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BMC Public Health Jun 2024Preconception health has the potential to improve parental, pregnancy and infant outcomes. This scoping review aims to (1) provide an overview of the strategies,... (Review)
Review
BACKGROUND
Preconception health has the potential to improve parental, pregnancy and infant outcomes. This scoping review aims to (1) provide an overview of the strategies, policies, guidelines, frameworks, and recommendations available in the UK and Ireland that address preconception health and care, identifying common approaches and health-influencing factors that are targeted; and (2) conduct an audit to explore the awareness and use of resources found in the scoping review amongst healthcare professionals, to validate and contextualise findings relevant to Northern Ireland.
METHODS
Grey literature resources were identified through Google Advanced Search, NICE, OpenAire, ProQuest and relevant public health and government websites. Resources were included if published, reviewed, or updated between January 2011 and May 2022. Data were extracted into Excel and coded using NVivo. The review design included the involvement of the "Healthy Reproductive Years" Patient and Public Involvement and Engagement advisory panel.
RESULTS
The searches identified 273 resources, and a subsequent audit with healthcare professionals in Northern Ireland revealed five additional preconception health-related resources. A wide range of resource types were identified, and preconception health was often not the only focus of the resources reviewed. Resources proposed approaches to improve preconception health and care, such as the need for improved awareness and access to care, preconceptual counselling, multidisciplinary collaborations, and the adoption of a life-course approach. Many behavioural (e.g., folic acid intake, smoking), biomedical (e.g., mental and physical health conditions), and environmental and social (e.g., deprivation) factors were identified and addressed in the resources reviewed. In particular, pre-existing physical health conditions were frequently mentioned, with fewer resources addressing psychological factors and mental health. Overall, there was a greater focus on women's, rather than men's, behaviours.
CONCLUSIONS
This scoping review synthesised existing resources available in the UK and Ireland to identify a wide range of common approaches and factors that influence preconception health and care. Efforts are needed to implement the identified resources (e.g., strategies, guidelines) to support people of childbearing age to access preconception care and optimise their preconception health.
Topics: Humans; Preconception Care; Ireland; Female; United Kingdom; Health Policy; Practice Guidelines as Topic; Pregnancy
PubMed: 38909211
DOI: 10.1186/s12889-024-19188-0 -
PloS One 2022While depression and anxiety are common in women and men of reproductive age, preconception interventions to optimize the health of individuals with mental illness...
OBJECTIVES
While depression and anxiety are common in women and men of reproductive age, preconception interventions to optimize the health of individuals with mental illness before pregnancy is limited and focuses primarily on psychotropic medication management. Comparing individuals with depression, anxiety, and comorbidity to those with neither condition, we identified areas of preconception care optimization related to psychosocial risk factors, general physical health, medication use, and uptake of high-risk health behaviours. We also investigated differences in preconception health care use, attitudes, and knowledge.
METHOD
We conducted a nationwide survey of 621 women (n = 529) and men (n = 92) across Canada who were planning a pregnancy within five years, including those with lifetime or current depression (n = 38), anxiety (n = 55), and comorbidity (n = 104) and those without mental illness (n = 413). Individuals with depression, anxiety, and comorbidity were compared to individuals without mental illness using logistic regression, adjusted for age, sex, and education level.
RESULTS
Individuals with a lifetime or current mental illness were significantly more likely to have several risk factors for suboptimal reproductive and perinatal outcomes, including increased rates of obesity, stress, fatigue, loneliness, number of chronic health conditions, and medication use. Further, they were more likely to have high-risk health behaviours including increased substance use, internet addiction, poorer eating habits, and decreased physical activity. By assessing depression, anxiety, or both separately, we also determined there was variation in risk factors by mental illness type.
CONCLUSION
Our nationwide study is one of the first and largest to examine the preconception care needs of women and men with a lifetime or current mental illness who are pregnancy-planning. We found this population has many important reproductive and perinatal risk factors that are modifiable via preconception interventions which could have a significant positive impact on their health trajectories and those of their future children.
Topics: Anxiety Disorders; Child; Chronic Disease; Delivery of Health Care; Female; Humans; Male; Mental Disorders; Preconception Care; Pregnancy; Risk Factors
PubMed: 35731809
DOI: 10.1371/journal.pone.0270158 -
JAMA Dec 2021
Topics: Female; Humans; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 34874428
DOI: 10.1001/jama.2021.16759 -
Journal of Perinatal Medicine Apr 2016Each year approximately 2400 pregnancies develop folic acid-preventable spina bifida and anencephaly in Europe. Currently, 70% of all affected pregnancies are terminated... (Review)
Review
Each year approximately 2400 pregnancies develop folic acid-preventable spina bifida and anencephaly in Europe. Currently, 70% of all affected pregnancies are terminated after prenatal diagnosis. The prevalence of neural tube defects (NTDs) has been significantly lowered in more than 70 countries worldwide by applying fortification with folic acid. Periconceptional supplementation of folic acid also reduces the risk of congenital heart diseases, preterm birth, low birth weight, and health problems associated with child mortality and morbidity. All European governments failed to issue folic acid fortification of centrally processed and widely eaten foods in order to prevent NTDs and other unwanted birth outcomes. The estimated average dietary intake of folate in Germany is 200 μg dietary folate equivalents (DFE)/day. More than half of German women of reproductive age do not consume sufficient dietary folate to achieve optimal serum or red blood cell folate concentrations (>18 or 1000 nmol/L, respectively) necessary to prevent spina bifida and anencephaly. To date, targeted supplementation is recommended in Europe, but this approach failed to reduce the rate of NTDs during the last 10 years. Public health centers for prenatal care and fortification with folic acid in Europe are urgently needed. Only such an action will sufficiently improve folate status, prevent at least 50% of the NTD cases, reduce child mortality and morbidity, and alleviate other health problems associated with low folate such as anemia.
Topics: Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Infant, Newborn; Neural Tube Defects; Nutritional Requirements; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 25825915
DOI: 10.1515/jpm-2014-0346 -
Family Medicine and Community Health Sep 2022The objective of this study is to describe the clustering of medical, behavioural and social preconception and interconception health risk factors and determine...
OBJECTIVES
The objective of this study is to describe the clustering of medical, behavioural and social preconception and interconception health risk factors and determine demographic factors associated with these risk clusters among Canadian women.
DESIGN
Cross-sectional data were collected via an online questionnaire assessing a range of preconception risk factors. Prevalence of each risk factor and the total number of risk factors present was calculated. Multivariable logistic regression models determined which demographic factors were associated with having greater than the mean number of risk factors. Exploratory factor analysis determined how risk factors clustered, and Spearman's r determined how demographic characteristics related to risk factors within each cluster.
SETTING
Canada.
PARTICIPANTS
Participants were recruited via advertisements on public health websites, social media, parenting webpages and referrals from ongoing studies or existing research datasets. Women were eligible to participate if they could read and understand English, were able to access a telephone or the internet, and were either planning a first pregnancy (preconception) or had ≥1 child in the past 5 years and were thus in the interconception period.
RESULTS
Most women (n=1080) were 34 or older, and were in the interconception period (98%). Most reported risks in only one of the 12 possible risk factor categories (55%), but women reported on average 4 risks each. Common risks were a history of caesarean section (33.1%), miscarriage (27.2%) and high birth weight (13.5%). Just over 40% had fair or poor eating habits, and nearly half were not getting enough physical activity. Three-quarters had a body mass index indicating overweight or obesity. Those without a postsecondary degree (OR 2.35; 95% CI 1.74 to 3.17) and single women (OR 2.22, 95% CI 1.25 to 3.96) had over twice the odds of having more risk factors. Those with two children or more had 60% lower odds of having more risk factors (OR 0.68, 95% CI 0.52 to 0.86). Low education and being born outside Canada were correlated with the greatest number of risk clusters.
CONCLUSIONS
Many of the common risk factors were behavioural and thus preventable. Understanding which groups of women are prone to certain risk behaviours provides opportunities for researchers and policy-makers to target interventions more efficiently and effectively.
Topics: Canada; Cesarean Section; Child; Cross-Sectional Studies; Female; Humans; Parturition; Preconception Care; Pregnancy; Risk Factors
PubMed: 36113893
DOI: 10.1136/fmch-2021-001175 -
The British Journal of General Practice... Jun 2019
Topics: Female; Hormone Replacement Therapy; Humans; Hypothyroidism; Patient Education as Topic; Preconception Care; Pregnancy; Pregnancy Complications; Thyroid Hormones
PubMed: 31147323
DOI: 10.3399/bjgp19X703805 -
BMJ Open May 2023Preconception care can significantly improve maternal and infant outcomes, and thus optimise intergenerational health. The aims of this scoping review are to (1) provide...
INTRODUCTION
Preconception care can significantly improve maternal and infant outcomes, and thus optimise intergenerational health. The aims of this scoping review are to (1) provide an up-to-date summary of preconception health and care strategies, policies, guidelines, frameworks and recommendations across the UK and Ireland and (2) explore preconception health and care services and interventions in Northern Ireland as a case study.
METHODS AND ANALYSIS
This scoping review of grey literature will be conducted as per the Scoping Review Methods Manual by the Joanna Briggs Institute and the Arksey-O'Malley framework for scoping studies, and reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted on Google Advanced Search, OpenAire, NICE, ProQuest and relevant public health websites in May 2022. Only results published, reviewed or updated between January 2011 and the time of the searches (May 2022) were considered for inclusion. In addition, searches on interventions and services provided in Northern Ireland will be supplemented by consultations and audits with key stakeholders to validate findings, identify other potentially eligible resources and ensure breadth of coverage. Data will be extracted into Excel and coded using NVivo, and ≥10% of the data will be double-coded. A narrative approach with content analysis highlighting key themes and concepts will be used to report findings.Throughout the research cycle, members of the wider public will be involved and engaged with to provide feedback.
ETHICS AND DISSEMINATION
Ethical approval is not required as analyses will be conducted on data available in the public domain. Findings will be shared with relevant stakeholders with the aim to inform future research, practice and decision-making, and disseminated through a peer-reviewed publication, conference presentations and infographics. Dissemination plans will be informed by the 'Healthy Reproductive Years' patient and public involvement and engagement advisory panel.
Topics: Pregnancy; Female; Humans; Preconception Care; Research Design; Policy; Reproduction; United Kingdom; Systematic Reviews as Topic; Review Literature as Topic
PubMed: 37147097
DOI: 10.1136/bmjopen-2022-067822 -
Fertility and Sterility Oct 2019Timely and appropriate medical care can significantly influence the health of a newborn. When considering how to best deliver such care, we must first note that each...
Timely and appropriate medical care can significantly influence the health of a newborn. When considering how to best deliver such care, we must first note that each human represents the result of a balance between nature (genetics) and nurture (environment). Importantly, while most of our care is centered on in utero development, the preconception period is also a time at which genetic and environmental factors can interact to exert effects that ultimately influence the health of the future offspring. In this issue's Views and Reviews, we provide data to suggest that modern preconceptional care should become a key component of reproductive medicine, not only to improve implantation and pregnancy rates, but also to reduce perinatal morbidity and mortality, further optimizing the health for mothers and children and setting the stage for the child's adult life. The preconception period should be regarded as an actionable "window of opportunity" for child health promotion, not only because of this gene-environment interaction and the opportunity to identify women's genetic risks, but also because it represents a time when women are most willing to abandon unhealthy habits.
Topics: Cellular Reprogramming; Female; Gene-Environment Interaction; Humans; MicroRNAs; Preconception Care; Pregnancy
PubMed: 31561862
DOI: 10.1016/j.fertnstert.2019.08.056 -
Journal of Preventive Medicine and... Mar 2022This systematic review summarizes the preconception health needs of women in childbearing age, necessary to be addressed to have an eventual safe and healthy pregnancy. (Review)
Review
BACKGROUND
This systematic review summarizes the preconception health needs of women in childbearing age, necessary to be addressed to have an eventual safe and healthy pregnancy.
METHODS
Web of Science, PubMed and Scopus were searched. We excluded studies involving women with reproductive system pathologies and referring to interconceptive or pregnancy period and non-empirical or only abstract studies. Two researchers independently performed the blind screening based on titles/abstracts and full-text and the quality assessment.
RESULTS
Four major domains resulted from the thematic analysis: knowledge, behaviors and attitudes, health status and access to healthcare services. The most examined topics were knowledge and awareness on preconception health, folic acid assumption, tobacco and alcohol consumption, physical activity and healthy diet.
CONCLUSIONS
This review could assist healthcare professionals (physicians, nurses, midwives) in guiding tailored counselling to women to provide the adequate level of preconception care and act as a reference to policymakers.
Topics: Alcohol Drinking; Female; Health Personnel; Humans; Preconception Care; Pregnancy
PubMed: 35647378
DOI: 10.15167/2421-4248/jpmh2022.63.1.2391 -
Midwifery Dec 2023To evaluate the current practice of preconception care in the Netherlands and the perceptions of birth care professionals concerning preconception care.
OBJECTIVE
To evaluate the current practice of preconception care in the Netherlands and the perceptions of birth care professionals concerning preconception care.
METHODS
We have developed a digital questionnaire and conducted a cross-sectional study by distributing the questionnaire among 102 organisations: 90 primary care midwifery practices and obstetric departments of 12 hospitals in the Southwest region of the Netherlands between December 2020 and March 2021. One birth care professional per organization was asked to complete the questionnaire. Descriptive statistics were used to present the results.
FINDINGS
Respondents of eighty-three organisations (81.4 %) filled in the questionnaire, of whom 74 respondents were independent primary care midwives and 9 respondents were obstetricians. Preconception care mostly consisted of an individual consultation in which personalized health and lifestyle advice was given. Among the respondents, 44.4 % reported that the organization had a preconception care protocol. The way in which the consultation was carried out, as well as the health and lifestyle related questions asked, differed between respondents. More than 85 % of the respondents inquire about the following possible risk factors for complications: maternal illnesses, obstetric history, folic acid supplement intake, alcohol intake, smoking, substance abuse, hereditary disease, prescription medication, dietary habits, overweight, and birth defects in the family. The respondents acknowledged that preconception care should be offered to all couples who wish to become pregnant, as opposed to offering preconception care only to those with an increased risk of complications. Still, respondents do not receive many questions regarding the preconception period or requests for preconception care consultations.
KEY CONCLUSION
Birth care professionals acknowledge the need for preconception care for all couples. In the Netherlands, preconception care consists mostly of an individual consultation with recommendations for health and lifestyle advice. However, the identification of risk factors varies between birth care professionals and less than half of the respondents indicate that they have a protocol available in their practice. Furthermore, the demand of parents-to-be for preconception care is low. More research, that includes more obstetricians, is necessary to investigate if there is a difference between the care provided by primary care midwives and obstetricians.
IMPLICATIONS FOR PRACTICE
To increase the awareness and uptake of preconception care, it would be prudent to emphasize its importance to parents-to-be and professionals, and actively promote the use of widespread, standardized protocols for birth care professionals.
Topics: Pregnancy; Female; Humans; Preconception Care; Netherlands; Cross-Sectional Studies; Midwifery; Surveys and Questionnaires
PubMed: 37890235
DOI: 10.1016/j.midw.2023.103855