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Australian Journal of Primary Health Feb 2021The aims of this study were to explore women's and health professionals' perspectives of preconception care and whether expanding the role of practice nurses (PNs) to...
The aims of this study were to explore women's and health professionals' perspectives of preconception care and whether expanding the role of practice nurses (PNs) to provide preconception care is acceptable. In a descriptive qualitative approach, 23 semistructured interviews and three focus groups were conducted with women (n=14), PNs (n=8), GPs (n=10) and practice managers (n=2) in the state of Victoria, Australia, between September and December 2019. An inductive process of thematic analysis identified five themes and 12 subthemes. Women and health professionals viewed preconception to be when a woman is planning a pregnancy. Women wanted personalised preconception care, and receiving this from a PN was considered to be acceptable. If the role of PNs is expanded, PNs would require training and professional recognition of their role to provide preconception care. Funding barriers were discussed by PNs, GPs and practice managers, along with potential solutions, such as Medicare item numbers and checklists to streamline consultations. Other resources in the wider community, such as schools, were identified as important aspects of a coordinated approach. Overall, expanding the role of PNs to provide preconception care was acceptable to women and health professionals to increase women's awareness and uptake of preconception care.
Topics: Adult; Attitude of Health Personnel; Australia; Female; General Practitioners; Humans; Interviews as Topic; Nurse Practitioners; Nurse's Role; Preconception Care; Qualitative Research; Victoria; Young Adult
PubMed: 32895115
DOI: 10.1071/PY20072 -
Journal of Public Health Policy Aug 2011Reproductive health has improved little in the last few decades. The Netherlands, particularly in large cities, has relatively high perinatal death rates compared with...
Reproductive health has improved little in the last few decades. The Netherlands, particularly in large cities, has relatively high perinatal death rates compared with other European countries. Lack of improvement in reproductive outcomes despite improved quality of and better access to prenatal care strongly suggests that prenatal care alone is insufficient. We discuss how preconception care offers new strategies for improving reproductive health, how it usefully connects the life course of the affected individual and many health-care disciplines, and the benefits of combining a top-down policy structure and bottom-up organisation around caregivers. Given the likely benefits and cost savings calculated for The Netherlands, we conclude that failing to facilitate preconception care would reflect a breakdown of both professional and governmental responsibilities.
Topics: Female; Health Promotion; Humans; Netherlands; Preconception Care; Pregnancy; Pregnancy Outcome; Reproductive Health; Reproductive Health Services; Risk Assessment; Women's Health
PubMed: 21808249
DOI: 10.1057/jphp.2011.13 -
Maternal and Child Health Journal Sep 2006To review what past studies have found with regard to existing clinical practices and approaches to providing preconception care. (Review)
Review
OBJECTIVES
To review what past studies have found with regard to existing clinical practices and approaches to providing preconception care.
METHODS
A literature review between 1966 and September 2005 was performed using Medline. Key words included preconception care, preconception counseling, preconception surveys, practice patterns, pregnancy outcomes, prepregnancy planning, and prepregnancy surveys.
RESULTS
There are no current national recommendations that fully address preconception care; as a result, there is wide variability in what is provided clinically under the rubric of preconception care.
CONCLUSIONS
In 2005, the Centers for Disease Control and Prevention sponsored a national summit regarding preconception care and efforts are underway to develop a uniform set of national recommendations and guidelines for preconception care. Understanding how preconception care is presently incorporated and manifested in current medical practices should help in the development of these national guidelines. Knowing where, how, and why some specific preconception recommendations have been successfully adopted and translated into clinical practice, as well as barriers to implementation of other recommendations or guidelines, is vitally important in developing an overarching set of national guidelines. Ultimately, the success of these recommendations rests on their ability to influence and shape women's health policy.
Topics: Female; Genetic Counseling; Humans; Practice Guidelines as Topic; Practice Patterns, Physicians'; Preconception Care; Pregnancy; Pregnancy Outcome; Reproductive Medicine; Time Factors; United States
PubMed: 16897374
DOI: 10.1007/s10995-006-0112-0 -
Maternal and Child Health Journal Sep 2006For more than two decades, prenatal care has been a cornerstone of our nation's strategy for improving pregnancy outcomes. In recent years, however, a growing...
For more than two decades, prenatal care has been a cornerstone of our nation's strategy for improving pregnancy outcomes. In recent years, however, a growing recognition of the limits of prenatal care and the importance of maternal health before pregnancy has drawn increasing attention to preconception and internatal care. Internatal care refers to a package of healthcare and ancillary services provided to a woman and her family from the birth of one child to the birth of her next child. For healthy mothers, internatal care offers an opportunity for wellness promotion between pregnancies. For high-risk mothers, internatal care provides strategies for risk reduction before their next pregnancy. In this paper we begin to define the contents of internatal care. The core components of internatal care consist of risk assessment, health promotion, clinical and psychosocial interventions. We identified several priority areas, such as FINDS (family violence, infections, nutrition, depression, and stress) for risk assessment or BBEEFF (breastfeeding, back-to-sleep, exercise, exposures, family planning and folate) for health promotion. Women with chronic health conditions such as hypertension, diabetes, or weight problems should receive on-going care per clinical guidelines for their evaluation, treatment, and follow-up during the internatal period. For women with prior adverse outcomes such as preterm delivery, we propose an internatal care model based on known etiologic pathways, with the goal of preventing recurrence by addressing these biobehavioral pathways prior to the next pregnancy. We suggest enhancing service integration for women and families, including possibly care coordination and home visitation for selected high-risk women. The primary aim of this paper is to start a dialogue on the content of internatal care.
Topics: Domestic Violence; Female; Folic Acid; Health Priorities; Health Promotion; Humans; Immunization Programs; Nutritional Status; Parity; Postnatal Care; Preconception Care; Pregnancy; Pregnancy, High-Risk; Premature Birth; Prenatal Care; Risk Assessment; Risk Factors; Time Factors; United States
PubMed: 16817001
DOI: 10.1007/s10995-006-0118-7 -
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 -
Acta Obstetricia Et Gynecologica... Apr 2016Many risk factors associated with adverse pregnancy outcomes can be identified and modified preconceptionally. Despite a broad consensus that preconception care should...
Many risk factors associated with adverse pregnancy outcomes can be identified and modified preconceptionally. Despite a broad consensus that preconception care should be provided to all couples of reproductive age, it has not been integrated in routine healthcare. There are several barriers to its implementation, and even in the most resourceful countries, it is only provided to some select high-risk groups, rather than being an organized healthcare service provision to all. Recently, China seems to be leading the way by implementing preconception care nationwide in all rural areas. Its National Free Preconception Health Examination Project is a unique model of comprehensive preconception care. Advantages of this ambitious project are now becoming evident and benefiting the most vulnerable sections of Chinese society. This commentary provides an overview of National Free Preconception Health Examination Project and highlights the concepts that could be further developed and adapted into a model of preconception care.
Topics: China; Female; Health Priorities; Health Services Accessibility; Health Services Needs and Demand; Humans; Preconception Care; Pregnancy; Pregnancy Outcome; Risk Factors; Rural Health Services; Vulnerable Populations; Women's Health
PubMed: 26866826
DOI: 10.1111/aogs.12865 -
BMC Pregnancy and Childbirth Mar 2022Preconception care (PCC) is care prior to conception to optimize parental health, and health of the future child, through biomedical and behavioral changes. Providing...
Facilitators and barriers of preconception care in women with inflammatory bowel disease and rheumatic diseases: an explorative survey study in a secondary and tertiary hospital.
BACKGROUND
Preconception care (PCC) is care prior to conception to optimize parental health, and health of the future child, through biomedical and behavioral changes. Providing PCC to all women with a wish to conceive will improve perinatal health. PCC is especially important for women with a chronic disease, such as inflammatory bowel disease (IBD) and rheumatic diseases (RD). At present PCC is not part of routine care for these women. The aim of this study is to identify facilitators and barriers on a patient and professional level regarding the provision of PCC in women with IBD and RD.
METHODS
An explorative survey study among women with IBD and RD, their treating physicians and obstetric professionals was performed. Patients with a wish to conceive, pregnant women or those with a recent pregnancy (< 1 year ago) visiting the outpatient clinic of a secondary and tertiary hospital and involved physicians and obstetric professionals were eligible.
RESULTS
A total of 71% of the IBD patients (n = 22/31) and 35% of the RD patients (n = 20/58) received a PCC consultation. PCC consultation was considered easy to enter, short in time and patients felt comfortable. Patients (71% IBD; 62% RD) preferred a personal PCC consultation with their disease specific specialist together with an obstetrician. Patients specifically wanted to receive information about the safety of medication use and disease activity following delivery. Of the included healthcare professionals 67% (n = 31) agreed PCC was applicable to their patients. Main barrier to providing PCC was lack of time and unavailability of professionals. In total 41% (n = 16) of obstetric professionals felt they had the knowledge and skills to provide PCC compared to 33% (n = 1) and 75% (n = 3) of gastroenterologists and rheumatologists, respectively.
CONCLUSION
Lack of awareness and urgency for the effectuation can be seen as important barriers for implementation of PCC. Due to the explorative nature generalisation of the results is not allowed. In the future, adaptation of the curricula of healthcare professionals by implementing interventions for pregnancy planning and preparation will generate awareness. Modelling of the impact of PCC might prove useful in resolving the lack of urgency for PCC realization.
Topics: Chronic Disease; Female; Humans; Inflammatory Bowel Diseases; Preconception Care; Pregnancy; Rheumatic Diseases; Tertiary Care Centers
PubMed: 35321664
DOI: 10.1186/s12884-022-04560-y -
Reproductive Health May 2021Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent...
BACKGROUND
Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for desired outcomes. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to assess the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020.
METHODS
A community-based cross-sectional study was conducted from February 1 to 30, 2020. A total of 600 mothers who have given birth in the last 12 months have been randomly selected. A two-stage sampling technique was employed. For data collection, a pre-tested, semi-structured questionnaire was used. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. Household wealth status was determined through the application of principal component analysis(PCA). The practice PCC was considered as a count variable and measured as a minimum score of 0 and a maximum of 10. A bivariable statistical analysis was performed through analysis of variance (ANOVA) and independent t-tests and variables with a p-value of < 0.05 were eligible for the generalized linear regression model. To see the weight of each explanatory variable on PCC utilization, generalized linear regression with a Poisson link was done.
RESULTS
Of the sampled 600 participants, 591 took part in the study, which yielded a response rate of 98.8%.The mean (± SD) score of the practice of PCC was 3.94 (± 1.98) with minimum and maximum scores of 0 and 10 respectively. Only 6.4% (95%CI: 4.6, 8.6) of mothers received all selected items of PCC services. Thecommonest item received by 67.2% of mothers was Folic acid supplementation, while 16.1% of mothers received the least item of optimizing psychological health. Education status of mother[AOR 0.74, 95%CI 0.63, 0.97], time spent to access nearby health facilities [AOR 0.69, 95%CI 0.58, 0.83], availability of PCC unit [AOR 1.46; 95%CI 1.17, 1.67], mother's knowledge on PCC [AOR 1.34, 95%CI 1.13, 1.65], being a model household [AOR 1.31, 95%CI 1.18, 1.52] and women's autonomy in decision making [AOR 0.75, 95%CI 0.64, 0.96] were identified as significant predictors of practice of PCC.
CONCLUSION
The uptake of WHO-recommended PCC service elements in the current study area was found to be unsatisfactory. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. Plain language summary Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for better endings. The main goal of the PCC is to improve maternal and child health outcomes, by-promoting wellness and providing preventive care. It can also be seen as an earlier chance for teenage girls, mothers, and children to live a better and longer-term healthy life. Pieces of PCC service packages suggested by the World Health Organization(WHO) are, micronutrient supplementation (Folate supplementation), infectious disease (STI/HIV) screening and testing, chronic disease screening and management, healthy diet therapy, vaccination, prevention of substance use (cessation of cigarette smoking and too much alcohol consumption), optimizing psychological health, counseling on the importance of exercise and reproductive health planning and implementation. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to evaluate the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Mothers who have given birth in the last 12 months have been randomly selected Household wealth status was determined through the application of principal component analysis(PCA). To see the weight of each explanatory variable on PCC, generalized linear regression with a Poisson type was done. Accordingly, the Education status of the mother, time spent to access nearby health facilities, availability of PCC unit, mother's knowledge on PCC, being a model household, and women's autonomy in decision making were identified as significant predictors of practice of PCC. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice.
Topics: Adolescent; Adult; Child; Cross-Sectional Studies; Delivery of Health Care; Ethiopia; Female; Health Facilities; Health Knowledge, Attitudes, Practice; Humans; Male; Patient Acceptance of Health Care; Preconception Care; Pregnancy; Reproductive Health; Women's Health
PubMed: 34020669
DOI: 10.1186/s12978-021-01154-3 -
Journal of the American Association of... May 2014A case study is used to explore barriers and challenges in the delivery of preconception care, and to highlight the future role of reproductive life planning in...
PURPOSE
A case study is used to explore barriers and challenges in the delivery of preconception care, and to highlight the future role of reproductive life planning in primary practice settings.
DATA SOURCES
Peer-reviewed journal articles and clinical practice guidelines pertaining to preconception care.
CONCLUSIONS
Because of the high rate of unintended pregnancy, preconception care should be incorporated into routine primary care for women of reproductive age. Reproductive life plans are tools that help formalize contraceptive and preconception care for women across the life span. They may prove particularly useful for women with chronic diseases and for young, low-income, and minority women.
IMPLICATIONS FOR PRACTICE
With their emphasis on holistic care and patient education, nurse practitioners are well suited to incorporate elements of preconception care into the routine care they provide patients. Clinicians can modify reproductive life plans to fit the unique needs of an individual, patient population, or clinical practice.
Topics: Counseling; Female; Health Knowledge, Attitudes, Practice; Humans; Nurse Practitioners; Preconception Care; Pregnancy; Primary Health Care; Women's Health; Young Adult
PubMed: 24170712
DOI: 10.1002/2327-6924.12054 -
BMC Pregnancy and Childbirth Sep 2020Preconception care has the potential to reduce maternal and child morbidities and mortalities. It is a window of opportunity to timely alter or eliminate risk factors...
Why do women not prepare for pregnancy? Exploring women's and health care providers' views on barriers to uptake of preconception care in Mana District, Southwest Ethiopia: a qualitative study.
BACKGROUND
Preconception care has the potential to reduce maternal and child morbidities and mortalities. It is a window of opportunity to timely alter or eliminate risk factors for adverse pregnancy outcomes. However, despite strong evidence on the effectiveness of preconception care in safeguarding maternal and child health, its uptake remains low. Therefore, this study aimed to explore barriers to the uptake of preconception care.
METHODS
A descriptive qualitative study was conducted in Mana district, Jimma Zone, Oromia region, Southwest Ethiopia from March 02 to April 10, 2019. A purposive sampling approach was used, and 13 key informant interviews (6 in rural and 7 in urban areas) were held with women of different age groups, health extension workers, and health care providers of different professions. In addition, 4 focused group discussions with women of reproductive age groups (two with rural women only and two with urban women only) were conducted. The data were collected by trained experts using semi-structured guides. An inductive process of thematic analysis was employed and the data were coded, categorized, and thematized using Atlas ti version 7.0.71 software.
RESULTS
Four women of reproductive age groups, 1 older woman (grandmother), 2 health extension workers, and 6 health care providers of different professions were interviewed. In addition, a total of 38 women of reproductive age groups participated in the 4 focused group discussions: 20 in the two rural-focused group discussions and 18 in the two urban-focused group discussions. The findings indicated the presence of many barriers affecting the uptake of preconception care and organized into five themes: women-related barriers, husband-related barriers, community-related barriers, health-service-related barriers, and media-related barriers.
CONCLUSIONS
This study found a diverse array of potentially modifiable barriers to the uptake of preconception care. The findings imply the importance of scaling up health education and counseling, establishing preconception care strategies and functional units that can address all the components at all levels of health care facilities. Therefore, we recommend all stakeholders, such as program planners and managers, non-governmental organizations, media personnel, and health care providers to work in collaboration to increase the uptake of preconception care.
Topics: Adolescent; Adult; Attitude of Health Personnel; Attitude to Health; Ethiopia; Female; Humans; Middle Aged; Patient Acceptance of Health Care; Preconception Care; Qualitative Research; Rural Population; Urban Population; Young Adult
PubMed: 32873249
DOI: 10.1186/s12884-020-03208-z