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Australian Journal of General Practice Jun 2020The importance of interconception care - defined as care given to women, and their partners, between one pregnancy and the next to optimise their health - is...
BACKGROUND
The importance of interconception care - defined as care given to women, and their partners, between one pregnancy and the next to optimise their health - is increasingly important, with rising rates of overweight, obesity, diabetes and hypertension among people of reproductive age. Women frequently visit their general practitioner (GP) in the first six months postpartum. This is an opportune time to discuss ideal interpregnancy intervals (IPIs) and advise women about contraception and healthy behaviours.
OBJECTIVE
The aim of this article is to review available research and guidelines on interconception care and IPIs, and propose best-practice care for the general practice setting.
DISCUSSION
GPs are uniquely placed to deliver the different aspects of interconception care including reviewing the outcomes of the previous pregnancy, advising women on optimal IPIs and providing contraception and lifestyle guidance. Studies have found that GPs may feel they lack the time and resources to provide interconception care, but support is available through online tools and easy-to-access checklists. As the prevalence of obesity and chronic diseases increases, interconception care has the potential to reduce future adverse perinatal outcomes.
Topics: Birth Intervals; Female; Humans; Maternal Health Services; Preconception Care
PubMed: 32464729
DOI: 10.31128/AJGP-02-20-5242 -
Hypertension (Dallas, Tex. : 1979) Sep 2020Preeclampsia and gestational hypertension are common complications of pregnancy associated with significant maternal and infant morbidity. Despite extensive research... (Randomized Controlled Trial)
Randomized Controlled Trial
Preeclampsia and gestational hypertension are common complications of pregnancy associated with significant maternal and infant morbidity. Despite extensive research evaluating risk factors during pregnancy, most women who develop a hypertensive disorder of pregnancy are not considered high-risk and strategies for prevention remain elusive. We evaluated preconception blood pressure and its change into early pregnancy as novel risk markers for development of a hypertensive disorder of pregnancy. The EAGeR (Effects of Aspirin in Gestation and Reproduction) trial (2007-2011) randomized 1228 healthy women with a history of pregnancy loss to preconception-initiated low-dose aspirin versus placebo and followed participants for up to 6 menstrual cycles attempting pregnancy and throughout pregnancy if they became pregnant. Blood pressure was measured during preconception and throughout early gestation. The primary outcomes, preterm preeclampsia, term preeclampsia, and gestational hypertension, were abstracted from medical records. Among 586 women with a pregnancy >20 weeks' gestation, preconception blood pressure levels were higher for preterm preeclampsia (87.3±6.7 mm Hg mean arterial pressure), term preeclampsia (88.3±9.8 mm Hg), and gestational hypertension (87.9±9.1 mm Hg) as compared with no hypertensive disorder of pregnancy (83.9±8.6 mm Hg). Change in blood pressure from preconception into very early pregnancy was associated with development of preeclampsia (relative risk, 1.13 [95% CI, 1.02-1.25] per 2 mm Hg increase in mean arterial pressure at 4 weeks' gestation), particularly preterm preeclampsia (relative risk, 1.21 [95% CI, 1.01-1.45]). Randomization to aspirin did not alter blood pressure trajectory or risk of hypertension in pregnancy. Preconception blood pressure and longitudinal changes during early pregnancy are underexplored but crucial windows in the detection and prevention of hypertensive disorders of pregnancy. Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00467363.
Topics: Adult; Aspirin; Blood Pressure Determination; Drug Monitoring; Early Diagnosis; Female; Humans; Hypertension, Pregnancy-Induced; Platelet Aggregation Inhibitors; Pre-Eclampsia; Preconception Care; Pregnancy; Pregnancy Trimester, First; Preventive Health Services
PubMed: 32755413
DOI: 10.1161/HYPERTENSIONAHA.120.14875 -
The Cochrane Database of Systematic... Apr 2021Infertility is a prevalent problem that has significant consequences for individuals, families, and the community. Modifiable lifestyle factors may affect the chance of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Infertility is a prevalent problem that has significant consequences for individuals, families, and the community. Modifiable lifestyle factors may affect the chance of people with infertility having a baby. However, no guideline is available about what preconception advice should be offered. It is important to determine what preconception advice should be given to people with infertility and to evaluate whether this advice helps them make positive behavioural changes to improve their lifestyle and their chances of conceiving.
OBJECTIVES
To assess the safety and effectiveness of preconception lifestyle advice on fertility outcomes and lifestyle behavioural changes for people with infertility.
SEARCH METHODS
We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, trial registers, Google Scholar, and Epistemonikos in January 2021; we checked references and contacted field experts to identify additional studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), randomised cross-over studies, and cluster-randomised studies that compared at least one form of preconception lifestyle advice with routine care or attention control for people with infertility.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures recommended by Cochrane. Primary effectiveness outcomes were live birth and ongoing pregnancy. Primary safety outcomes were adverse events and miscarriage. Secondary outcomes included reported behavioural changes in lifestyle, birth weight, gestational age, clinical pregnancy, time to pregnancy, quality of life, and male factor infertility outcomes. We assessed the overall quality of evidence using GRADE criteria.
MAIN RESULTS
We included in the review seven RCTs involving 2130 participants. Only one RCT included male partners. Three studies compared preconception lifestyle advice on a combination of topics with routine care or attention control. Four studies compared preconception lifestyle advice on one topic (weight, alcohol intake, or smoking) with routine care for women with infertility and specific lifestyle characteristics. The evidence was of low to very low-quality. The main limitations of the included studies were serious risk of bias due to lack of blinding, serious imprecision, and poor reporting of outcome measures. Preconception lifestyle advice on a combination of topics versus routine care or attention control Preconception lifestyle advice on a combination of topics may result in little to no difference in the number of live births (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.79 to 1.10; 1 RCT, 626 participants), but the quality of evidence was low. No studies reported on adverse events or miscarriage. Due to very low-quality evidence, we are uncertain whether preconception lifestyle advice on a combination of topics affects lifestyle behavioural changes: body mass index (BMI) (mean difference (MD) -1.06 kg/m², 95% CI -2.33 to 0.21; 1 RCT, 180 participants), vegetable intake (MD 12.50 grams/d, 95% CI -8.43 to 33.43; 1 RCT, 264 participants), alcohol abstinence in men (RR 1.08, 95% CI 0.74 to 1.58; 1 RCT, 210 participants), or smoking cessation in men (RR 1.01, 95% CI 0.91 to 1.12; 1 RCT, 212 participants). Preconception lifestyle advice on a combination of topics may result in little to no difference in the number of women with adequate folic acid supplement use (RR 0.98, 95% CI 0.95 to 1.01; 2 RCTs, 850 participants; I² = 4%), alcohol abstinence (RR 1.07, 95% CI 0.99 to 1.17; 1 RCT, 607 participants), and smoking cessation (RR 1.01, 95% CI 0.98 to 1.04; 1 RCT, 606 participants), on low quality evidence. No studies reported on other behavioural changes. Preconception lifestyle advice on weight versus routine care Studies on preconception lifestyle advice on weight were identified only in women with infertility and obesity. Compared to routine care, we are uncertain whether preconception lifestyle advice on weight affects the number of live births (RR 0.94, 95% CI 0.62 to 1.43; 2 RCTs, 707 participants; I² = 68%; very low-quality evidence), adverse events including gestational diabetes (RR 0.78, 95% CI 0.48 to 1.26; 1 RCT, 317 participants; very low-quality evidence), hypertension (RR 1.07, 95% CI 0.66 to 1.75; 1 RCT, 317 participants; very low-quality evidence), or miscarriage (RR 1.50, 95% CI 0.95 to 2.37; 1 RCT, 577 participants; very low-quality evidence). Regarding lifestyle behavioural changes for women with infertility and obesity, preconception lifestyle advice on weight may slightly reduce BMI (MD -1.30 kg/m², 95% CI -1.58 to -1.02; 1 RCT, 574 participants; low-quality evidence). Due to very low-quality evidence, we are uncertain whether preconception lifestyle advice affects the percentage of weight loss, vegetable and fruit intake, alcohol abstinence, or physical activity. No studies reported on other behavioural changes. Preconception lifestyle advice on alcohol intake versus routine care Studies on preconception lifestyle advice on alcohol intake were identified only in at-risk drinking women with infertility. We are uncertain whether preconception lifestyle advice on alcohol intake affects the number of live births (RR 1.15, 95% CI 0.53 to 2.50; 1 RCT, 37 participants; very low-quality evidence) or miscarriages (RR 1.31, 95% CI 0.21 to 8.34; 1 RCT, 37 participants; very low-quality evidence). One study reported on behavioural changes for alcohol consumption but not as defined in the review methods. No studies reported on adverse events or other behavioural changes. Preconception lifestyle advice on smoking versus routine care Studies on preconception lifestyle advice on smoking were identified only in smoking women with infertility. No studies reported on live birth, ongoing pregnancy, adverse events, or miscarriage. One study reported on behavioural changes for smoking but not as defined in the review methods.
AUTHORS' CONCLUSIONS
Low-quality evidence suggests that preconception lifestyle advice on a combination of topics may result in little to no difference in the number of live births. Evidence was insufficient to allow conclusions on the effects of preconception lifestyle advice on adverse events and miscarriage and on safety, as no studies were found that looked at these outcomes, or the studies were of very low quality. This review does not provide clear guidance for clinical practice in this area. However, it does highlight the need for high-quality RCTs to investigate preconception lifestyle advice on a combination of topics and to assess relevant effectiveness and safety outcomes in men and women with infertility.
Topics: Alcohol Drinking; Bias; Caffeine; Central Nervous System Stimulants; Counseling; Diet, Healthy; Exercise; Female; Folic Acid; Humans; Infertility; Infertility, Female; Life Style; Live Birth; Male; Preconception Care; Randomized Controlled Trials as Topic; Sex Factors; Smoking Cessation; Vitamin B Complex; Weight Loss
PubMed: 33914901
DOI: 10.1002/14651858.CD008189.pub3 -
Journal of Obstetrics and Gynaecology... Jul 2018To provide a comprehensive review and evidence-based recommendations for the delivery of fertility care to women with obesity.
OBJECTIVE
To provide a comprehensive review and evidence-based recommendations for the delivery of fertility care to women with obesity.
OUTCOMES
The impact of obesity on fertility, fertility treatments, and both short and long-term maternal fetal outcomes was carefully considered.
EVIDENCE
Published literature was reviewed through searches of MEDLINE and CINAHL using appropriate vocabulary and key words. Results included systematic reviews, clinical trials, observational studies, clinical practice guidelines, and expert opinions.
VALUES
The Canadian Fertility & Andrology Society (CFAS) is a multidisciplinary, national non-profit society that serves as the voice of reproductive specialists, scientists, and allied health professionals working in the field of assisted reproduction in Canada. The evidence obtained for this guideline was reviewed and evaluated by the Clinical Practice Guideline (CPG) Committee of the CFAS under the leadership of the principal authors.
BENEFITS, HARMS, AND COSTS
The implementation of these recommendations should assist clinicians and other health care providers in counselling and providing reproductive care to women with obesity.
VALIDATION
This guideline and its recommendations have been reviewed and approved by the membership, the CPG Committee and the Board of Directors of the CFAS.
SPONSORS
Canadian Fertility & Andrology Society.
RECOMMENDATIONS
Twenty-one evidence based recommendations are provided. These recommendations specifically evaluate the impact of obesity on natural fertility, fertility treatments, and maternal-fetal outcomes. Strategies to lose weight and BMI cut-offs are also addressed.
Topics: Canada; Female; Humans; Obesity; Preconception Care; Pregnancy; Pregnancy Complications; Reproductive Techniques, Assisted; Societies, Medical
PubMed: 29921431
DOI: 10.1016/j.jogc.2018.04.030 -
Fertility and Sterility Jan 2021
Topics: Blood Glucose; Cohort Studies; Female; Fertility; Humans; Preconception Care; Pregnancy; Singapore
PubMed: 33413961
DOI: 10.1016/j.fertnstert.2020.10.062 -
Upsala Journal of Medical Sciences Aug 2019Reproductive life plan counseling (RLPC) is a tool to encourage women and men to reflect upon their reproduction, to avoid unintended pregnancies and negative health... (Comparative Study)
Comparative Study Randomized Controlled Trial
Reproductive life plan counseling (RLPC) is a tool to encourage women and men to reflect upon their reproduction, to avoid unintended pregnancies and negative health behavior that can threaten reproduction. The aim was to evaluate the effect of RLPC among women attending contraceptive counseling. Outcomes were knowledge about fertility and awareness of preconception health, use of contraception, and women's experience of RLPC. Swedish-speaking women, aged 20-40 years, were randomized to intervention group (IG) or control group (CG). Participants ( = 1,946) answered a questionnaire before and two months after ( = 1,198, 62%) the consultation. All women received standard contraceptive counseling, and the IG also received the RLPC, i.e. questions on reproductive intentions, information about fertility, and preconception health. Women in the IG increased their knowledge about fertility: age and fertility, chances of getting pregnant, fecundity of an ovum, and chances of having a child with help of IVF. They also increased their awareness of factors affecting preconception health, such as to stop using tobacco, to refrain from alcohol, to be of normal weight, and to start with folic acid before a pregnancy. The most commonly used contraceptive method was combined oral contraceptives, followed by long-acting reversible contraception. Three out of four women (76%) in the IG stated that the RLPC should be part of the routine in contraceptive counseling. Knowledge about fertility and awareness of preconception health increased after the intervention. The RLPC can be recommended as a tool in contraceptive counseling.
Topics: Adult; Awareness; Contraception; Contraceptive Agents; Counseling; Family Planning Services; Female; Fertility; Health Knowledge, Attitudes, Practice; Humans; Preconception Care; Pregnancy; Pregnancy, Unwanted; Reproductive Health; Risk Assessment; Surveys and Questionnaires; Sweden; Young Adult
PubMed: 31495254
DOI: 10.1080/03009734.2019.1653407 -
Frontiers in Public Health 2022Preconception care has emerged as a developing field in maternal and child healthcare worldwide. This care type provides couples of reproductive age with the opportunity... (Review)
Review
Preconception care has emerged as a developing field in maternal and child healthcare worldwide. This care type provides couples of reproductive age with the opportunity for early detection and management of biomedical, behavioral, and social health problems. In 2010, the Chinese government launched a nationwide preconception care program as a welfare project. During the past decade, this project has received international attention, and experiences from the project have been published in the literature. In this review, we summarize the history, implementation, and evaluation of preconception care services in China, and its related maternal and children's health service initiatives, to thereby provide knowledge for policymakers and clinicians in other countries.
Topics: Pregnancy; Female; Child; Humans; Preconception Care; China
PubMed: 36339191
DOI: 10.3389/fpubh.2022.934983 -
The British Journal of General Practice... Apr 2022
Topics: Female; Health Status; Humans; Preconception Care; Pregnancy; Prenatal Care; Primary Health Care
PubMed: 35361583
DOI: 10.3399/bjgp22X718853 -
Reproductive Health Sep 2014Infections can impact the reproductive health of women and hence may influence pregnancy related outcomes for both the mother and the child. These infections range from... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Infections can impact the reproductive health of women and hence may influence pregnancy related outcomes for both the mother and the child. These infections range from sexually transmitted infections (STIs) to TORCHS infections to periodontal disease to systemic infections and may be transmitted to the fetus during pregnancy, labor, delivery or breastfeeding.
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 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
Preconception behavioral interventions significantly declines re-infection or new STI rates by 35% (95% CI: 20-47%). Further, condom use has been shown to be the most effective way to prevent HIV infection (85% protection in prospective studies) through sexual intercourse. Intervention trials showed that preconception vaccination against tetanus averted a significant number of neonatal deaths (including those specifically due to tetanus) when compared to placebo in women receiving more than 1 dose of the vaccine (OR 0.28; 95% CI: 0.15-0.52); (OR 0.02; 95% CI: 0.00-0.28) respectively.
CONCLUSION
Preconception counseling should be offered to women of reproductive age as soon as they test HIV-positive, and conversely women of reproductive age should be screened with their partners before pregnancy. Risk assessment, screening, and treatment for specific infections should be a component of preconception care because there is convincing evidence that treatment of these infections before pregnancy prevents neonatal infections.
Topics: Female; HIV Infections; Humans; Preconception Care; Pregnancy; Pregnancy Complications, Infectious; Sexually Transmitted Diseases; Vaccination
PubMed: 25415557
DOI: 10.1186/1742-4755-11-S3-S4 -
Reproductive Health Sep 2014The notion of preconception care aims to target the existing risks before pregnancy, whereby resources may be used to improve reproductive health and optimize knowledge... (Review)
Review
The notion of preconception care aims to target the existing risks before pregnancy, whereby resources may be used to improve reproductive health and optimize knowledge before conceiving. The preconception period provides an opportunity to intervene earlier to optimize the health of potential mothers (and fathers) and to prevent harmful exposures from affecting the developing fetus. These interventions include birth spacing and preventing teenage pregnancy, promotion of contraceptive use, optimization of weight and micronutrient status, prevention and management of infectious diseases, and screening for and managing chronic conditions. Given existing interventions and the need to organize services to optimize delivery of care in a logical and effective manner, interventions are frequently co-packaged or bundled together. This paper highlights packages of preconception interventions that can be combined and co-delivered to women through various delivery channels and provides a logical framework for development of such packages in varying contexts.
Topics: Delivery of Health Care, Integrated; Female; Health Promotion; Humans; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Reproductive Health
PubMed: 25415178
DOI: 10.1186/1742-4755-11-S3-S7