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SAGE Open Medicine 2023Preconception care is aimed to promote optimal health in women before conception to reduce or prevent poor pregnancy outcomes. Although there are several published...
Preconception care in sub-Saharan Africa: A systematic review and meta-analysis on the prevalence and its correlation with knowledge level among women in the reproductive age group.
OBJECTIVE
Preconception care is aimed to promote optimal health in women before conception to reduce or prevent poor pregnancy outcomes. Although there are several published primary studies from sub-Saharan African countries on preconception care, they need to quantify the extent of preconception care utilization, the knowledge level about preconception care, and the association among women in the reproductive age group in this region. This systematic review and meta-analysis aimed to estimate the pooled utilization of preconception care, pooled knowledge level about preconception care, and their association among women in the reproductive age group in sub-Saharan Africa.
METHODS
Databases including PubMed, Science Direct, Hinari, Google Scholar, and Cochrane library were systematically searched for relevant literature. Additionally, the references of included articles were checked for additional possible sources. The Cochrane test statistics and tests were used to assess the heterogeneity of the included studies. A random-effect meta-analysis model was used to estimate the pooled prevalence of preconception care, knowledge level of preconception care, and their correlation among reproductive-aged women in sub-Saharan African countries.
RESULTS
Of the identified 1593 articles, 20 studies were included in the final analysis. The pooled utilization of preconception care and good knowledge level about preconception care among women of reproductive age were found to be 24.05% (95% confidence interval: 16.61, 31.49) and 33.27% (95% confidence interval: 24.78, 41.77), respectively. Women in the reproductive age group with good knowledge levels were greater than two times more likely to utilize the preconception care than the women with poor knowledge levels in sub-Saharan African countries (odds ratio: 2.35, 95% confidence interval: 1.16, 4.76).
CONCLUSION
In sub-Saharan African countries, the utilization of preconception care and knowledge toward preconception care were low. Additionally, the current meta-analysis found good knowledge level to be significantly associated with the utilization of preconception care among women of reproductive age. These findings indicate that it is imperative to launch programs to improve the knowledge level about preconception care utilization among women in the reproductive age group in sub-Saharan African countries.
PubMed: 36819933
DOI: 10.1177/20503121231153511 -
Health Services Research Apr 2023To identify and describe the standardized interconception and preconception screening tools for reproductive health needs that are applicable in general outpatient...
OBJECTIVE
To identify and describe the standardized interconception and preconception screening tools for reproductive health needs that are applicable in general outpatient clinical practice.
DATA SOURCES AND STUDY SETTING
This systematic review identifies research on pregnancy intention screening and counseling tools, and standardized approaches to preconception and interconception care. We focus on tools designed for clinical settings, but also include research tools with potential for clinical implementation. These tools may include a component of contraceptive counseling, but those focusing solely on contraceptive counseling were excluded. Data were collected from studies done in the United States between January 2000 and March 2022.
STUDY DESIGN
We performed a systematic literature search to generate a list of unique tools, assessed the quality of evidence supporting each tool, and described the peer-reviewed clinical applications of each. We used the Mixed Methods Appraisal Tool to appraise the quality of individual studies.
DATA COLLECTION/EXTRACTION METHODS
We searched PubMed, Web of Science, and CINAHL databases for standardized preconception and interconception health screening tools published in English from January 2000 through March 2022. We used keywords "preconception care," "interconception care," "family planning," "contraception," "reproductive health services," and "counseling." Utilizing the Preferred Reporting Items for Systematic Reviews guidelines, we screened titles and abstracts to identify studies for full text review.
PRINCIPAL FINDINGS
The search resulted in 15,399 studies. After removing 4172 duplicates, we screened 11,227 titles/abstracts and advanced 207 for full-text review. From these, we identified 53 eligible studies representing 22 tools/standardized approaches, of which 10 had evidence from randomized clinical trials. These ranged widely in design, setting, and population of study.
CONCLUSIONS
Clinicians have a choice of tools when implementing standard reproductive screening services. A growing body of research can inform the selection of an appropriate tool, and more study is needed to establish effects on long-term patient outcomes.
Topics: Pregnancy; Female; Humans; Reproductive Health; Contraception; Family Planning Services; Counseling; Contraceptive Agents
PubMed: 36573542
DOI: 10.1111/1475-6773.14123 -
Implementation Science Communications Nov 2022Clinical guideline recommendations for addressing modifiable risk factors are not routinely implemented into preconception and antenatal care. This review assessed the... (Review)
Review
BACKGROUND
Clinical guideline recommendations for addressing modifiable risk factors are not routinely implemented into preconception and antenatal care. This review assessed the effectiveness of implementation strategies in improving health professional provision of preconception and antenatal care addressing tobacco smoking, weight management and alcohol consumption.
METHODS
A systematic review of randomised and non-randomised studies with a parallel comparison group was conducted. Eligible studies used implementation strategy/ies targeted at health professionals to improve at least one element of preconception and/or antenatal care (smoking: ask, advise, assess, assist, arrange; weight/alcohol: assess, advise, refer) compared to usual practice/control or alternative strategies. Eligible studies were identified via CENTRAL, MEDLINE, EMBASE, Maternity and Infant Care, CINAHL and other sources. Random-effects meta-analyses were conducted where appropriate, with other findings summarised using the direction of effect. The certainty of the pooled evidence was assessed using the GRADE approach.
RESULTS
Fourteen studies were included in the review. Thirteen were in the antenatal period and 12 tested multiple implementation strategies (median: three). Meta-analyses of RCTs found that implementation strategies compared to usual practice/control probably increase asking (OR: 2.52; 95% CI: 1.13, 5.59; 3 studies; moderate-certainty evidence) and advising (OR: 4.32; 95% CI: 3.06, 6.11; 4 studies; moderate-certainty evidence) about smoking and assessing weight gain (OR: 57.56; 95% CI: 41.78, 79.29; 2 studies; moderate-certainty evidence), and may increase assessing (OR: 2.55; 95% CI: 0.24, 27.06; 2 studies; low-certainty evidence), assisting (OR: 6.34; 95% CI: 1.51, 26.63; 3 studies; low-certainty evidence) and arranging support (OR: 3.55; 95% CI: 0.50, 25.34; 2 studies; low-certainty evidence) for smoking. The true effect of implementation strategies in increasing advice about weight gain (OR: 3.37; 95% CI: 2.34, 4.84; 2 non-randomised studies; very low-certainty evidence) and alcohol consumption (OR: 10.36; 95% CI: 2.37, 41.20; 2 non-randomised studies; very low-certainty evidence) is uncertain due to the quality of evidence to date.
CONCLUSIONS
Review findings provide some evidence to support the effectiveness of implementation strategies in improving health professional delivery of antenatal care addressing smoking and weight management. Rigorous research is needed to build certainty in the evidence for improving alcohol and weight gain advice, and in preconception care.
TRIAL REGISTRATION
PROSPERO-CRD42019131691.
PubMed: 36419177
DOI: 10.1186/s43058-022-00368-1 -
The British Journal of General Practice... Dec 2022Primary care-based preconception care (PCC) has the potential to improve pregnancy outcomes, but the effectiveness is unclear.
BACKGROUND
Primary care-based preconception care (PCC) has the potential to improve pregnancy outcomes, but the effectiveness is unclear.
AIM
To evaluate the effectiveness of primary care-based PCC delivered to reproductive-aged females and/or males to improve health knowledge, reduce preconception risk factors, and improve pregnancy outcomes.
DESIGN AND SETTING
A systematic review of primary care-based PCC.
METHOD
Ovid MEDLINE, Cochrane CENTRAL, Embase, Web of Science, Scopus, and CINAHL were searched for randomised controlled trials (RCTs) published between July 1999 and May 2021. Two reviewers independently evaluated article eligibility and quality.
RESULTS
Twenty-eight articles reporting on 22 RCTs were included. All but one focused on females. Interventions included brief education (single session) ( = 8), intensive education (multiple sessions) ( = 9), supplementary medication ( = 7), and dietary modification ( = 4). Brief education improved health knowledge in females ( = 3) and males ( = 1), reduced alcohol/tobacco consumption ( = 2), and increased folate intake ( = 3). Intensive education reduced spontaneous pregnancy loss ( = 1), alcohol-exposed pregnancies ( = 2), and increased physical activity ( = 2). Supplementary medication increased folate intake ( = 4) and dietary modification reduced pre-eclampsia ( = 1) and increased birth weight ( = 1). Only eight articles reported on pregnancy outcomes, with a range of interventions used; of these, four reported improvements in pregnancy outcomes. Most RCTs were of low quality ( = 12).
CONCLUSION
Primary care-based PCC including brief and intensive education, supplementary medication, and dietary modification are effective in improving health knowledge and reducing preconception risk factors in females, although there is limited evidence for males. Further research is required to determine whether primary care-based PCC can improve pregnancy outcomes.
Topics: Pregnancy; Male; Female; Humans; Adult; Pregnancy Outcome; Risk Factors; Alcohol Drinking; Primary Health Care; Folic Acid; Preconception Care
PubMed: 36376068
DOI: 10.3399/BJGP.2022.0040 -
European Journal of Clinical Nutrition Jul 2023Pre-eclampsia can lead to maternal and neonatal complications and is a common cause of maternal mortality worldwide. This review has examined the effect of micronutrient... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pre-eclampsia can lead to maternal and neonatal complications and is a common cause of maternal mortality worldwide. This review has examined the effect of micronutrient supplementation interventions in women identified as having a greater risk of developing pre-eclampsia.
METHODS
A systematic review was performed using the PRISMA guidelines. The electronic databases MEDLINE, EMBASE and the Cochrane Central Register of Controlled trials were searched for relevant literature and eligible studies identified according to a pre-specified criteria. A meta-analysis of randomised controlled trials (RCTs) was conducted to examine the effect of micronutrient supplementation on pre-eclampsia in high-risk women.
RESULTS
Twenty RCTs were identified and supplementation included vitamin C and E (n = 7), calcium (n = 5), vitamin D (n = 3), folic acid (n = 2), magnesium (n = 1) and multiple micronutrients (n = 2). Sample size and recruitment time point varied across studies and a variety of predictive factors were used to identify participants, with a previous history of pre-eclampsia being the most common. No studies utilised a validated prediction model. There was a reduction in pre-eclampsia with calcium (risk difference, -0.15 (-0.27, -0.03, I = 83.4%)), and vitamin D (risk difference, -0.09 (-0.17, -0.02, I = 0.0%)) supplementation.
CONCLUSION
Our findings show a lower rate of pre-eclampsia with calcium and vitamin D, however, conclusions were limited by small sample sizes, methodological variability and heterogeneity between studies. Further higher quality, large-scale RCTs of calcium and vitamin D are warranted. Exploration of interventions at different time points before and during pregnancy as well as those which utilise prediction modelling methodology, would provide greater insight into the efficacy of micronutrient supplementation intervention in the prevention of pre-eclampsia in high-risk women.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Calcium; Calcium, Dietary; Dietary Supplements; Pre-Eclampsia; Pregnant Women; Premature Birth; Vitamin D; Vitamins; Preconception Care
PubMed: 36352102
DOI: 10.1038/s41430-022-01232-0 -
BMC Public Health Jun 2022The health of an (unborn) child is largely determined by the health and social determinants of its parents. The extent to which social determinants of parents or...
BACKGROUND
The health of an (unborn) child is largely determined by the health and social determinants of its parents. The extent to which social determinants of parents or prospective parents affect their own health depends partly on their coping or resilience abilities. Inadequate abilities allow negative effects of unfavourable social determinants to prevail, rendering them vulnerable to adverse health outcomes. Addressing these determinants in the reproductive-aged population is therefore a key approach in improving the health of the future generation. This systematic review aims to synthesise evidence on social determinants of vulnerability, i.e., inadequate coping or low resilience, in the general population of reproductive age.
METHODS
The databases EMBASE, Medline, PsycINFO, CINAHL, Google Scholar, Web of Science, and Cochrane Library, were systematically searched from database inception to December 2th 2021. Observational studies examining social determinants and demographics in relation to vulnerability among the general population of reproductive age (men and women aged 18-40 years), conducted in a high-income country in Europe or North America, Australia or New Zealand were eligible for inclusion. Relevant data was extracted from each included article and findings were presented in a narrative and tabulated manner.
RESULTS
We identified 40,028 unique articles, of which 78 were full text reviewed. Twenty-five studies were included, of which 21 had a cross-sectional study design (84%). Coping was the most frequently assessed outcome measure (n = 17, 68%). Thirty social determinants were identified. Overall, a younger age, lower socioeconomic attainment, lack of connection with the social environment, and adverse life events were associated with inadequate coping or low resilience.
CONCLUSIONS
This review shows that certain social determinants are associated with vulnerability in reproductive-aged individuals. Knowing which factors make people more or less vulnerable carries health-related implications. More high-quality research is needed to obtain substantial evidence on the strength of the effect of these social conditions in this stage of life.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Income; Male; Prospective Studies; Social Determinants of Health; Social Factors
PubMed: 35751043
DOI: 10.1186/s12889-022-13651-6 -
Genetics in Medicine : Official Journal... Sep 2022Genes associated with nonsyndromic hearing loss are commonly included in reproductive carrier screening panels, which are now routinely offered in preconception and... (Review)
Review
PURPOSE
Genes associated with nonsyndromic hearing loss are commonly included in reproductive carrier screening panels, which are now routinely offered in preconception and prenatal care in many countries. However, there is debate whether hearing loss should be considered a medical condition appropriate for screening. This systematic review assessed research on opinions of those with a lived experience of deafness and the general public regarding genetic testing for deafness in the reproductive setting.
METHODS
Search of 5 online databases yielded 423 articles, 20 of which met inclusion criteria. We assessed the quality of each study, extracted data, and performed thematic analysis on qualitative studies.
RESULTS
Most studies indicated interest in the use of prenatal diagnosis for deafness. However, there were mixed views, and sometimes strongly held views, expressed regarding the reproductive options that should be available to those with an increased chance of having a child with deafness. Studies were small, from a limited number of countries, and most were too old to include views regarding preimplantation genetic testing.
CONCLUSION
There is a broad range of views regarding the use of reproductive options for deafness. Further research is essential to explore the benefits and harms of including nonsyndromic hearing loss genes in carrier screening.
Topics: Child; Deafness; Female; Genetic Testing; Humans; Pregnancy; Prenatal Diagnosis; Reproduction
PubMed: 35659827
DOI: 10.1016/j.gim.2022.05.005 -
Journal of Preventive Medicine and... Mar 2022This systematic review summarizes the preconception health needs of women in childbearing age, necessary to be addressed to have an eventual safe and healthy pregnancy. (Review)
Review
BACKGROUND
This systematic review summarizes the preconception health needs of women in childbearing age, necessary to be addressed to have an eventual safe and healthy pregnancy.
METHODS
Web of Science, PubMed and Scopus were searched. We excluded studies involving women with reproductive system pathologies and referring to interconceptive or pregnancy period and non-empirical or only abstract studies. Two researchers independently performed the blind screening based on titles/abstracts and full-text and the quality assessment.
RESULTS
Four major domains resulted from the thematic analysis: knowledge, behaviors and attitudes, health status and access to healthcare services. The most examined topics were knowledge and awareness on preconception health, folic acid assumption, tobacco and alcohol consumption, physical activity and healthy diet.
CONCLUSIONS
This review could assist healthcare professionals (physicians, nurses, midwives) in guiding tailored counselling to women to provide the adequate level of preconception care and act as a reference to policymakers.
Topics: Alcohol Drinking; Female; Health Personnel; Humans; Preconception Care; Pregnancy
PubMed: 35647378
DOI: 10.15167/2421-4248/jpmh2022.63.1.2391 -
Fertility and Sterility Jul 2022To investigate whether a significant association between vitamin D status and the risk of miscarriage or recurrent miscarriage (RM) exists. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate whether a significant association between vitamin D status and the risk of miscarriage or recurrent miscarriage (RM) exists.
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Women with miscarriage and RM.
INTERVENTION(S)
We searched the Ovid MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials from database inception to May 2021. Randomized and observational studies investigating the association between maternal vitamin D status and miscarriage and/or vitamin D treatment and miscarriage were included.
MAIN OUTCOME MEASURE(S)
The primary outcome was miscarriage or RM, with vitamin D status used as the predictor of risk. Whether vitamin D treatment reduces the risk of miscarriage and RM was also assessed.
RESULT(S)
Of 902 studies identified, 10 (n = 7,663 women) were included: 4 randomized controlled trials (n = 666 women) and 6 observational studies (n = 6,997 women). Women diagnosed with vitamin D deficiency (<50 nmol/L) had an increased risk of miscarriage compared with women who were vitamin D replete (>75 nmol/L) (odds ratio, 1.94; 95% confidence interval, 1.25-3.02; 4 studies; n = 3,674; I = 18%). Combined analysis, including women who were vitamin D insufficient (50-75 nmol/L) and deficient (<50 nmol/L) compared with women who were replete (>75 nmol/L), found an association with miscarriage (odds ratio, 1.60; 95% confidence interval, 1.11-2.30; 6 studies; n = 6,338; I = 35%). Although 4 randomized controlled trials assessed the effect of vitamin D treatment on miscarriage, study heterogeneity, data quality, and reporting bias precluded direct comparison and meta-analysis. The overall study quality was "low" or "very low" using the Grading of Recommendations, Assessment, Development and Evaluations approach.
CONCLUSION(S)
Vitamin D deficiency and insufficiency are associated with miscarriage. Whether preconception treatment of vitamin D deficiency protects against pregnancy loss in women at risk of miscarriage remains unknown.
REGISTRATION NUMBER
CRD42021259899.
Topics: Abortion, Habitual; Female; Humans; Pregnancy; Vitamin D; Vitamin D Deficiency; Vitamins
PubMed: 35637024
DOI: 10.1016/j.fertnstert.2022.04.017 -
American Journal of Obstetrics and... Oct 2022This study aimed to systematically assess the impact of cardiomyopathy on maternal pregnancy outcomes. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to systematically assess the impact of cardiomyopathy on maternal pregnancy outcomes.
DATA SOURCES
PubMed, Ovid Embase, Ovid MEDLINE, Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to April 24, 2022.
STUDY ELIGIBILITY CRITERIA
Observational cohort, case-control, and case-cohort studies in human populations were included if they reported predefined maternal outcomes for pregnant women with cardiomyopathy (any subtype) and for an appropriate control population (pregnant women with no known heart disease or pregnant women with noncardiomyopathy heart disease).
METHODS
Two reviewers independently assessed the articles for eligibility and risk of bias, and conflicts were resolved by a third reviewer. Data were extracted and synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analyses of Observational Studies in Epidemiology guidelines.
RESULTS
A total of 14 studies (n=57,539,306 pregnancies) were eligible for inclusion. Women with cardiomyopathy were more likely to deliver by cesarean delivery than women with no heart disease (odds ratio, 2.96; 95% confidence interval, 2.47-3.55; I=95%; P≤.00001) or women with noncardiomyopathy heart disease (odds ratio, 1.90; 95% confidence interval, 1.62-2.22; I=91%; P<.00001). Having cardiomyopathy conferred a greater risk for experiencing severe maternal adverse cardiovascular events during pregnancy when compared with not having any heart disease (odds ratio, 206.64; 95% confidence interval, 192.09-222.28; I=73%; P<.0001) or having noncardiomyopathy heart disease (odds ratio, 7.09; 95% confidence interval; 6.08-8.27; I=88%; P<.00001). In-hospital mortality was significantly higher among women with cardiomyopathy than among women with no heart disease (odds ratio, 126.67; 95% confidence interval, 43.01-373.07; I=87%; P<.00001) or among women with noncardiomyopathy heart disease (odds ratio, 4.30; 95% confidence interval, 3.42-5.40; I=0%; P<.00001).
CONCLUSION
Pregnant women with cardiomyopathy have increased risks for adverse maternal outcomes, including maternal death, when compared with both women with no heart disease and women with noncardiomyopathy heart disease. Our results highlight the importance of preconception risk assessments to allow for informed decision-making before pregnancy. Pregnancies affected by cardiomyopathy are high risk and should be managed by expert, multidisciplinary obstetrical and cardiology teams.
Topics: Cardiomyopathies; Cesarean Section; Female; Humans; Odds Ratio; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 35609641
DOI: 10.1016/j.ajog.2022.05.039