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Cancer Feb 2022Female adolescent and young adult (AYA) cancer survivors face higher infertility and pregnancy risks than peers with no cancer history. Preconception health behaviors...
BACKGROUND
Female adolescent and young adult (AYA) cancer survivors face higher infertility and pregnancy risks than peers with no cancer history. Preconception health behaviors such as physical activity (PA), tobacco smoking, and alcohol intake influence reproductive outcomes. In general populations, pregnancy intention is positively associated with healthy preconception behaviors, but it has not been studied among AYA survivors. The authors hypothesized that higher pregnancy intention would be associated with healthier behaviors, especially among AYA survivors with perceived infertility risk.
METHODS
A cross-sectional analysis was conducted with data collected between 2013 and 2017 from 1071 female AYA survivors aged 18 to 39 years who had completed their primary cancer treatment and enrolled in an ovarian function study. Self-reported intention dimensions were measured as a pregnancy intention score (PIS) and trying now to become pregnant. Multivariable linear (PA), binary (smoking), and ordinal (alcohol use) logistic regressions were used to estimate associations between intentions and preconception behaviors, with adjustments made for demographic and cancer characteristics. Effect modification by perceived infertility risk was assessed.
RESULTS
The mean PIS was 1.1 (SD, 0.77) on a 0 to 2 scale (2 = high intention), and 8.9% were attempting pregnancy now. A higher PIS was associated with increased PA (β, 0.08; 95% CI, 0.11-1.04), whereas ambivalence in pregnancy intention was associated with lower alcohol consumption (odds ratio, 0.72; 95% CI, 0.55-0.95). Pregnancy intentions were not associated with smoking. Perceived infertility risk strengthened the relationship between PIS and PA (P < .05).
CONCLUSIONS
Pregnancy intentions were associated with some healthier preconception behaviors in AYA survivors. Medical professionals caring for AYA survivors may consider pregnancy intention screening to guide conversations on preconception health.
Topics: Adolescent; Adult; Cancer Survivors; Cross-Sectional Studies; Female; Health Behavior; Humans; Intention; Preconception Care; Pregnancy; Young Adult
PubMed: 34634132
DOI: 10.1002/cncr.33958 -
American Family Physician Mar 2020Family physicians should use a proactive, integrated, patient-centered approach to sexual health that includes, but is not limited to, disease identification and...
Family physicians should use a proactive, integrated, patient-centered approach to sexual health that includes, but is not limited to, disease identification and treatment. Successfully delivering positive, affirming, nonjudgmental sexual health care requires intentionally creating safe spaces for all patients. Physician and staff training could include identifying individual implicit bias around sexuality and sexual topics, adverse childhood experiences, and trauma-informed care. Models such as the five Ps (partners, practices, protection from sexually transmitted diseases, past history of sexually transmitted diseases, and pregnancy plans) and ExPLISSIT (extended permission giving, limited information, specific suggestions, and intensive therapy) can help physicians organize their approach to sexual health histories. Preventive health strategies include screening for sexually transmitted diseases and sexually transmitted infections, screening for and offering preexposure prophylaxis for HIV, behavioral counseling to reduce the risk of sexually transmitted infections, and preconception care for all patients, including gender-diverse patients. Because sexual health concerns are quite common, family physicians should be prepared to discuss topics such as erectile dysfunction, dyspareunia, and arousal disorders.
Topics: Anti-HIV Agents; Counseling; HIV Infections; Humans; Medical History Taking; Physician-Patient Relations; Physicians, Family; Pre-Exposure Prophylaxis; Preconception Care; Sexual Behavior; Sexual Health; Sexually Transmitted Diseases
PubMed: 32109033
DOI: No ID Found -
Journal of Medical Internet Research Nov 2016Worldwide, 199.5 million women have diabetes mellitus (DM). Preconception care (PCC) education starting from adolescence has been recommended as an effective strategy... (Review)
Review
BACKGROUND
Worldwide, 199.5 million women have diabetes mellitus (DM). Preconception care (PCC) education starting from adolescence has been recommended as an effective strategy for safeguarding maternal and child health. However, traditional preconception care advice provided by health care professionals (HCPs) within clinic settings is hindered by inadequate resources, suboptimal coverage, and busy clinics. Electronic health (eHealth), which is instrumental in solving problems around scarce health resources, could be of value in overcoming these limitations and be used to improve preconception care and pregnancy outcomes for women with DM.
OBJECTIVE
The objectives were to: (1) identify, summarize, and critically appraise the current methods of providing PCC education; (2) examine the relationship between PCC educational interventions (including use of technology as an intervention medium) on patient and behavioral outcomes; and (3) highlight limitations of current interventions and make recommendations for development of eHealth in this field.
METHODS
Electronic databases were searched using predefined search terms for PCC education in women with type 1 or 2 DM for quantitative studies from 2003 until June 2016. Of the 1969 titles identified, 20 full papers were retrieved and 12 papers were included in this review.
RESULTS
The reviewed studies consistently reported that women receiving educational interventions via health care professionals and eHealth had significantly improved levels of glycosylated hemoglobin (P<.001) with fewer preterm deliveries (P=.02) and adverse fetal outcomes (P=.03). Significant improvements in knowledge (P<.001) and attitudes toward seeking PCC (P=.003) were reported along with reduced barriers (P<.001).
CONCLUSIONS
PCC has a positive effect on pregnancy outcomes for women with DM. However, uptake of PCC is low and the use of eHealth applications for PCC of women with DM is still in its infancy. Initial results are promising; however, future research incorporating mobile phones and apps is needed. Clearly, there is much to be done if the full potential of eHealth PCC to improve obstetric outcomes for women with DM is to be realized.
Topics: Diabetes Mellitus; Female; Humans; Mobile Applications; Preconception Care; Telemedicine
PubMed: 27826131
DOI: 10.2196/jmir.5615 -
Journal of Developmental Origins of... Apr 2022Initiatives to optimise preconception health are emerging following growing recognition that this may improve the health and well-being of women and men of reproductive... (Review)
Review
Initiatives to optimise preconception health are emerging following growing recognition that this may improve the health and well-being of women and men of reproductive age and optimise health in their children. To inform and evaluate such initiatives, guidance is required on indicators that describe and monitor population-level preconception health. We searched relevant databases and websites (March 2021) to identify national and international preconception guidelines, recommendations and policy reports. These were reviewed to identify preconception indicators. Indicators were aligned with a measure describing the prevalence of the indicator as recorded in national population-based data sources in England. From 22 documents reviewed, we identified 66 indicators across 12 domains. Domains included wider (social/economic) determinants of health; health care; reproductive health and family planning; health behaviours; environmental exposures; cervical screening; immunisation and infections; mental health, physical health; medication and genetic risk. Sixty-five of the 66 indicators were reported in at least one national routine health data set, survey or cohort study. A measure of preconception health assessment and care was not identified in any current national data source. Perspectives from three (healthcare) professionals described how indicator assessment and monitoring may influence patient care and inform awareness campaign development. This review forms the foundation for developing a national surveillance system for preconception health in England. The identified indicators can be assessed using national data sources to determine the population's preconception needs, improve patient care, inform and evaluate new campaigns and interventions and enhance accountability from responsible agencies to improve preconception health.
Topics: Child; Cohort Studies; Early Detection of Cancer; Female; Humans; Information Storage and Retrieval; Male; Preconception Care; Pregnancy; Uterine Cervical Neoplasms
PubMed: 34085623
DOI: 10.1017/S2040174421000258 -
BMC Health Services Research Aug 2017The purpose of this situation analysis was to explore the views of health and non-health professionals working with women of childbearing age on current and future...
BACKGROUND
The purpose of this situation analysis was to explore the views of health and non-health professionals working with women of childbearing age on current and future delivery of preconception care in one National Health Service (NHS) Board area in Scotland.
METHODS
The situation analysis was undertaken using a mixed methods approach. Six focus groups were conducted organised by profession - general practitioners (GPs), practice nurses, health visitors, family nurses, guidance teachers and youth workers. Existing evidence of effective preconception care interventions informed focus group guides. A survey was undertaken with community pharmacists which provided qualitative data for analysis. Focus group transcripts were analysed by two researchers using a thematic analysis approach.
RESULTS
There was lack of awareness of preconception health and its importance amongst the target group. Levels of unplanned pregnancy hampered efforts to deliver interventions. Professional knowledge, capacity and consistency of practice were viewed as challenges, as was individual compliance with preconception care advice. Improvement requires multifaceted action, including ensuring the school curriculum adequately prepares adolescents for future parenthood, increasing awareness through communication and marketing, supporting professional knowledge and practice and capitalising on existing opportunities for preconception care, and ensuring services are equitable and targeted to need.
CONCLUSIONS
Delivery of preconception care needs to be improved both before and between pregnancies to improve outcomes for women and infants. Action is required at individual, organisational and community levels to ensure this important issue is at the forefront of preventative care and preventative spending.
Topics: Adolescent; Adolescent Behavior; Adolescent Health Services; Female; Focus Groups; Health Knowledge, Attitudes, Practice; Health Promotion; Humans; Infant; Infant, Newborn; Pharmacists; Practice Patterns, Nurses'; Practice Patterns, Physicians'; Preconception Care; Pregnancy; Program Evaluation; School Health Services; Scotland
PubMed: 28835244
DOI: 10.1186/s12913-017-2544-1 -
BioMed Research International 2016Emerging research suggests that much pediatric affliction has origins in the vulnerable phase of fetal development. Prenatal factors including deficiency of various... (Review)
Review
Emerging research suggests that much pediatric affliction has origins in the vulnerable phase of fetal development. Prenatal factors including deficiency of various nutrients and exposure to assorted toxicants are major etiological determinants of myriad obstetrical complications, pediatric chronic diseases, and perhaps some genetic mutations. With recent recognition that modifiable environmental determinants, rather than genetic predestination, are the etiological source of most chronic illness, modification of environmental factors prior to conception offers the possibility of precluding various mental and physical health conditions. Environmental and lifestyle modification through informed patient choice is possible but evidence confirms that, with little to no training in clinical nutrition, toxicology, or environmental exposures, most clinicians are ill-equipped to counsel patients about this important area. With the totality of available scientific evidence that now exists on the potential to modify disease-causing gestational determinants, failure to take necessary precautionary action may render members of the medical community collectively and individually culpable for preventable illness in children. We advocate for environmental health education of maternity health professionals and the widespread adoption and implementation of preconception care. This will necessitate the translation of emerging knowledge from recent research literature, to health professionals, to reproductive-aged women, and to society at large.
Topics: Canada; Female; Gynecology; Humans; Maternal Health; Maternal Health Services; Obstetrics; Patient Education as Topic; Practice Guidelines as Topic; Preconception Care; Pregnancy; Pregnancy Complications
PubMed: 27314031
DOI: 10.1155/2016/6150976 -
Journal of Women's Health (2002) May 2018Diabetes during pregnancy can adversely affect the health of women and infants. In this report, we provide an overview of the state of the science, and highlight Centers...
Diabetes during pregnancy can adversely affect the health of women and infants. In this report, we provide an overview of the state of the science, and highlight Centers for Disease Control and Prevention (CDC) activities related to (1) surveillance of preexisting and gestational diabetes mellitus (GDM); (2) preconception care for women with preexisting diabetes; (3) postpartum diabetes screening among women with GDM-affected pregnancies; and (4) preventing the progression to Type 2 diabetes among women with GDM-affected pregnancies through lifestyle intervention programs. Improving preconception care, increasing postpartum diabetes screening rates, and promoting lifestyle interventions in the postpartum period all provide opportunities to improve the health of women and their infants.
Topics: Adult; Blood Glucose; Diabetes Mellitus, Type 2; Diabetes, Gestational; Female; Glucose Intolerance; Humans; Life Style; Population Surveillance; Postnatal Care; Postpartum Period; Preconception Care; Pregnancy
PubMed: 29715050
DOI: 10.1089/jwh.2018.7052 -
The Journal of Adolescent Health :... Aug 2020Preconception care is important for all women to improve infant and maternal health outcomes and may be especially important for adolescents and young adults. This study... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Preconception care is important for all women to improve infant and maternal health outcomes and may be especially important for adolescents and young adults. This study assesses the acceptance, usability, and use of an automated intervention to screen women on 108 preconception care risks and address them over the course of a year via a Web-based virtual animated health counselor and compares these measures for the adolescent and young adult users aged 18-25 years with those of users aged 26-34 years. We hypothesize that the younger cohort will have significantly greater use of and satisfaction with the online intervention.
METHODS
A randomized controlled trial involving a national sample of 528 women was conducted. We present a secondary data analysis on the system use and self-reported usability and satisfaction of the 79 women aged 18-25 years randomized to the intervention group, compared with the 183 women aged 26-34 years in the intervention group. Participants were required to self-identify as female, black or African American, aged 18-34 years, not pregnant, and English-speaking and were recruited through a variety of advertisements and outreach activities.
RESULTS
Of the adolescent and young adult participants (aged 18-25 years) enrolled and randomized to the intervention, 20.25% of participants accessed the system 0 times; 29.11%, 1-3 times; and 50.63%, >3 times over the course of a year. At the end of the year, almost all (96.4%) indicated they had either acted on recommendations made by the agent or planned to. Most (75.0%) said they would recommend the system to someone they knew. There were no significant differences between the two age groups on intervention use or satisfaction.
CONCLUSIONS
Web-based conversational agents are a viable medium for delivering longitudinal preconception care counseling to adolescents and young adults.
Topics: Adolescent; Adult; Black or African American; Communication; Computer Simulation; Counseling; Female; Health Promotion; Humans; Preconception Care; Pregnancy; User-Computer Interface; Young Adult
PubMed: 32718515
DOI: 10.1016/j.jadohealth.2019.09.006 -
Fertility and Sterility Jan 2019The goal of prepregnancy care is to reduce the risk of adverse health effects for the woman, fetus, and neonate by working with the woman to optimize health, address... (Review)
Review
The goal of prepregnancy care is to reduce the risk of adverse health effects for the woman, fetus, and neonate by working with the woman to optimize health, address modifiable risk factors, and provide education about healthy pregnancy. All those planning to initiate a pregnancy should be counseled, including heterosexual, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and gender nonconforming individuals. Counseling can begin with the following question: "Would you like to become pregnant in the next year?" Prepregnancy counseling is appropriate whether the reproductive-aged patient is currently using contraception or planning pregnancy. Because health status and risk factors can change over time, prepregnancy counseling should occur several times during a woman's reproductive lifespan, increasing her opportunity for education and potentially maximizing her reproductive and pregnancy outcomes. Many chronic medical conditions such as diabetes, hypertension, psychiatric illness, and thyroid disease have implications for pregnancy outcomes and should be optimally managed before pregnancy. Counseling patients about optimal intervals between pregnancies may be helpful to reduce future complications. Assessment of the need for sexually transmitted infection screening should be performed at the time of prepregnancy counseling. Women who present for prepregnancy counseling should be offered screening for the same genetic conditions as recommended for pregnant women. All patients should be routinely asked about their use of alcohol, nicotine products, and drugs, including prescription opioids and other medications used for nonmedical reasons. Screening for intimate partner violence should occur during prepregnancy counseling. Female prepregnancy folic acid supplementation should be encouraged to reduce the risk of neural tube defects.
Topics: Counseling; Diagnostic Techniques, Obstetrical and Gynecological; Female; Humans; Preconception Care; Pregnancy; Risk Factors
PubMed: 30611411
DOI: 10.1016/j.fertnstert.2018.12.003 -
European Heart Journal Oct 2015Congenital heart defects are the most common birth defects. Major advances in open-heart surgery have led to rapidly evolving cohorts of adult survivors and the majority... (Review)
Review
Congenital heart defects are the most common birth defects. Major advances in open-heart surgery have led to rapidly evolving cohorts of adult survivors and the majority of affected women now survive to childbearing age. The risk of cardiovascular complications during pregnancy and peripartum depends on the type of the underlying defect, the extent and severity of residual haemodynamic lesions and comorbidities. Careful individualized, multi-disciplinary pre-pregnancy risk assessment and counselling, including assessment of risks in the offspring and estimation on long-term outcomes of the underlying heart defect, will enable informed decision making. Depending on the estimated risks, a careful follow-up plan during pregnancy as well as a detailed plan for delivery and postpartum care can reduce the risks and should be made by the multi-disciplinary team.
Topics: Adult; Arrhythmias, Cardiac; Checklist; Clinical Decision-Making; Counseling; Delivery, Obstetric; Female; Fetal Diseases; Heart Defects, Congenital; Heart Failure; Heart Valve Prosthesis; Hemodynamics; Humans; Maternal Mortality; Patient Care Planning; Patient Care Team; Preconception Care; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Prenatal Care; Prognosis; Risk Assessment; Risk Factors
PubMed: 26112887
DOI: 10.1093/eurheartj/ehv288