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PloS One 2024Pregnant beneficiaries in the two primary Medicaid eligibility categories, traditional Medicaid and pregnancy Medicaid, have differing access to care especially in the...
OBJECTIVES
Pregnant beneficiaries in the two primary Medicaid eligibility categories, traditional Medicaid and pregnancy Medicaid, have differing access to care especially in the preconception and postpartum periods. Pregnancy Medicaid has higher income limits for eligibility than traditional Medicaid but only provides coverage during and for a limited time period after pregnancy. Our objective was to determine the association between type of Medicaid (traditional Medicaid and pregnancy Medicaid) on receipt of outpatient care during the perinatal period.
METHODS
This retrospective cohort study compared outpatient visits using linked birth certificate and Medicaid claims from all Medicaid births in Oregon and South Carolina from 2014 through 2019. Pregnancy Medicaid ended 60 days postpartum during the study. Our primary outcome was average number of outpatient visits per 100 beneficiaries each month during three perinatal time points: preconceputally (three months prior to conception), prenatally (9 months prior to birthdate) and postpartum (from birth to 12 months).
RESULTS
Among 105,808 Medicaid-covered births in Oregon and 141,385 births in South Carolina, pregnancy Medicaid was the most prevelant categorical eligibility. Traditional Medicaid recipients had a higher average number of preconception, prenatal and postpartum visits as compared to those in pregnancy Medicaid.
DISCUSSION
In South Carolina, those using traditional Medicaid had 450% more preconception visits and 70% more postpartum visits compared with pregnancy Medicaid. In Oregon, those using traditional Medicaid had 200% more preconception visits and 29% more postpartum visits than individuals using pregnancy Medicaid. Lack of coverage in both the preconception and postpartum period deprive women of adequate opportunities to access health care or contraception. Changes to pregnancy Medicaid, including extended postpartum coverage through the American Rescue Plan Act of 2021, may facilitate better continuity of care.
Topics: Pregnancy; United States; Female; Humans; Medicaid; Retrospective Studies; Prenatal Care; Postpartum Period; Contraception
PubMed: 38568923
DOI: 10.1371/journal.pone.0299818 -
BMC Women's Health Mar 2024Preconception care (PCC) is an important window to target maternal morbidity and mortality, especially for women with chronic diseases. However, little is known about...
Knowledge and attitude towards preconception care and associated factors among women of reproductive age with chronic disease in Amhara region referral hospitals, Ethiopia, 2022.
INTRODUCTION
Preconception care (PCC) is an important window to target maternal morbidity and mortality, especially for women with chronic diseases. However, little is known about knowledge and attitudes towards preconception care among women with chronic disease. Therefore, this study aimed to assess knowledge and attitude towards preconception care and associated factors among women of reproductive age with chronic disease in Amhara region referral hospitals, Ethiopia, 2022.
METHOD
A multicenter cross-sectional study was conducted in Amhara region referral hospitals from April 15 to June 1, 2022. A total 828 women of reproductive age with chronic disease in four referral hospitals were selected using a stratified and systematic random sampling technique. Data was collected by using a structured interviewer-administered questionnaire and chart review. Bivariate and multivariable logistic regression analyses were carried out. An Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was computed to see the strength of association between outcome and independent variables. P-value < 0.05 was considered as statistically significant.
RESULTS
This study found that 55.6% of respondents had a good knowledge of preconception care, and 50.2% had a good attitude towards PCC. Formal education (AOR: 1.997, 95% CI: 1.247, 3.196), primiparity (AOR: 2.589, 95% CI: 1.132, 5.921), preconception counseling (AOR: 3.404, 95% CI: 2.170, 5.340), duration of disease ≥ 5 years (AOR: 6.495, 95% CI: 4.091, 10.310) were significantly associated with knowledge of PCC. Older age (≥ 35years) (AOR: 2.143, 95% CI: 1.058, 4.339), secondary education and above (AOR: 2.427, 95% CI: 1.421, 4.146), history of modern family planning use (AOR: 2.853 95% CI: 1.866, 4.362), preconception counseling (AOR: 2.209, 95% CI: 1.429, 3.414) and good knowledge of PCC (AOR: 20.629, 95% CI: 12.425, 34.249) were significantly associated with attitude towards PCC.
CONCLUSIONS
Women's knowledge and attitude towards preconception care were found to be low. Important measures include promoting secondary education and carrying out awareness campaigns, incorporating preconception counseling into routine medical follow-up care, and encouraging the use of modern family planning methods.
Topics: Pregnancy; Female; Humans; Preconception Care; Ethiopia; Cross-Sectional Studies; Health Knowledge, Attitudes, Practice; Hospitals; Referral and Consultation; Chronic Disease
PubMed: 38504291
DOI: 10.1186/s12905-024-02994-4 -
Indian Pediatrics Apr 2024The preconception period is the earliest window of opportunity to ensure optimal human development. Pregnancy and childbirth outcomes can be improved by interventions... (Review)
Review
JUSTIFICATION
The preconception period is the earliest window of opportunity to ensure optimal human development. Pregnancy and childbirth outcomes can be improved by interventions offered to support the health and well-being of women and couples prior to conception. Thus, preconception care is essential in preparing for the first thousand days of life. Adolescence, the stage of life that typically comes before the preconception stage, is characterized by various high-risk behaviors like substance abuse, sexual experimentation, injuries, obesity, and mental health issues which can adversely affect their health in adult life. Thus, a Consensus Guideline for pediatricians on providing preconception care to adolescents and young adults can go a long way in making the generations to come, healthier and more productive.
OBJECTIVES
The purpose of these recommendations is to formulate an evidence-based Consensus Statement that can serve as a guidance for medical professionals to provide preconception care for young adults and adolescents.
INTENDED USERS
All obstetric, pediatric, and adolescent health care providers.
TARGET POPULATION
Adolescents and young adults.
PROCESS
A large proportion of adolescents seek care from pediatricians and there is a lack of Consensus Guidelines on preconception care. Therefore, the Indian Academy of Pediatrics called an online National Consultative Meeting on April 03, 2023, under the chairmanship of Dr MKC Nair and the National Convenor Dr Himabindu Singh. A group of pediatricians with wide experience and expertise in adolescent health care were assigned the task of formulating evidence-based guidelines on preconception care. The group conducted a comprehensive review of existing evidence by searching resources including PubMed and Cochrane databases. Subsequently, a physical meeting was held at Amritsar on October 07, 2023 during which the consensus was reached through discussions and voting. The level of evidence (LoE) of each recommendation was graded as per the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011.
RECOMMENDATIONS
Every woman planning a pregnancy needs to attain and maintain a eumetabolic state. Prospective couples need to be counselled on the importance of a healthy lifestyle including a nutritious diet, avoidance of substance abuse, and timely screening for genetic disorders. Screening for and management of sexually transmitted diseases in males and females, appropriate vaccination and addressing mental health concerns are also recommended.
Topics: Adolescent; Female; Humans; Male; Pregnancy; Young Adult; Asian People; Consensus; Preconception Care; Prospective Studies; Substance-Related Disorders
PubMed: 38597099
DOI: No ID Found -
JMIR Research Protocols May 2024Preconception is the period before a young woman or woman conceives, which draws attention to understanding how her health condition and certain risk factors affect her...
BACKGROUND
Preconception is the period before a young woman or woman conceives, which draws attention to understanding how her health condition and certain risk factors affect her and her baby's health once she becomes pregnant. Adolescence and youth represent a life-course continuum between childhood and adulthood, in which the prepregnancy phase lacks sufficient research.
OBJECTIVE
The aim of the study is to identify, map, and describe existing empirical evidence on preconception interventions that enhance health outcomes for adolescents, young adults, and their offspring.
METHODS
We will conduct an evidence gap map (EGM) activity following the Campbell guidelines by populating searches identified from electronic databases such as MEDLINE, Embase, CINAHL, and Cochrane Library. We will include interventional studies and reviews of interventional studies that report the impact of preconception interventions for adolescents and young adults (aged 10 to 25 years) on adverse maternal, perinatal, and child health outcomes. All studies will undergo title or abstract and full-text screening on Covidence software (Veritas Health Innovation). All included studies will be coded using the Evidence for Policy and Practice Information (EPPI) Reviewer software (EPPI Centre, UCL Social Research Institute, University College London). Cochrane Risk of Bias tool 2.0 and Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2) tool will be used to assess the quality of the included trials and reviews. A 2D graphical EGM will be developed using the EPPI Mapper software (version 2.2.4; EPPI Centre, UCL Social Research Institute, University College London).
RESULTS
This EGM exercise began in July 2023. Through electronic search, 131,031 publications were identified after deduplication, and after the full-text screening, 18 studies (124 papers) were included in the review. We plan to submit the paper to a peer-reviewed journal once it is finalized, with an expected completion date in May 2024.
CONCLUSIONS
This study will facilitate the prioritization of future research and allocation of funding while also suggesting interventions that may improve maternal, perinatal, and child health outcomes.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/56052.
Topics: Humans; Adolescent; Preconception Care; Female; Pregnancy; Young Adult; Child Health; Child; Adult; Maternal Health; Evidence Gaps
PubMed: 38788203
DOI: 10.2196/56052 -
International Journal of Environmental... Nov 2023Weight stigma is a well-recognised public health issue affecting many members of society including women during the preconception period. The impacts of preconception...
The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care.
Weight stigma is a well-recognised public health issue affecting many members of society including women during the preconception period. The impacts of preconception weight stigma on women are significant and may result in decreased access to and uptake of healthcare, and mental health concerns. The consequences of this weight stigma may translate to negative maternal outcomes and even intergenerational effects on the child. Eliminating weight stigma is therefore imperative. The aim of this paper is to report recommendations to reduce weight stigma for preconception women produced at a workshop with clinical and academic experts on preconception health and weight stigma at the 5th European Conference on Preconception Health and Care. The recommendations are related to two key areas: general societal recommendations prompting all people to acknowledge and adjust our attitudes towards larger-bodied people; and healthcare-specific recommendations imploring clinicians to upskill themselves to reduce weight stigma in practice. We therefore call for urgent approaches to address societal weight-stigmatising attitudes and norms related to both the general population and preconception women, while providing professional development opportunities for healthcare professionals relating to weight stigma. Eliminating weight stigma for preconception women may have positive impacts on the outcomes for mothers and children during pregnancy and beyond.
Topics: Pregnancy; Child; Humans; Female; Preconception Care; Weight Prejudice; Mothers
PubMed: 37998265
DOI: 10.3390/ijerph20227034 -
The Mental Health Clinician Dec 2023Psychiatric illness may develop or relapse during pregnancy, and understanding best practices is paramount. In 2017, the British Association for Psychopharmacology (BAP)...
Psychiatric illness may develop or relapse during pregnancy, and understanding best practices is paramount. In 2017, the British Association for Psychopharmacology (BAP) consensus guidance on the use of psychotropic medication preconception, in pregnancy, and postpartum was released. The BAP guidelines provide concise evidence and additional insight and flexibility for use of psychiatric medication. Key takeaways of these guidelines are highlighted serving as a concise reference for practitioners. Additionally, practice points, such as recommendations for rapid tranquilization and the role of long-acting injectable antipsychotic medications as well as additional insights to the growing body of literature associated with psychiatric medications in pregnancy since 2017 are summarized. Providers are strongly encouraged to stay up to date to provide optimal care for pregnant patients and their babies.
PubMed: 38058594
DOI: 10.9740/mhc.2023.12.255 -
Midwifery Aug 2023The widespread availability of reproductive technology and family planning services has led to an increase in the number of available pathways to parenthood for LGBTIQA+...
Experiences in the delivery of preconception and pregnancy care for LGBTIQA+ people: A systematic review and thematic synthesis of patient and healthcare provider perspectives.
BACKGROUND
The widespread availability of reproductive technology and family planning services has led to an increase in the number of available pathways to parenthood for LGBTIQA+ people. However, emerging research indicates that significant healthcare inequities have been documented among LGBTIQA+ people and attributed to the pervasiveness of structural and systemic discrimination that extends to preconception and pregnancy care.
AIM
The aim of this systematic review was to synthesise qualitative research that has explored the experiences of LGBTIQA+ people in navigating preconception and pregnancy care services to inform healthcare quality improvement.
METHOD
Six databases were searched for relevant research published between 2012 and 2023. The findings of all included studies underwent a secondary thematic synthesis, and methodological quality was assessed using the Joanna Briggs Institute Checklist for Qualitative Research.
FINDINGS
A total of 37 studies were eligible for inclusion. Four major themes were constructed through thematic synthesis: (1) unavailability of information, services, and support; (2) clinical competencies of healthcare staff; (3) hetero- and cis-sexist care experiences; and (4) discrimination and traumatisation.
CONCLUSIONS AND IMPLICATIONS FOR PRACTICE
The findings of this review indicate that LGBTIQA+ people experience significant challenges during the journey towards parenthood, marked predominantly by the pervasiveness of inequity, and defined by discriminatory healthcare processes. This review has led to several recommendations for future healthcare quality improvement through an investment in policies, procedures, and interactions that are sensitive to the needs of LGBTIQA+ people. Importantly, future research must be co-designed and led by LGBTIQA+ community input.
Topics: Pregnancy; Female; Humans; Delivery of Health Care; Prenatal Care; Qualitative Research; Clinical Competence; Health Personnel
PubMed: 37178659
DOI: 10.1016/j.midw.2023.103712 -
BMJ Open Mar 2024To assess factors associated with knowledge and attitudes towards preconception care among reproductive-aged women in Mizan Aman town, southwest, Ethiopia.
OBJECTIVES
To assess factors associated with knowledge and attitudes towards preconception care among reproductive-aged women in Mizan Aman town, southwest, Ethiopia.
DESIGN AND METHODS
A community-based cross-sectional study was conducted from 1 November to 25 November 2021. The data were entered into Epidata V.3.1 and exported to SPSS V.26. Binary logistic regression analyses were performed to identify factors associated with outcome variables.
SETTING AND PARTICIPANTS
The study was conducted in Mizan Aman town, Southwest, Ethiopia. A total of 422 reproductive-aged women were enrolled in the study.
OUTCOME
Knowledge and attitude towards preconception care, associated factors of preconception care.
RESULTS
168 (39.8%) study subjects had good knowledge about preconception care, and 52.4% of the study subjects had a favourable attitude. Knowledge of preconception care was significantly associated with educational status (adjusted OR, AOR=6, p=0.01), marital status (AOR=1.47, p=0.001) and a positive attitude (AOR=1.8, p=0.08). Preconception care attitude was strongly associated with the maternal age group of 25-35 years (AOR=5.4, p=0.001), maternal age group of 36-42 years (AOR=3.5, p=0.02), source of income (AOR=5.3, p=0.01) and occupation (AOR=13.9, p=001).
CONCLUSION
The study revealed that knowledge about preconception care was significantly lower. Disseminating preconception education and incorporating preconception care into the maternal continuum of care was the most important to boost the knowledge and attitude level of women towards preconception care.
Topics: Pregnancy; Female; Humans; Adult; Preconception Care; Cross-Sectional Studies; Ethiopia; Health Knowledge, Attitudes, Practice; Reproduction
PubMed: 38508636
DOI: 10.1136/bmjopen-2023-077314 -
BMJ Open Nov 2023Women with type 2 diabetes (T2DM) are more likely to experience adverse reproductive outcomes, yet preconception care can significantly reduce these risks. For women...
Promoting REproductive Planning And REadiness in Diabetes (PREPARED) Study protocol: a clinic-randomised controlled trial testing a technology-based strategy to promote preconception care for women with type 2 diabetes.
INTRODUCTION
Women with type 2 diabetes (T2DM) are more likely to experience adverse reproductive outcomes, yet preconception care can significantly reduce these risks. For women with T2DM, preconception care includes reproductive planning and patient education on: (1) the importance of achieving glycaemic control before pregnancy, (2) using effective contraception until pregnancy is desired, (3) discontinuing teratogenic medications if pregnancy could occur, (4) taking folic acid, and (5) managing cardiovascular and other risks. Despite its importance, few women with T2DM receive recommended preconception care.
METHODS AND ANALYSIS
We are conducting a two-arm, clinic-randomised trial at 51 primary care practices in Chicago, Illinois to evaluate a technology-based strategy to 'hardwire' preconception care for women of reproductive age with T2DM (the PREPARED (Promoting REproductive Planning And REadiness in Diabetes) strategy) versus usual care. PREPARED leverages electronic health record (EHR) technology before and during primary care visits to: (1) promote medication safety, (2) prompt preconception counselling and reproductive planning, and (3) deliver patient-friendly educational tools to reinforce counselling. Post-visit, text messaging is used to: (4) encourage healthy lifestyle behaviours. English and Spanish-speaking women, aged 18-44 years, with T2DM will be enrolled (N=840; n=420 per arm) and will receive either PREPARED or usual care based on their clinic's assignment. Data will be collected from patient interviews and the EHR. Outcomes include haemoglobin A1c (primary), reproductive knowledge and self-management behaviours. We will use generalised linear mixed-effects models (GLMMs) to evaluate the impact of PREPARED on these outcomes. GLMMs will include a fixed effect for treatment assignment (PREPARED vs usual care) and random clinic effects.
ETHICS AND DISSEMINATION
This study was approved by the Northwestern University Institutional Review Board (STU00214604). Study results will be published in journals with summaries shared online and with participants upon request.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov Registry (NCT04976881).
Topics: Pregnancy; Humans; Female; Diabetes Mellitus, Type 2; Preconception Care; Reproduction; Contraception; Folic Acid; Randomized Controlled Trials as Topic
PubMed: 37940161
DOI: 10.1136/bmjopen-2023-078282 -
Journal of Migration and Health 2024The low utilization of antenatal healthcare services among Rohingya refugee women contributes to high maternal and child mortality rates. The objective of this study was...
Exploring the impact of preconception care and unintended pregnancy on access to antenatal healthcare services among Rohingya women: Insights from a cross-sectional survey.
BACKGROUND
The low utilization of antenatal healthcare services among Rohingya refugee women contributes to high maternal and child mortality rates. The objective of this study was to evaluate the prevalence of antenatal healthcare services utilization and the impacts of preconception care and pregnancy intention on accessing these services among Rohingya refugee women in Bangladesh.
METHODS
We analyzed data from 708 women collected through a multistage cross-sectional survey conducted in April 2023. The outcome variable was the uptake of at least one antenatal healthcare services, while the exposure variables were preconception care uptake and unintended pregnancy. We used a multivariate logistic regression model to determine the effects of preconception care and unintended pregnancy on antenatal care utilization, adjusting for potential covariates.
RESULTS
Approximately 47 % of women reported not accessing any antenatal healthcare services during their most recent pregnancy. Moreover, around 68 % of women did not receive any preconception care, and nearly one-third of pregnancies were unintended at conception. We observed lower likelihoods of antenatal care utilization among women without preconception care or with unintended pregnancy. The negative effects were even more pronounced when women reported no use of preconception care along with experiencing mistimed (aOR, 0.61, 95 % CI: 0.45-0.77) and unwanted (aOR, 0.43, 95 % CI: 0.34-0.52) pregnancy for their most recent pregnancy.
CONCLUSION
Maternal healthcare service utilization is alarmingly low among Rohingya refugees, with a significant lack of preconception care and a high prevalence of unintended pregnancies. This underscores the critical importance of implementing awareness-building programs to increase uptake of antenatal healthcare services.
PubMed: 38312934
DOI: 10.1016/j.jmh.2024.100213