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American Family Physician Jun 2002Appropriate preconception health care improves pregnancy outcomes. When started at least one month before conception, folic acid supplements can prevent neural tube...
Appropriate preconception health care improves pregnancy outcomes. When started at least one month before conception, folic acid supplements can prevent neural tube defects. Targeted genetic screening and counseling should be offered on the basis of age, ethnic background, or family history. Before conception, women should be screened for human immunodeficiency virus and syphilis infection and begin treatment to prevent the transmission of disease to the fetus. Immunizations against hepatitis B, rubella, and varicella should be completed, if needed. Women should be counseled on ways to prevent infection with toxoplasmosis, cytomegalovirus, and parvovirus B19. Environmental toxins such as cigarette smoke, alcohol, and street drugs, and chemicals such as solvents and pesticides should be avoided. In women with diabetes, it is important to optimize disease control through intensive management before pregnancy. Medications for hypertension, epilepsy, thromboembolism, depression, and anxiety should be reviewed and changed, if necessary, before the patient becomes pregnant. Counseling about exercise, obesity, nutritional deficiencies, and the overuse of vitamins A and D is beneficial. Physicians may also choose to discuss occupational and financial issues related to pregnancy and to screen patients for domestic violence.
Topics: Chronic Disease; Drug-Related Side Effects and Adverse Reactions; Environmental Exposure; Female; Folic Acid; Health Behavior; Humans; Neural Tube Defects; Preconception Care; Pregnancy; Pregnancy Complications; Prenatal Care
PubMed: 12086240
DOI: No ID Found -
The Lancet. Public Health Jan 2023Prevention of pregnancy (contraception) and preparation for pregnancy (preconception care) are services that most people need during their reproductive life course.... (Review)
Review
Prevention of pregnancy (contraception) and preparation for pregnancy (preconception care) are services that most people need during their reproductive life course. Despite increased attention, and growing recognition that health before pregnancy is crucial to addressing disparities in maternity outcomes, service provision is far from routine. We bring together evidence from the literature, new quantitative and qualitative data on women's preferences, and case studies of existing practice, to develop an integrated, community-based model that synthesises reproductive life planning, contraception, and preconception care. Our model provides a holistic, life course approach, encompassing school-based education, social media, and national campaigns, and highlights the need for training and system-level support for the range of health-care professionals who can deliver it. This high-level model can be adapted across settings, leading to a step change in the provision of preconception care in the community with consequent improvements in health and wellbeing, and reductions in inequalities at population level.
Topics: Pregnancy; Female; Humans; Preconception Care; Reproductive Health; Contraception
PubMed: 36603914
DOI: 10.1016/S2468-2667(22)00254-7 -
Maternal and Child Health Journal Aug 2014A key challenge of preconception healthcare is identifying how it can best be delivered at a population level. To review current strategies of preconception healthcare,... (Review)
Review
A key challenge of preconception healthcare is identifying how it can best be delivered at a population level. To review current strategies of preconception healthcare, explore methods of preconception healthcare delivery, and develop public health models which reflect different preconception healthcare pathways. Preconception care strategies, programmes and evaluations were identified through a review of Medline and Embase databases. Search terms included: preconception, pre-pregnancy, intervention, primary care, healthcare, model, delivery, program, prevention, trial, effectiveness, congenital disorders OR abnormalities, evaluation, assessment, impact. Inclusion criteria for review articles were: (1) English, (2) human subjects, (3) women of childbearing age, (4) 1980–current data, (5) all countries, (6) both high risk and universal approaches, (7) guidelines or recommendations, (8) opinion articles, (9) experimental studies. Exclusion criteria were: (1) non-human subjects, (2) non-English, (3) outside of the specified timeframe, (4) articles on male healthcare. The results of the literature review were synthesised into public health models of care: (1) primary care; (2) hospital-based and inter-conception care; (3) specific preconception care clinics; and, (4) community outreach. Fifteen evaluations of preconception care were identified. Community programmes demonstrated a significant impact on substance use, folic acid supplementation, diabetes optimization, and hyperphenylalaninemia. An ideal preconception visits entail risk screening, education, and intervention if indicated. Subsequently, four public health models were developed synthesizing preconception care delivery at a population level. Heterogeneity of risk factors, health systems and strategies of care reflect the lack of consensus about the best way to deliver preconception care. The proposed models aim to reflect differing aspects of preconception healthcare delivery.
Topics: Female; Humans; Male; Models, Organizational; Preconception Care; Pregnancy; Public Health Administration
PubMed: 24234279
DOI: 10.1007/s10995-013-1393-8 -
Midwifery Dec 2023To evaluate the current practice of preconception care in the Netherlands and the perceptions of birth care professionals concerning preconception care.
OBJECTIVE
To evaluate the current practice of preconception care in the Netherlands and the perceptions of birth care professionals concerning preconception care.
METHODS
We have developed a digital questionnaire and conducted a cross-sectional study by distributing the questionnaire among 102 organisations: 90 primary care midwifery practices and obstetric departments of 12 hospitals in the Southwest region of the Netherlands between December 2020 and March 2021. One birth care professional per organization was asked to complete the questionnaire. Descriptive statistics were used to present the results.
FINDINGS
Respondents of eighty-three organisations (81.4 %) filled in the questionnaire, of whom 74 respondents were independent primary care midwives and 9 respondents were obstetricians. Preconception care mostly consisted of an individual consultation in which personalized health and lifestyle advice was given. Among the respondents, 44.4 % reported that the organization had a preconception care protocol. The way in which the consultation was carried out, as well as the health and lifestyle related questions asked, differed between respondents. More than 85 % of the respondents inquire about the following possible risk factors for complications: maternal illnesses, obstetric history, folic acid supplement intake, alcohol intake, smoking, substance abuse, hereditary disease, prescription medication, dietary habits, overweight, and birth defects in the family. The respondents acknowledged that preconception care should be offered to all couples who wish to become pregnant, as opposed to offering preconception care only to those with an increased risk of complications. Still, respondents do not receive many questions regarding the preconception period or requests for preconception care consultations.
KEY CONCLUSION
Birth care professionals acknowledge the need for preconception care for all couples. In the Netherlands, preconception care consists mostly of an individual consultation with recommendations for health and lifestyle advice. However, the identification of risk factors varies between birth care professionals and less than half of the respondents indicate that they have a protocol available in their practice. Furthermore, the demand of parents-to-be for preconception care is low. More research, that includes more obstetricians, is necessary to investigate if there is a difference between the care provided by primary care midwives and obstetricians.
IMPLICATIONS FOR PRACTICE
To increase the awareness and uptake of preconception care, it would be prudent to emphasize its importance to parents-to-be and professionals, and actively promote the use of widespread, standardized protocols for birth care professionals.
Topics: Pregnancy; Female; Humans; Preconception Care; Netherlands; Cross-Sectional Studies; Midwifery; Surveys and Questionnaires
PubMed: 37890235
DOI: 10.1016/j.midw.2023.103855 -
Revue Medicale Suisse May 2019In patients with diabetes, pregnancy is associated with high maternal and fetal risks, especially in unplanned pregnancies. Current evidence confirms that timely family...
In patients with diabetes, pregnancy is associated with high maternal and fetal risks, especially in unplanned pregnancies. Current evidence confirms that timely family planning and interdisciplinary care and management starting at the preconceptional period can optimize metabolic control and significantly reduce these risks. The purpose of this article is to summarize the different aspects to consider as well as provide tools to use when preparing patients with diabetes for a pregnancy.
Topics: Diabetes Mellitus; Family Planning Services; Female; Humans; Preconception Care; Pregnancy; Pregnancy in Diabetics
PubMed: 31148426
DOI: No ID Found -
Infectious Diseases in Obstetrics and... 2012Women living with HIV have fertility desires and intentions that are similar to those of uninfected women, and with advances in treatment most women can realistically... (Review)
Review
Women living with HIV have fertility desires and intentions that are similar to those of uninfected women, and with advances in treatment most women can realistically plan to have and raise children to adulthood. Although HIV may have adverse effects on fertility, recent studies suggest that antiretroviral therapy may increase or restore fertility. Data indicate the increasing numbers of women living with HIV who are becoming pregnant, and that many pregnancies are unintended and contraception is underutilized, reflecting an unmet need for preconception care (PCC). In addition to the PCC appropriate for all women of reproductive age, women living with HIV require comprehensive, specialized care that addresses their unique needs. The goals of PCC for women living with HIV are to prevent unintended pregnancy, optimize maternal health prior to pregnancy, improve maternal and fetal outcomes in pregnancy, prevent perinatal HIV transmission, and prevent HIV transmission to an HIV-uninfected sexual partner when trying to conceive. This paper discusses the rationale for preconception counseling and care in the setting of HIV and reviews current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on well-resourced settings.
Topics: Contraception; Female; HIV Infections; Humans; Preconception Care
PubMed: 23097595
DOI: 10.1155/2012/604183 -
Seminars in Reproductive Medicine Jul 2022
Topics: Female; Humans; Preconception Care; Pregnancy
PubMed: 35901809
DOI: 10.1055/s-0042-1754339 -
Obstetrical & Gynecological Survey Oct 2016Preconception care (PCC) has the potential to optimize pregnancy outcomes. However, awareness of PCC among the target population is generally limited, and the use of PCC... (Review)
Review
IMPORTANCE
Preconception care (PCC) has the potential to optimize pregnancy outcomes. However, awareness of PCC among the target population is generally limited, and the use of PCC remains low.
IMPORTANCE
The objective of this study was to review the literature on women's perceptions regarding barriers and facilitators for the use of PCC.
EVIDENCE ACQUISITION
A systematic search was conducted in MEDLINE, Embase, CINAHL, and PsycINFO for published studies until February 2015. Original qualitative and quantitative peer-reviewed studies from Western countries in English, holding women's perceptions regarding barriers and facilitators for the use of PCC. Data extraction and analysis were performed using NVivo version 10 software. A coding frame was derived from the findings and applied by 2 authors. Thematic analysis was used to identify key topics and themes.
RESULTS
Twenty-one good-quality articles were included, of which 10 qualitative and 11 quantitative studies. Seven main themes were identified: preconditions, emotions and beliefs, perceived need, knowledge and experience, social structure, accessibility, and provider characteristics. "Not (fully) planning pregnancy", "perceived absence of risks", "lack of awareness", and "pregnancy experiences" were the most frequently identified barriers and "believing in the benefits" and "availability of PCC" the most frequently identified facilitators for PCC use.
CONCLUSIONS AND RELEVANCE
Women perceive more barriers than facilitators related to PCC uptake, which explains why the use of PCC remains low. Our results provide a starting point to refocus interventions and strategies, aiming on enlarging the awareness, perceived importance, and accessibility of PCC to improve its uptake.
Topics: Communication Barriers; Female; Health Knowledge, Attitudes, Practice; Health Services Misuse; Humans; Preconception Care; Pregnancy; Social Perception
PubMed: 27770130
DOI: 10.1097/OGX.0000000000000360 -
BMC Health Services Research Aug 2017The purpose of this situation analysis was to explore the views of health and non-health professionals working with women of childbearing age on current and future...
BACKGROUND
The purpose of this situation analysis was to explore the views of health and non-health professionals working with women of childbearing age on current and future delivery of preconception care in one National Health Service (NHS) Board area in Scotland.
METHODS
The situation analysis was undertaken using a mixed methods approach. Six focus groups were conducted organised by profession - general practitioners (GPs), practice nurses, health visitors, family nurses, guidance teachers and youth workers. Existing evidence of effective preconception care interventions informed focus group guides. A survey was undertaken with community pharmacists which provided qualitative data for analysis. Focus group transcripts were analysed by two researchers using a thematic analysis approach.
RESULTS
There was lack of awareness of preconception health and its importance amongst the target group. Levels of unplanned pregnancy hampered efforts to deliver interventions. Professional knowledge, capacity and consistency of practice were viewed as challenges, as was individual compliance with preconception care advice. Improvement requires multifaceted action, including ensuring the school curriculum adequately prepares adolescents for future parenthood, increasing awareness through communication and marketing, supporting professional knowledge and practice and capitalising on existing opportunities for preconception care, and ensuring services are equitable and targeted to need.
CONCLUSIONS
Delivery of preconception care needs to be improved both before and between pregnancies to improve outcomes for women and infants. Action is required at individual, organisational and community levels to ensure this important issue is at the forefront of preventative care and preventative spending.
Topics: Adolescent; Adolescent Behavior; Adolescent Health Services; Female; Focus Groups; Health Knowledge, Attitudes, Practice; Health Promotion; Humans; Infant; Infant, Newborn; Pharmacists; Practice Patterns, Nurses'; Practice Patterns, Physicians'; Preconception Care; Pregnancy; Program Evaluation; School Health Services; Scotland
PubMed: 28835244
DOI: 10.1186/s12913-017-2544-1 -
American Journal of Obstetrics and... Jan 2015
Topics: Cost of Illness; Diabetes Mellitus; Female; Humans; Preconception Care; Pregnancy; Pregnancy in Diabetics
PubMed: 25529608
DOI: 10.1016/j.ajog.2014.10.030