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The Australian & New Zealand Journal of... Dec 2019Preconception care (PCC) defines health interventions prior to conception aimed at improving pregnancy and infant outcomes.
BACKGROUND
Preconception care (PCC) defines health interventions prior to conception aimed at improving pregnancy and infant outcomes.
AIM
To explore the understanding and provision of PCC by general practitioners (GPs) within the Sydney Local Health District.
MATERIALS AND METHODS
A questionnaire developed with GPs assessed structure and content of PCC provided, attitudes toward PCC and perceived barriers and facilitators.
RESULTS
One hundred and ten GPs completed the survey: 84% reported that GPs should be the main providers of PCC; however, only 53% were aware of PCC guidelines. Seventy-five percent of responders initiated PCC discussion with women of reproductive age, 56% provided PCC to women at higher risk of adverse outcomes and 16% waited for the discussion to be initiated by the patient. Smoking, vaccination, alcohol and supplements/medication use were the most discussed PCC components, while serology, full blood count and blood pressure were the most performed assessments. Most respondents stated that PCC is essential for women with pre-existing diabetes, previous pregnancy complications or chronic illness. However, only 45% stated PCC was essential for women >35 years and 39% for women who were overweight. Importantly, weight and mental health were among the least discussed PCC components.
CONCLUSION
General practitioners are key providers of PCC; however, only half are aware of PCC guidelines and most do not recognise overweight to be a significant preconception issue. The most common barriers to PCC delivery were time constraints, lack of knowledge and lack of resources for patients. Improved resources and education are required to support adequate PCC provision.
Topics: Attitude of Health Personnel; Australia; Female; General Practice; Humans; Practice Patterns, Physicians'; Preconception Care; Pregnancy; Surveys and Questionnaires
PubMed: 30773610
DOI: 10.1111/ajo.12962 -
Cardiology Clinics Feb 2021Coordinated preconception through postpartum cardio-obstetrics care is necessary to optimize both maternal and fetal health. Maternal mortality in the United States is... (Review)
Review
Coordinated preconception through postpartum cardio-obstetrics care is necessary to optimize both maternal and fetal health. Maternal mortality in the United States is increasing, largely driven by increasing cardiovascular (CV) disease burden during pregnancy and needs to be addressed emergently. Both for women with congenital and acquired heart disease, CV complications during pregnancy are associated with increased future risk of CV disease. Comprehensive cardio-obstetrics care is a powerful way of ensuring that women's CV risks before and during pregnancy are appropriately identified and treated and that they remain engaged in CV care long term to prevent future CV complications.
Topics: Cardiovascular Diseases; Female; Heart Disease Risk Factors; Humans; Patient Care Team; Perinatal Care; Preconception Care; Pregnancy; Pregnancy Complications, Cardiovascular; Prognosis; Risk Adjustment
PubMed: 33222811
DOI: 10.1016/j.ccl.2020.09.012 -
Journal of Women's Health (2002) Jul 2020Limited surveillance of preconception care (PCC) impedes states' ability to monitor access and provision of quality PCC. In response, we describe PCC indicators and the...
Limited surveillance of preconception care (PCC) impedes states' ability to monitor access and provision of quality PCC. In response, we describe PCC indicators and the evaluation process used to identify a set of PCC indicators for state use. The Surveillance and Research Workgroup and Clinical Workgroup of the National Preconception Health and Health Care Initiative used a systematic process to identify, evaluate, and prioritize PCC indicators from nationwide public health surveillance systems that Maternal and Child Health (MCH) programs can use for state-level surveillance using the Pregnancy Risk Assessment Monitoring System (PRAMS) and Behavioral Risk Factor Surveillance System (BRFSS). For each indicator, we assessed target population, prevalence, measurement simplicity, data availability, clinical utility, and whether it was related to the 10 prioritized preconception health indicators. We also assessed relevance to clinical recommendations, Healthy People (HP)2020 objectives, and the National Quality Forum measures. Lastly, we considered input from stakeholders and subject matter experts. Eighty potential PCC indicators were initially identified. After conducting evaluations, obtaining stakeholder input, and consulting with subject matter experts, the list was narrowed to 30 PCC indicators for states to consider using in their MCH programs to inform the need for new strategies and monitor programmatic activities. PRAMS is the data source for 27 of the indicators, and BRFSS is the data source for three indicators. The identification and evaluation of population-based PCC indicators that are available at the state level increase opportunities for state MCH programs to document, monitor, and address PCC in their locales.
Topics: Adult; Behavioral Risk Factor Surveillance System; Female; Health Services Needs and Demand; Health Status; Health Status Indicators; Humans; Population Surveillance; Preconception Care; Public Health Surveillance; Quality of Life; Risk Assessment; United States
PubMed: 32357078
DOI: 10.1089/jwh.2019.8146 -
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 -
Cardiology Clinics Feb 2021Women with congenital heart disease are pursuing pregnancy in increasing numbers. Counseling about genetic transmission, medication management, maternal and fetal risks,... (Review)
Review
Women with congenital heart disease are pursuing pregnancy in increasing numbers. Counseling about genetic transmission, medication management, maternal and fetal risks, and maternal longevity should be initiated well before pregnancy is considered. Although preconception medical and surgical optimization as well as coordinated multidisciplinary care throughout pregnancy decrease maternal and fetal risks, the rate of complications remains increased compared with the general population. Lesion-specific risk stratification and care throughout pregnancy further improve outcomes and decrease unnecessary interventions.
Topics: Female; Heart Defects, Congenital; Humans; Patient Care Team; Preconception Care; Pregnancy; Pregnancy Complications, Cardiovascular; Risk Adjustment
PubMed: 33222814
DOI: 10.1016/j.ccl.2020.09.004 -
Seminars in Perinatology Oct 2019This review underlines the important role that obstetricians play in the prevention of retinopathy of prematurity. Efforts predominately focus on predicting which... (Review)
Review
This review underlines the important role that obstetricians play in the prevention of retinopathy of prematurity. Efforts predominately focus on predicting which pregnant women are at highest risk of preterm birth, instigating treatments to prevent pre-eclampsia, fetal growth restriction and maternal infection which could lead to iatrogenic or spontaneous preterm birth, and optimizing care when preterm birth is inevitable. More broadly, optimizing maternal health pre-conception through stopping smoking, improving diet, reducing obesity with its associated gestational diabetes, and treating hypertension may reduce preterm birth and other pregnancy complications. This is a message that all healthcare professionals including obstetricians, neonatologists and GPs, nursing and midwifery staff need to communicate all women and men who are contemplating having a baby.
Topics: Delivery, Obstetric; Female; Humans; Infant, Newborn; Infant, Premature; Obstetrics; Physician's Role; Preconception Care; Pregnancy; Pregnancy Complications; Prenatal Care; Retinopathy of Prematurity; Risk Factors
PubMed: 31174873
DOI: 10.1053/j.semperi.2019.05.003 -
Chest Dec 2021People with cystic fibrosis (pwCF) have experienced increased survival and wellbeing in recent decades, such that more than half of those living with CF are adults.... (Review)
Review
People with cystic fibrosis (pwCF) have experienced increased survival and wellbeing in recent decades, such that more than half of those living with CF are adults. Consequently, sexual and reproductive health is increasingly important for pwCF, because many are considering parenthood. Most men and some women with CF (wwCF) will have reduced fertility, which in both sexes is multifactorial. However, unplanned pregnancies in women are not rare, and contraception and its interaction with CF complications need to be addressed by the CF team. Reduced fertility may be overcome in most pwCF through use of assisted reproductive technologies; however, the risk of having offspring with CF must be considered. Most wwCF will have normal pregnancies, but premature birth is common, especially in the setting of reduced lung function and CF-related diabetes (CFRD); optimization of treatment is recommended during pregnancy planning. Parenting imposes an increased burden on pwCF, with the challenges of caring for the newborn, postpartum physiologic changes, and maintaining CF treatments. Most drugs used to treat CF are considered safe in pregnancy and lactation, but exceptions need to be acknowledged, including the limited data regarding safety of CF transmembrane conductance regulator (CFTR) modulators during conception, pregnancy, and lactation. Because most pwCF are eligible for highly effective CFTR modulators, fertility, contraception, and pregnancy in people with CF is changing. Prospective studies regarding these issues in people treated with CFTR modulators are paramount to provide evidence-based guidance for management in the current era of CF care.
Topics: Chloride Channel Agonists; Cystic Fibrosis; Female; Genetic Counseling; Genetic Testing; Humans; Infertility; Lactation; Male; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Rate; Reproductive Techniques, Assisted; Respiratory Function Tests; Risk Assessment
PubMed: 34284004
DOI: 10.1016/j.chest.2021.07.024 -
Journal of the American Pharmacists... 2019
Topics: Contraception; Female; Humans; Pharmacists; Preconception Care; Pregnancy; Women's Health
PubMed: 31422025
DOI: 10.1016/j.japh.2019.07.018 -
Scientific Reports May 2021Preconception care (PCC) increases the chance of couple's being healthy and having a healthier baby. It is an important strategy to prevent maternal and perinatal... (Meta-Analysis)
Meta-Analysis
Preconception care (PCC) increases the chance of couple's being healthy and having a healthier baby. It is an important strategy to prevent maternal and perinatal complications. The level of knowledge on preconception care increases its uptake. It is also considered as an input for further intervention of reduction in maternal and neonatal mortality enabling progress towards sustainable development goals (SDGs). Therefore, this systematic review and meta-analysis aimed to estimate the pooled knowledge level of PCC and its association with family planning usage among women in Ethiopia. All observational studies regardless of publication status were retrieved. Important search terms were used to search articles in Google scholar, African Journals Online, CINHAL, HINARI, Science Direct, Cochrane Library, EMBASE, and PubMed/Medline. Independent critical appraisal of retrieved studies was done using the Newcastle-Ottawa assessment checklist. The meta-analysis was conducted using STATA version 14 software. The I statistics were used to test heterogeneity, whereas publication bias was assessed by Begg's and Egger's tests. The results of the meta-analysis were explained in the Odds ratio (OR) with a 95% confidence interval (CI) and presented using forest plots. A total of seven articles were included in the current systematic review and meta-analysis. Based on the data retrieved from the articles, 35.7% of women in Ethiopia had good knowledge about preconception care. The subgroup analysis based on region revealed the lowest (22.34%) and highest (45.06%) percentage of good knowledge on preconception care among women who were living in Amhara and Oromia regions, respectively. Moreover, women who utilized family planning services were three and more times (OR 3.65 (95% CI 2.11, 6.31)) more likely to have a good level of knowledge about preconception care. One-third of Ethiopian women had good knowledge about preconception care. Family planning utilization had a positive impact on women's knowledge of preconception care.
Topics: Ethiopia; Family Planning Services; Female; Health Knowledge, Attitudes, Practice; Humans; Odds Ratio; Preconception Care
PubMed: 34035339
DOI: 10.1038/s41598-021-89819-8 -
BMJ Open Jan 2023To understand Australian women's knowledge, attitudes and behaviours surrounding preconception and pregnancy health and their preferences for information about these...
OBJECTIVE
To understand Australian women's knowledge, attitudes and behaviours surrounding preconception and pregnancy health and their preferences for information about these periods.
DESIGN
Cross-sectional survey.
SETTING
Making healthy changes can optimise preconception and pregnancy outcomes. Clinical practice guidelines inform preconception and pregnancy care in Australia. Women often have access to multiple sources of information on reproductive and pregnancy health.
PARTICIPANTS
Women of reproductive age were asked to complete a web-based survey. The survey development was informed by preconception guidelines, consensus statements and the national pregnancy care guidelines. The survey was distributed through social media, local and national networks from 2017 to 2018.
RESULTS
Completed surveys were received from 553 women.The majority (80.4%) had high educational attainment. Checking immunisation status and ensuring good mental health were rated as equally important actions both preconception (65%) and during pregnancy (78%). Limiting sedentary activities was not rated as an important action to take either preconception (36%), or during pregnancy (38%). Although women have good knowledge about the impact of weight on their own health outcomes (eg, gestational diabetes), there was less knowledge about adverse outcomes for babies like stillbirth and preterm birth. Women access many sources for reproductive health information, however, the most trusted source was from healthcare professionals.
CONCLUSION
Most women of reproductive age in Australia have knowledge of the key health recommendations for preconception and pregnancy. However, there are gaps related to lifestyle behaviours particularly connected to weight gain and outcomes for babies. There is a strong preference to receive trusted information from healthcare providers through multiple resources.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Preconception Care; Cross-Sectional Studies; Health Knowledge, Attitudes, Practice; Australia; Premature Birth; Pregnancy Outcome
PubMed: 36596638
DOI: 10.1136/bmjopen-2022-065055