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Current Opinion in Obstetrics &... Dec 2008This study reviews what we know about preconception care, its definition, goals, and content; the science behind the recommended interventions; opportunities for... (Review)
Review
PURPOSE OF REVIEW
This study reviews what we know about preconception care, its definition, goals, and content; the science behind the recommended interventions; opportunities for implementing preconception care; and the challenges facing its implementation.
RECENT FINDINGS
There is solid scientific evidence that many interventions will improve pregnancy outcomes if delivered before pregnancy or early in pregnancy. Experts continue to explore the most effective means for implementing preconception care, taking into consideration issues related to policy, finance, public health practice, research/surveillance, and consumer and provider education.
SUMMARY
Over the past 4 years, there has been renewed interest and a great emphasis on preconception health and healthcare as alternative and additional approaches to counter the persistent increasing incidence in adverse pregnancy outcomes in the United States. Following the publication of the 'Recommendations to Improve Preconception Health and Healthcare' in 2006, many state and local health departments initiated programs to implement the recommendations. Several countries such as Canada, Belgium, and the Netherlands have also started to implement preconception care programs. There are many opportunities for promoting preconception health and providing preconception care; however, making preconception care a standard practice continues to face many barriers.
Topics: Adult; Female; Health Promotion; Humans; Infant, Newborn; Obstetrics; Perinatal Care; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Public Health
PubMed: 18989135
DOI: 10.1097/GCO.0b013e328317a27c -
Reproductive Health Sep 2014Preconception care includes any intervention to optimize a woman's health before pregnancy with the aim to improve maternal, newborn and child health (MNCH) outcomes.... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Preconception care includes any intervention to optimize a woman's health before pregnancy with the aim to improve maternal, newborn and child health (MNCH) outcomes. Preconception care bridges the gap in the continuum of care, and addresses pre-pregnancy health risks and health problems that could have negative maternal and fetal consequences. It therefore has potential to further reduce global maternal and child mortality and morbidity, especially in low-income countries where the highest burden of pregnancy-related deaths and disability occurs.
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
Women who received preconception care in either a healthcare center or the community showed improved outcomes, such as smoking cessation; increased use of folic acid; breastfeeding; greater odds of obtaining antenatal care; and lower rates of neonatal mortality.
CONCLUSION
Preconception care is effective in improving pregnancy outcomes. Further studies are needed to evaluate consistency and magnitude of effect in different contexts; develop and assess new preconception interventions; and to establish guidelines for the provision of preconception care.
Topics: Child; Child Welfare; Continuity of Patient Care; Evidence-Based Medicine; Female; Humans; Infant, Newborn; Preconception Care; Pregnancy; Pregnancy Outcome; Women's Health
PubMed: 25414942
DOI: 10.1186/1742-4755-11-S3-S1 -
Women and Birth : Journal of the... Sep 2020A recognised gap exists between current and recommended practices in the provision of lifestyle advice and weight management support for women across preconception and...
PROBLEM
A recognised gap exists between current and recommended practices in the provision of lifestyle advice and weight management support for women across preconception and pregnancy care.
BACKGROUND
Preconception and pregnancy are critical stages for promoting healthy maternal lifestyles and obesity prevention. Co-design is a novel approach with the potential to strengthen existing models of care to facilitate the implementation of clinical practice guidelines promoting preconception and pregnancy health, especially in relation to preconception weight management and preventing excessive gestational weight gain.
AIM AND METHODS
The aims of this discussion paper are to (i) define co-design in the context of preconception and pregnancy care, (ii) outline key considerations when planning co-design initiatives and (iii) describe co-design opportunities in preconception and pregnancy care for promoting women's health and obesity prevention.
DISCUSSION
While several definitions of co-design exist, one critical element is the meaningful involvement of all key stakeholders. In this discussion, we specifically identified the involvement of women and expanding the role of practice nurses in primary care may assist to overcome barriers to the provision of healthy lifestyle advice and support for women during preconception. Co-designing pregnancy care will involve input from women, nurses, midwives, obstetricians, allied health and administration and management staff. Additional attention is required to co-design care for women considered most at-risk.
CONCLUSION
There is potential to enhance current provision of preconception and pregnancy care using co-design. Nursing and midwifery professions are active across both preconception and pregnancy and therefore, they have an important role to play.
Topics: Adult; Family Planning Services; Female; Healthy Lifestyle; Humans; Midwifery; Obesity; Preconception Care; Pregnancy; Prenatal Care; Primary Health Care; Women's Health
PubMed: 31812498
DOI: 10.1016/j.wombi.2019.11.005 -
Maternal and Child Health Journal Sep 2006This literature review briefly describes international programs, policies, and activities related to preconception care and resulting pregnancy outcomes. (Review)
Review
OBJECTIVES
This literature review briefly describes international programs, policies, and activities related to preconception care and resulting pregnancy outcomes.
METHODS
Electronic databases were searched and findings supplemented with secondary references cited in the original articles as well as textbook chapters, declarations, reports, and recommendations.
RESULTS
Forty-two articles, book chapters, declarations, and other published materials were reviewed. Policies, programs, and recommendations related to preconceptional health promotion exist worldwide and comprise a readily identifiable component of historic and modern initiatives pertaining to women's health, reproductive freedom, and child survival.
CONCLUSIONS
The integration of preconception care services within a larger maternal and child health continuum of care is well aligned with a prevention-based approach to enhancing global health.
Topics: Child Health Services; Female; Global Health; Health Promotion; Humans; Infant, Newborn; Internationality; Maternal Welfare; Perinatal Care; Preconception Care; Pregnancy; Program Evaluation
PubMed: 16710763
DOI: 10.1007/s10995-006-0091-1 -
Australian Journal of General Practice Jun 2020The importance of interconception care - defined as care given to women, and their partners, between one pregnancy and the next to optimise their health - is...
BACKGROUND
The importance of interconception care - defined as care given to women, and their partners, between one pregnancy and the next to optimise their health - is increasingly important, with rising rates of overweight, obesity, diabetes and hypertension among people of reproductive age. Women frequently visit their general practitioner (GP) in the first six months postpartum. This is an opportune time to discuss ideal interpregnancy intervals (IPIs) and advise women about contraception and healthy behaviours.
OBJECTIVE
The aim of this article is to review available research and guidelines on interconception care and IPIs, and propose best-practice care for the general practice setting.
DISCUSSION
GPs are uniquely placed to deliver the different aspects of interconception care including reviewing the outcomes of the previous pregnancy, advising women on optimal IPIs and providing contraception and lifestyle guidance. Studies have found that GPs may feel they lack the time and resources to provide interconception care, but support is available through online tools and easy-to-access checklists. As the prevalence of obesity and chronic diseases increases, interconception care has the potential to reduce future adverse perinatal outcomes.
Topics: Birth Intervals; Female; Humans; Maternal Health Services; Preconception Care
PubMed: 32464729
DOI: 10.31128/AJGP-02-20-5242 -
American Journal of Medical Genetics Jun 1999Couples who plan their pregnancies can elect anticipatory care with the aim of improved health for mother and child. While it has proved to be beneficial in such... (Review)
Review
Couples who plan their pregnancies can elect anticipatory care with the aim of improved health for mother and child. While it has proved to be beneficial in such specific disorders as maternal diabetes mellitus, preconception care is not yet established as a part of primary care. Preconception care is a form of community genetics and consists of three main components: risk assessment, health promotion, and intervention. Intake of folic acid during the time surrounding conception is important in preventing neural tube defects and other congenital anomalies. Primary care health professionals may be involved in providing preconception care, as may be gynecologists, midwives, nurses, clinical geneticists, and genetic counselors. Several questions arose from a Dutch pilot study. Is there a need for preconception care? Do women want this care? Can positive effects (and cost-effectiveness) be documented? How best are the parents-to-be contacted? Last, but not least, who should provide the care?
Topics: Cost-Benefit Analysis; Dietary Supplements; Female; Folic Acid; Genetic Counseling; Humans; Male; Netherlands; Preconception Care; Primary Health Care; Risk Assessment; Treatment Outcome
PubMed: 10559759
DOI: 10.1002/(sici)1096-8628(19990625)89:2<58::aid-ajmg2>3.0.co;2-t -
Mayo Clinic Proceedings May 2002Clinicians who provide health care to women during their childbearing years have the opportunity to affect pregnancy outcomes positively through preconception care. The... (Review)
Review
Clinicians who provide health care to women during their childbearing years have the opportunity to affect pregnancy outcomes positively through preconception care. The goal of preconception care is to identify medical and social conditions that may put the mother or fetus at risk. Key elements include screening for certain infectious diseases, obtaining genetic history, updating immunizations, providing specific nutritional advice, and optimizing health status. Some women, and their partners, may require additional care, including a prepregnancy consultation with an obstetrician or maternal-fetal medicine specialist. The clinician can also offer advice that may enhance conception and encourage either early prenatal care when a pregnancy is achieved or early evaluation for infertility.
Topics: Congenital Abnormalities; Diet; Environmental Exposure; Exercise; Female; Health Behavior; Health Personnel; Humans; Infection Control; Male; Mass Screening; Preconception Care; Risk Factors
PubMed: 12004996
DOI: 10.4065/77.5.469 -
FP Essentials Apr 2018Family physicians are in a unique position to ensure that women receive preconception care. The Centers for Disease Control and Prevention, the American College of...
Family physicians are in a unique position to ensure that women receive preconception care. The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians recommend preconception care for all women, but particularly for women with comorbid conditions such as obesity, diabetes, and chronic hypertension. Family physicians should ask all women of reproductive age who are at risk of unintended pregnancy if they desire pregnancy within the next year and, based on this answer, provide counseling on contraception or preconception care. Given that more than half of all pregnancies in the United States are unplanned, all women of reproductive age should be prescribed at least 400 mcg/day of folic acid. They also should be counseled to modify risk factors such as smoking, alcohol use, overweight and obesity, and travel to countries where Zika virus infection is endemic. Women with significant chronic conditions should be counseled to achieve optimum control of their conditions before conception. Long-term treatment of such conditions with drugs should be reviewed and modified to prevent potentially teratogenic effects after the risks and benefits of continuing the drugs are considered.
Topics: Directive Counseling; Female; Folic Acid; Humans; Physician's Role; Physicians, Family; Preconception Care; Pregnancy; Risk Factors; United States
PubMed: 29683305
DOI: No ID Found -
American Family Physician Aug 2007Every woman of reproductive age who is capable of becoming pregnant is a candidate for preconception care, regardless of whether she is planning to conceive.... (Review)
Review
Every woman of reproductive age who is capable of becoming pregnant is a candidate for preconception care, regardless of whether she is planning to conceive. Preconception care is aimed at identifying and modifying biomedical, behavioral, and social risks through preventive and management interventions. Key components include risk assessment, health promotion, and medical and psychosocial interventions. Patients should formulate a reproductive life plan that outlines personal goals about becoming pregnant based on the patient's values and resources. Preconception care can be provided in the primary care setting and through activities linked to schools, workplaces, and the community.
Topics: Congenital Abnormalities; Female; Humans; Practice Guidelines as Topic; Preconception Care; Pregnancy; Pregnancy Complications; Risk Assessment
PubMed: 17708141
DOI: No ID Found -
Midwifery Apr 2022To explore healthcare providers' views on improving preconception care in their region.
OBJECTIVE
To explore healthcare providers' views on improving preconception care in their region.
DESIGN
Mixed-methods study.
SETTING
Working conferences aimed to educate healthcare providers on preconceptional risk factors and conduct a region-specific analysis of barriers and facilitators for implementing preconception care, were organised in ten municipalities in the Netherlands.
PARTICIPANTS
250 healthcare providers of various disciplines attended a working conference and participated in the study.
MEASUREMENTS AND FINDINGS
Participants were asked to both fill out a questionnaire concerning statements and experiences with preconception care and to participate in a workshop, to identify barriers and facilitators for the implementation of a local preconception care program. Almost all healthcare providers suggested that the responsibility for providing preconception care consultations lies within primary care (general practitioners (n = 239; 95.6%) and midwives (n = 236; 94.4%)). Professionals other than midwives found it significantly more difficult to start a conversation about a wish to conceive compared to midwives (26.8% versus 20.2%, p-value = 0.006) and felt less competent to provide preconceptional information (32.3% versus 15.1%, p-value = <0.001). Innovative facilitators were mentioned to improve reaching the target population with preconceptional information, i.e. the use of social media and local ambassadors.
KEY CONCLUSION
While the responsibility for providing preconception care consultations is best suited with primary care, many other healthcare providers involved may act as referrers towards preconception care. Still, approximately 1 in 7 midwives (strongly) disagree with the statement that it is part of their job to provide preconceptional information to couples with a wish to conceive.
IMPLICATIONS FOR PRACTICE
There is a need for integrating preconception care in many curricula and postgraduate courses, especially for non-midwives, to improve the delivery of preconception care. Insights in the suggested barriers and facilitators can improve the implementation of (local) preconception care programs.
Topics: Attitude of Health Personnel; Female; Health Personnel; Humans; Midwifery; Preconception Care; Pregnancy; Surveys and Questionnaires
PubMed: 35202897
DOI: 10.1016/j.midw.2022.103274