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Reproductive Health Sep 2014There is increasingly a double burden of under-nutrition and obesity in women of reproductive age. Preconception underweight or overweight, short stature and... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
There is increasingly a double burden of under-nutrition and obesity in women of reproductive age. Preconception underweight or overweight, short stature and micronutrient deficiencies all contribute to excess maternal and fetal complications during pregnancy.
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 maternal, newborn and child health (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
Maternal pre-pregnancy weight is a significant factor in the preconception period with underweight contributing to a 32% higher risk of preterm birth, and obesity more than doubling the risk for preeclampsia, gestational diabetes. Overweight women are more likely to undergo a Cesarean delivery, and their newborns have higher chances of being born with a neural tube or congenital heart defect. Among nutrition-specific interventions, preconception folic acid supplementation has the strongest evidence of effect, preventing 69% of recurrent neural tube defects. Multiple micronutrient supplementation shows promise to reduce the rates of congenital anomalies and risk of preeclampsia. Although over 40% of women worldwide are anemic in the preconception period, only one study has shown a risk for low birth weight.
CONCLUSION
All women, but especially those who become pregnant in adolescence or have closely-spaced pregnancies (inter-pregnancy interval less than six months), require nutritional assessment and appropriate intervention in the preconception period with an emphasis on optimizing maternal body mass index and micronutrient reserves. Increasing coverage of nutrition-specific and nutrition-sensitive strategies (such as food fortification; integration of nutrition initiatives with other maternal and child health interventions; and community based platforms) is necessary among adolescent girls and women of reproductive age. The effectiveness of interventions will need to be simultaneously monitored, and form the basis for the development of improved delivery strategies and new nutritional interventions.
Topics: Body Weight; Congenital Abnormalities; Dietary Supplements; Female; Folic Acid; Humans; Infant, Newborn; Preconception Care; Pregnancy; Pregnancy Complications; Prenatal Nutritional Physiological Phenomena
PubMed: 25415364
DOI: 10.1186/1742-4755-11-S3-S3 -
Minerva Ginecologica Feb 2018There is a growing realization that efforts to optimize the health of women and reduce the risk of adverse maternal, perinatal and neonatal outcomes during pregnancy... (Review)
Review
There is a growing realization that efforts to optimize the health of women and reduce the risk of adverse maternal, perinatal and neonatal outcomes during pregnancy should commence in the preconception period. The preconception period (prior to or between pregnancies) provides an opportune time to address reproductive intentions and promote and support wellbeing and healthy behavior change regardless of pregnancy intention. Research over the last 30 years has explored the influence of a range of preconception risk factors and determinants of health on pregnancy and maternal and neonatal outcomes including: pregnancy planning, diet and micronutrient supplementation, physical activity, weight, smoking, recreational drug and alcohol use, mental health, oral hygiene, and chronic health and medical conditions. Preconception health messages, recommendations and guidelines originated in the USA and the preconception movement has gained momentum internationally with a variety of strategies developed and tested for improving preconception health, and related outcomes. The shift to integrate preconception health promotion into the continuum of women's healthcare requires a diverse multilevel and multistrategic approach involving a range of sectors and health professionals to address the determinants of health. This includes a system-wide effort to raise awareness of the importance of women's health prior to pregnancy, creating supportive environments as well as optimizing clinical practice, policy and programs informed by high quality research and longitudinal studies. While preconception health is relevant to both women and men globally, this review summarizes the predominant areas of preconception health for women in developed countries including the emergence of preconception health, the current health messages and evidence, the state of international guidelines and evidence-based interventions in preconception.
Topics: Developed Countries; Female; Health Behavior; Health Promotion; Humans; Infant Health; Infant, Newborn; Maternal Health; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Risk Factors
PubMed: 28895680
DOI: 10.23736/S0026-4784.17.04140-5 -
American Family Physician Oct 2020For many patients, pregnancy is a highly anticipated and exciting phase of life, but it can also be anxiety provoking. Family physicians can resolve some of this anxiety... (Review)
Review
For many patients, pregnancy is a highly anticipated and exciting phase of life, but it can also be anxiety provoking. Family physicians can resolve some of this anxiety and promote maternal and fetal health by making specific recommendations at prenatal visits. A daily prenatal vitamin with at least 400 mcg of folic acid and 30 mg of elemental iron should be recommended to promote neurologic and musculoskeletal fetal development. Weight gain in pregnancy should be guided by preconception body mass index. People who are underweight should gain 28 to 40 lb, those who have a normal weight should gain 25 to 35 lb, and those who are overweight or obese should gain 15 to 25 lb or 11 to 20 lb, respectively. A well-balanced diet including omega-3 fatty acids should be encouraged. Unpasteurized foods should be avoided during pregnancy because of the risk of listeriosis. Caffeine intake should be limited to 200 mg per day (about two small cups of coffee), and artificial sweeteners should be avoided. Pregnant patients should be encouraged to engage in regular cardiovascular activity for at least 150 minutes per week. Bed rest is not recommended. Sex can be continued throughout an uncomplicated pregnancy. Avoidance of alcohol and marijuana is recommended. The effects of hair dye or hair straightening products on fetal development or neonatal outcomes are unclear.
Topics: Female; Humans; Practice Guidelines as Topic; Preconception Care; Pregnancy; Prenatal Care
PubMed: 32996758
DOI: No ID Found -
Annals of the Rheumatic Diseases May 2016A European League Against Rheumatism (EULAR) task force was established to define points to consider on use of antirheumatic drugs before pregnancy, and during pregnancy...
A European League Against Rheumatism (EULAR) task force was established to define points to consider on use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Based on a systematic literature review and pregnancy exposure data from several registries, statements on the compatibility of antirheumatic drugs during pregnancy and lactation were developed. The level of agreement among experts in regard to statements and propositions of use in clinical practice was established by Delphi voting. The task force defined 4 overarching principles and 11 points to consider for use of antirheumatic drugs during pregnancy and lactation. Compatibility with pregnancy and lactation was found for antimalarials, sulfasalazine, azathioprine, ciclosporin, tacrolimus, colchicine, intravenous immunoglobulin and glucocorticoids. Methotrexate, mycophenolate mofetil and cyclophosphamide require discontinuation before conception due to proven teratogenicity. Insufficient documentation in regard to fetal safety implies the discontinuation of leflunomide, tofacitinib as well as abatacept, rituximab, belimumab, tocilizumab, ustekinumab and anakinra before a planned pregnancy. Among biologics tumour necrosis factor inhibitors are best studied and appear reasonably safe with first and second trimester use. Restrictions in use apply for the few proven teratogenic drugs and the large proportion of medications for which insufficient safety data for the fetus/child are available. Effective drug treatment of active inflammatory rheumatic disease is possible with reasonable safety for the fetus/child during pregnancy and lactation. The dissemination of the data to health professionals and patients as well as their implementation into clinical practice may help to improve the management of pregnant and lactating patients with rheumatic disease.
Topics: Abnormalities, Drug-Induced; Antirheumatic Agents; Biological Products; Delphi Technique; Female; Humans; Infant, Newborn; Lactation; Maternal-Fetal Exchange; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Exposure Delayed Effects; Rheumatic Diseases
PubMed: 26888948
DOI: 10.1136/annrheumdis-2015-208840 -
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 -
British Medical Bulletin Dec 2018Poorly-controlled hypertension in the first trimester significantly increases maternal and fetal morbidity and mortality. The majority of guidelines and clinical trials... (Review)
Review
INTRODUCTION OR BACKGROUND
Poorly-controlled hypertension in the first trimester significantly increases maternal and fetal morbidity and mortality. The majority of guidelines and clinical trials focus on the management and treatments for hypertension during pregnancy and breast-feeding, while limited evidence could be applied to the management for hypertension before pregnancy. In this review, we summarized the existing guidelines and treatments of pre-pregnancy treatment of hypertension.
SOURCES OF DATA
PubMed.
AREAS OF AGREEMENT
Methyldopa and labetalol are considered the first choice, but angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) need to be withdrawn if a hypertensive woman wishes to become pregnant. In women with chronic hypertension, it is very important to make an assessment before conception to exclude secondary causes of hypertension, evaluate their hypertensive control to ensure that it is optimal, discuss the increased risks of pre-eclampsia, and provide education regarding any drug alterations before they become pregnant.
AREAS OF CONTROVERSY
There is increasing debate regarding discouraging the use of diuretics. There is also controversy regarding the use of supplementations such as calcium, antioxidants and low-dose aspirin.
GROWING POINTS
A less restricted blood-pressure goal could be set for hypertensive women planning for pregnancy. A healthy body weight before pregnancy could lower the risk of pregnancy-related hypertensive disorders. Recent guidelines also encourage women with chronic hypertension to keep their dietary sodium intake low, either by reducing or substituting sodium salt before pregnancy.
TIMELY AREAS FOR DEVELOPING RESEARCH
Large, worldwide, randomized trials should be conducted to see the outcomes for hypertensive women who take antioxidants/physical activity before pregnancy.
Topics: Antihypertensive Agents; Female; Guidelines as Topic; Humans; Hypertension; Preconception Care; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Care
PubMed: 30371746
DOI: 10.1093/bmb/ldy035 -
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 -
Hypertension (Dallas, Tex. : 1979) Sep 2020Preeclampsia and gestational hypertension are common complications of pregnancy associated with significant maternal and infant morbidity. Despite extensive research... (Randomized Controlled Trial)
Randomized Controlled Trial
Preeclampsia and gestational hypertension are common complications of pregnancy associated with significant maternal and infant morbidity. Despite extensive research evaluating risk factors during pregnancy, most women who develop a hypertensive disorder of pregnancy are not considered high-risk and strategies for prevention remain elusive. We evaluated preconception blood pressure and its change into early pregnancy as novel risk markers for development of a hypertensive disorder of pregnancy. The EAGeR (Effects of Aspirin in Gestation and Reproduction) trial (2007-2011) randomized 1228 healthy women with a history of pregnancy loss to preconception-initiated low-dose aspirin versus placebo and followed participants for up to 6 menstrual cycles attempting pregnancy and throughout pregnancy if they became pregnant. Blood pressure was measured during preconception and throughout early gestation. The primary outcomes, preterm preeclampsia, term preeclampsia, and gestational hypertension, were abstracted from medical records. Among 586 women with a pregnancy >20 weeks' gestation, preconception blood pressure levels were higher for preterm preeclampsia (87.3±6.7 mm Hg mean arterial pressure), term preeclampsia (88.3±9.8 mm Hg), and gestational hypertension (87.9±9.1 mm Hg) as compared with no hypertensive disorder of pregnancy (83.9±8.6 mm Hg). Change in blood pressure from preconception into very early pregnancy was associated with development of preeclampsia (relative risk, 1.13 [95% CI, 1.02-1.25] per 2 mm Hg increase in mean arterial pressure at 4 weeks' gestation), particularly preterm preeclampsia (relative risk, 1.21 [95% CI, 1.01-1.45]). Randomization to aspirin did not alter blood pressure trajectory or risk of hypertension in pregnancy. Preconception blood pressure and longitudinal changes during early pregnancy are underexplored but crucial windows in the detection and prevention of hypertensive disorders of pregnancy. Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00467363.
Topics: Adult; Aspirin; Blood Pressure Determination; Drug Monitoring; Early Diagnosis; Female; Humans; Hypertension, Pregnancy-Induced; Platelet Aggregation Inhibitors; Pre-Eclampsia; Preconception Care; Pregnancy; Pregnancy Trimester, First; Preventive Health Services
PubMed: 32755413
DOI: 10.1161/HYPERTENSIONAHA.120.14875 -
Fertility and Sterility Jan 2021
Topics: Blood Glucose; Cohort Studies; Female; Fertility; Humans; Preconception Care; Pregnancy; Singapore
PubMed: 33413961
DOI: 10.1016/j.fertnstert.2020.10.062 -
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