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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 -
Sexual & Reproductive Healthcare :... Dec 2017Pregnancy is often framed as a "window of opportunity" for intervening on a variety of health practices such as alcohol and tobacco use. However, there is evidence that... (Review)
Review
Pregnancy is often framed as a "window of opportunity" for intervening on a variety of health practices such as alcohol and tobacco use. However, there is evidence that interventions focusing solely on the time of pregnancy can be too narrow and potentially stigmatizing. Indeed, health risks observed in the preconception period often continue during pregnancy. Using a scoping review methodology, this study consolidates knowledge and information related to current preconception and interconception health care interventions published in the academic literature. We identified a total of 29 intervention evaluations, and summarized these narratively. Findings suggest that there has been some progress in intervening on preconception health, with the majority of interventions offering assessment or screening followed by brief intervention or counselling. Overall, these interventions demonstrated improvements in at least some of the outcomes measured. However, further preconception care research and intervention design is needed. In particular, the integration of gender transformative principles into preconception care is needed, along with further intervention design for partners/ men, and more investigation on how best to deliver preconception care.
Topics: Adult; Female; Humans; Patient Education as Topic; Preconception Care; Pregnancy; Pregnancy Complications; Primary Health Care; Reproductive Health
PubMed: 29195631
DOI: 10.1016/j.srhc.2017.08.004 -
Australian Journal of General Practice Jul 2018Preconception care (PCC) comprises counselling and the provision of biomedical, behavioural and social health interventions to optimise the health of women and their...
BACKGROUND
Preconception care (PCC) comprises counselling and the provision of biomedical, behavioural and social health interventions to optimise the health of women and their partners prior to pregnancy and improve health related outcomes for themselves and their children.
OBJECTIVE
With a focus on women, the aim of this paper is to discuss the evidence for PCC, available guidelines and strategies to increase primary care access.
DISCUSSION
Each year an estimated 10% of women in Australia become pregnant. There is increasing evidence that optimising health in the preconception period is crucial to improving short-term and long-term outcomes for mothers and babies. General practitioners can have a key role in assisting women to identify modifiable and non‑modifiable preconception risks and to make informed decisions about planning or avoiding pregnancy. The Royal Australian College of General Practitioners Guidelines for preventive activities in general practice includes a chapter on preventive activities prior to pregnancy, which is a useful resource. The critical first step is screening women for their pregnancy intentions by asking a simple question that can help facilitate the start of the PCC conversation.
Topics: Adolescent; Adult; Diabetes Mellitus; Diet, Healthy; Exercise; Female; Folic Acid; Humans; Obesity; Preconception Care; Smoking; Substance-Related Disorders; Time Factors; Vitamin B Complex
PubMed: 30114868
DOI: 10.31128/AJGP-02-18-4485 -
American Family Physician Dec 2023Primary care for women and other patients with similar reproductive potential can include a discussion about pregnancy and, depending on the patient's intent,...
Primary care for women and other patients with similar reproductive potential can include a discussion about pregnancy and, depending on the patient's intent, contraceptive care or preconception care. Folic acid supplementation of at least 400 mcg per day is recommended to reduce the risk of neural tube defects, because many pregnancies are unplanned. Having a body mass index of 18.5 to 24.9 kg per m2 before pregnancy also reduces complications. Patients with a history of bariatric surgery should delay pregnancy for at least 12 months post-procedure and ensure that their nutritional status is adequate before conception. It is essential to review the patient's medications and chronic medical conditions to avoid teratogens and optimize treatment before conception to reduce maternal and fetal morbidity and mortality. Having a prepregnancy A1C level of less than 6.5% is strongly recommended for patients with diabetes mellitus to minimize congenital anomalies and complications. Vaccinations should be updated to prevent adverse outcomes related to infections. Infectious disease screenings should be updated before conception to allow for treatment, prophylaxis, or timing of pregnancy to avoid complications. Screening and counseling should be provided for substance use and potential environmental exposures to identify and mitigate detrimental exposures before pregnancy.
Topics: Pregnancy; Female; Humans; Preconception Care; Prenatal Care; Counseling; Family Planning Services; Neural Tube Defects
PubMed: 38215421
DOI: No ID Found -
Minerva Ginecologica Jun 2013Preconceptional health has been shown to be an important determinant of fertility, fecundity and perinatal outcomes. In recent years the impact of periconceptional... (Review)
Review
Preconceptional health has been shown to be an important determinant of fertility, fecundity and perinatal outcomes. In recent years the impact of periconceptional factors on developmental programming, and the health of the resultant child have become increasingly clear. Since fertility specialists care for couples during this critical phase, they have a unique opportunity to collaborate with the couple to optimise preconceptional health and thus fertility and pregnancy outcomes. In this review article, the current evidence available for the importance of preconceptional health care is considered, specific lifestyle and dietary interventions are described and the care of the medically complicated patient prior to fertility treatment is discussed. Finally strategies for overcoming challenges in implementing preconceptional care into the fertility clinic are addressed.
Topics: Cooperative Behavior; Female; Fertility; Humans; Infant, Newborn; Infertility; Life Style; Physician-Patient Relations; Preconception Care; Pregnancy; Pregnancy Outcome; Specialization
PubMed: 23689168
DOI: No ID Found -
Journal of Midwifery & Women's Health May 2016Approximately 50% of the pregnancies in the United States are unintended. Most pregnancies are not diagnosed until after the period of organogenesis. Environmental... (Review)
Review
Approximately 50% of the pregnancies in the United States are unintended. Most pregnancies are not diagnosed until after the period of organogenesis. Environmental exposures, chronic and acute illnesses, and ingestion of teratogens that can negatively affect the fetus may occur during these early weeks of pregnancy. Some chronic disease effects and lifestyle behaviors that affect the fetus can be adjusted prior to conception. Because of this, the health of a woman and her partner prior to pregnancy are of utmost importance. The Centers for Disease Control and Prevention and the Preconception Health and Health Care Initiative have established goals and evidence-based guidelines for preconception care. Preconception health care can be threaded into every visit with all women of reproductive age who are not pregnant. The guidelines focus on 3 main areas: screening, health promotion, and interventions. Screening is accomplished with women and couples via a thorough history and assessment of risks including a reproductive life plan; assessment of tobacco, alcohol and drug use; sexually transmitted infection (STI) testing and education; and assessment of environmental or teratogenic risk factors. Health promotion includes making sure the woman is current with regard to recommended vaccines, taking appropriate levels of folic acid, and maintaining a healthy weight and level of physical activity. The health care provider can intervene when indicated with management of chronic and acute illnesses, as well as provide assistance with tobacco, alcohol, and drug cessation as necessary. When a woman and her partner are healthy prior to pregnancy, unintended or planned, the woman and her fetus have a better chance at a healthy gestation and beyond. This article, via the use of case presentations, reviews how preconception health can be integrated into an office visit.
Topics: Adolescent; Adult; Family Planning Services; Female; Health Promotion; Humans; Male; Men's Health; Preconception Care; Pregnancy; Women's Health; Young Adult
PubMed: 27218593
DOI: 10.1111/jmwh.12465 -
The Nursing Clinics of North America Jun 2018Preconception counseling is essential for women of childbearing age and family members who have decided to conceive because the level of well health of the mother and... (Review)
Review
Preconception counseling is essential for women of childbearing age and family members who have decided to conceive because the level of well health of the mother and unborn child are affected by decisions and actions of the mother before and during pregnancy. Proactively planning pregnancy includes scheduling a preconception counseling consultation with a provider. Understanding physical, psychological, and emotional needs promotes healthy pregnancy outcomes for mother and baby. This article offers a reflective and holistic perspective of how health care providers frame, prioritize, and engage with the patient and family during the preconception consultation.
Topics: Family; Female; Humans; Maternal Health Services; Preconception Care; Pregnancy; Referral and Consultation
PubMed: 29779511
DOI: 10.1016/j.cnur.2018.01.012 -
Reproductive Health Sep 2014Preconception care recognizes that many adolescent girls and young women will be thrust into motherhood without the knowledge, skills or support they need. Sixty million... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Preconception care recognizes that many adolescent girls and young women will be thrust into motherhood without the knowledge, skills or support they need. Sixty million adolescents give birth each year worldwide, even though pregnancy in adolescence has mortality rates at least twice as high as pregnancy in women aged 20-29 years. Reproductive planning and contraceptive use can prevent unintended pregnancies, unsafe abortions and sexually-transmitted infections in adolescent girls and women. Smaller families also mean better nutrition and development opportunities, yet 222 million couples continue to lack access to modern contraception.
METHOD
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
Comprehensive interventions can prevent first pregnancy in adolescence by 15% and repeat adolescent pregnancy by 37%. Such interventions should address underlying social and community factors, include sexual and reproductive health services, contraceptive provision; personal development programs and emphasizes completion of education. Appropriate birth spacing (18-24 months from birth to next pregnancy compared to short intervals <6 months) can significantly lower maternal mortality, preterm births, stillbirths, low birth weight and early neonatal deaths.
CONCLUSION
Improving adolescent health and preventing adolescent pregnancy; and promotion of birth spacing through increasing correct and consistent use of effective contraception are fundamental to preconception care. Promoting reproductive planning on a wider scale is closely interlinked with the reliable provision of effective contraception, however, innovative strategies will need to be devised, or existing strategies such as community-based health workers and peer educators may be expanded, to encourage girls and women to plan their families.
Topics: Adolescent; Contraception; Family Planning Services; Female; Health Promotion; Health Services Accessibility; Humans; Preconception Care; Pregnancy; Pregnancy in Adolescence
PubMed: 25415259
DOI: 10.1186/1742-4755-11-S3-S2 -
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 -
JAMA Dec 2021
Topics: Female; Humans; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 34874428
DOI: 10.1001/jama.2021.16759