronic health and medical conditions. Preconception health messages, recommendations and guidelines originated in the USA and the preconception movement has gained momentum internationally with a variety of strategies developed and tested for improving preconception health, and related outcomes. The shift to integrate preconception health promotion into the continuum of women's healthcare requires a diverse multilevel and multistrategic approach involving a range of sectors and health professionals to address the determinants of health. This includes a system-wide effort to raise awareness of the importance of women's health prior to pregnancy, creating supportive environments as well as optimizing clinical practice, policy and programs informed by high quality research and longitudinal studies. While preconception health is relevant to both women and men globally, this review summarizes the predominant areas of preconception health for women in developed countries including the emergence of preconception health, the current health messages and evidence, the state of international guidelines and evidence-based interventions in preconception.
Topics: Developed Countries; Female; Health Behavior; Health Promotion; Humans; Infant Health; Infant, Newborn; Maternal Health; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Risk Factors
PubMed: 28895680
DOI: 10.23736/S0026-4784.17.04140-5 -
Fertility and Sterility Jun 2021This document provides the latest recommendations for the evaluation of potential sperm, oocyte, and embryo donors as well as their recipients, incorporating recent... (Review)
Review
This document provides the latest recommendations for the evaluation of potential sperm, oocyte, and embryo donors as well as their recipients, incorporating recent information about optimal screening and testing for sexually transmitted infections, genetic diseases, and psychological assessments. This revised document incorporates recent information from the US Centers for Disease Control and Prevention, US Food and Drug Administration, and American Association of Tissue Banks, which all programs offering gamete and embryo donation services must be thoroughly familiar with, and replaces the document titled "Recommendations for gamete and embryo donation: a committee opinion," last published in 2013.
Topics: Consensus; Counseling; Donor Selection; Embryo Disposition; Female; Genetic Testing; Health Status; Humans; Male; Mental Health; Oocyte Donation; Preconception Care; Pregnancy; Reproductive Medicine; Risk Assessment; Risk Factors; Semen; Tissue Donors
PubMed: 33838871
DOI: 10.1016/j.fertnstert.2021.01.045 -
Annals of the Rheumatic Diseases May 2016A European League Against Rheumatism (EULAR) task force was established to define points to consider on use of antirheumatic drugs before pregnancy, and during pregnancy...
A European League Against Rheumatism (EULAR) task force was established to define points to consider on use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Based on a systematic literature review and pregnancy exposure data from several registries, statements on the compatibility of antirheumatic drugs during pregnancy and lactation were developed. The level of agreement among experts in regard to statements and propositions of use in clinical practice was established by Delphi voting. The task force defined 4 overarching principles and 11 points to consider for use of antirheumatic drugs during pregnancy and lactation. Compatibility with pregnancy and lactation was found for antimalarials, sulfasalazine, azathioprine, ciclosporin, tacrolimus, colchicine, intravenous immunoglobulin and glucocorticoids. Methotrexate, mycophenolate mofetil and cyclophosphamide require discontinuation before conception due to proven teratogenicity. Insufficient documentation in regard to fetal safety implies the discontinuation of leflunomide, tofacitinib as well as abatacept, rituximab, belimumab, tocilizumab, ustekinumab and anakinra before a planned pregnancy. Among biologics tumour necrosis factor inhibitors are best studied and appear reasonably safe with first and second trimester use. Restrictions in use apply for the few proven teratogenic drugs and the large proportion of medications for which insufficient safety data for the fetus/child are available. Effective drug treatment of active inflammatory rheumatic disease is possible with reasonable safety for the fetus/child during pregnancy and lactation. The dissemination of the data to health professionals and patients as well as their implementation into clinical practice may help to improve the management of pregnant and lactating patients with rheumatic disease.
Topics: Abnormalities, Drug-Induced; Antirheumatic Agents; Biological Products; Delphi Technique; Female; Humans; Infant, Newborn; Lactation; Maternal-Fetal Exchange; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Exposure Delayed Effects; Rheumatic Diseases
PubMed: 26888948
DOI: 10.1136/annrheumdis-2015-208840 -
British Medical Bulletin Dec 2018Poorly-controlled hypertension in the first trimester significantly increases maternal and fetal morbidity and mortality. The majority of guidelines and clinical trials... (Review)
Review
INTRODUCTION OR BACKGROUND
Poorly-controlled hypertension in the first trimester significantly increases maternal and fetal morbidity and mortality. The majority of guidelines and clinical trials focus on the management and treatments for hypertension during pregnancy and breast-feeding, while limited evidence could be applied to the management for hypertension before pregnancy. In this review, we summarized the existing guidelines and treatments of pre-pregnancy treatment of hypertension.
SOURCES OF DATA
PubMed.
AREAS OF AGREEMENT
Methyldopa and labetalol are considered the first choice, but angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) need to be withdrawn if a hypertensive woman wishes to become pregnant. In women with chronic hypertension, it is very important to make an assessment before conception to exclude secondary causes of hypertension, evaluate their hypertensive control to ensure that it is optimal, discuss the increased risks of pre-eclampsia, and provide education regarding any drug alterations before they become pregnant.
AREAS OF CONTROVERSY
There is increasing debate regarding discouraging the use of diuretics. There is also controversy regarding the use of supplementations such as calcium, antioxidants and low-dose aspirin.
GROWING POINTS
A less restricted blood-pressure goal could be set for hypertensive women planning for pregnancy. A healthy body weight before pregnancy could lower the risk of pregnancy-related hypertensive disorders. Recent guidelines also encourage women with chronic hypertension to keep their dietary sodium intake low, either by reducing or substituting sodium salt before pregnancy.
TIMELY AREAS FOR DEVELOPING RESEARCH
Large, worldwide, randomized trials should be conducted to see the outcomes for hypertensive women who take antioxidants/physical activity before pregnancy.
Topics: Antihypertensive Agents; Female; Guidelines as Topic; Humans; Hypertension; Preconception Care; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Care
PubMed: 30371746
DOI: 10.1093/bmb/ldy035 -
Seminars in Nephrology Jul 2017Pregnancy associated with lupus, especially lupus nephritis, is often fraught with concern for both the mother and fetus. Thus, it is paramount that care begins... (Review)
Review
Pregnancy associated with lupus, especially lupus nephritis, is often fraught with concern for both the mother and fetus. Thus, it is paramount that care begins preconception so that proper planning in terms of optimizing the medical regimen, discontinuation of fetotoxic agents, and treatment of active disease can occur. It is well known that active nephritis at the time of conception is associated with poor outcomes. Even with quiescent disease, recent data indicate that being lupus anticoagulant-positive, nonwhite or Hispanic, and using antihypertensive medications were all predictors of worse pregnancy outcomes. Further, prior lupus nephritis also predicts higher rates of preeclampsia and HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. Differentiating lupus nephritis from preeclampsia often presents as a conundrum, but lupus nephritis can be confirmed by the presence of decreasing complement levels and increasing double-stranded DNA (dsDNA) antibody levels in addition to new onset hypertension and proteinuria. We hope that the more mechanistic approach of measuring angiogenic markers, which are diagnostic for preeclampsia, will be the standard of care in the future. Women with lupus and prior lupus nephritis can have successful pregnancies, but outcomes are dependent on "the art of planning" as well as close communication between the obstetrician, the nephrologist, and the rheumatologist.
Topics: Diagnosis, Differential; Female; Humans; Lupus Nephritis; Pre-Eclampsia; Preconception Care; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk; Symptom Flare Up
PubMed: 28711073
DOI: 10.1016/j.semnephrol.2017.05.006 -
Australian Journal of General Practice Jul 2018Preconception care (PCC) comprises counselling and the provision of biomedical, behavioural and social health interventions to optimise the health of women and their...
BACKGROUND
Preconception care (PCC) comprises counselling and the provision of biomedical, behavioural and social health interventions to optimise the health of women and their partners prior to pregnancy and improve health related outcomes for themselves and their children.
OBJECTIVE
With a focus on women, the aim of this paper is to discuss the evidence for PCC, available guidelines and strategies to increase primary care access.
DISCUSSION
Each year an estimated 10% of women in Australia become pregnant. There is increasing evidence that optimising health in the preconception period is crucial to improving short-term and long-term outcomes for mothers and babies. General practitioners can have a key role in assisting women to identify modifiable and non‑modifiable preconception risks and to make informed decisions about planning or avoiding pregnancy. The Royal Australian College of General Practitioners Guidelines for preventive activities in general practice includes a chapter on preventive activities prior to pregnancy, which is a useful resource. The critical first step is screening women for their pregnancy intentions by asking a simple question that can help facilitate the start of the PCC conversation.
Topics: Adolescent; Adult; Diabetes Mellitus; Diet, Healthy; Exercise; Female; Folic Acid; Humans; Obesity; Preconception Care; Smoking; Substance-Related Disorders; Time Factors; Vitamin B Complex
PubMed: 30114868
DOI: 10.31128/AJGP-02-18-4485