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American Journal of Obstetrics &... Mar 2022In the United States, approximately 52,000 women per year (accounting for 1.46% of births) experience severe maternal morbidity, which is defined as a complication that...
BACKGROUND
In the United States, approximately 52,000 women per year (accounting for 1.46% of births) experience severe maternal morbidity, which is defined as a complication that causes significant maternal harm or risk of death. It disproportionately affects women from racial or ethnic minorities, people with chronic diseases, and those with Medicaid or no insurance. Preconception care has been hailed as a strategy to improve pregnancy outcomes and reduce disparities, but its broad benefits for maternal outcomes have not been demonstrated.
OBJECTIVE
Our objective was to measure the association between preconception care and the odds of severe maternal morbidity among women with Medicaid.
STUDY DESIGN
This is a secondary analysis of Medicaid claims using the Medicaid Analytic Extract files (2010-2012). We used the International Classification of Diseases, Ninth Revision codes, published by the US Office of Population Affairs' Quality Family Planning program to define 7 domains of preconception care. The primary outcome was maternal death within 12 weeks of delivery or severe maternal morbidity during birth hospitalization, defined by the presence of any diagnosis or procedure on the severe maternal morbidity International Classification of Diseases, Ninth Revision code list from the Centers for Disease Control and Prevention. Because this list may overestimate severe maternal morbidity by counting any blood transfusion, our secondary outcome used the same code list but without transfusion. We reviewed care in the year before conception and used logistic regression to estimate the association between each domain and severe maternal morbidity for all births to women enrolled in Medicaid and aged 15 to 45 years with births during 2012. We performed a subgroup analysis for women with chronic disease (kidney disease, hypertension, or diabetes).
RESULTS
Severe maternal morbidity or death occurred in 26,285 births (1.74%) when including blood transfusions and 9,481 births (0.63%) when excluding transfusions. Receiving contraceptive services in the year before conception was associated with decreased odds of severe maternal morbidity (adjusted odds ratio, 0.92; 95% confidence interval, 0.88-0.95) and pregnancy test services were associated with increased odds (adjusted odds ratio, 1.08; 95% confidence interval, 1.01-1.14). In the primary analysis, no significant associations were observed for other preconception care domains. Among those women with at least 1 chronic disease, contraceptive care (adjusted odds ratio, 0.84; 95% confidence interval, 0.75-0.95) and routine physical or gynecologic exams (adjusted odds ratio, 0.79; 95% confidence interval, 0.71-0.88) were associated with decreased odds of severe maternal morbidity. Similar associations were found for severe maternal morbidity when excluding blood transfusion.
CONCLUSIONS
Contraceptive services in the year before conception and routine exams for women with chronic disease are associated with decreased odds of severe maternal morbidity or death for Medicaid enrollees.
Topics: Blood Transfusion; Contraceptive Agents; Female; Hospitalization; Humans; Male; Preconception Care; Pregnancy; Pregnancy Outcome; United States
PubMed: 34871778
DOI: 10.1016/j.ajogmf.2021.100549 -
The British Journal of General Practice... Apr 2022
Topics: Female; Health Status; Humans; Preconception Care; Pregnancy; Prenatal Care; Primary Health Care
PubMed: 35361583
DOI: 10.3399/bjgp22X718853 -
Reproductive Health Sep 2014The notion of preconception care aims to target the existing risks before pregnancy, whereby resources may be used to improve reproductive health and optimize knowledge... (Review)
Review
The notion of preconception care aims to target the existing risks before pregnancy, whereby resources may be used to improve reproductive health and optimize knowledge before conceiving. The preconception period provides an opportunity to intervene earlier to optimize the health of potential mothers (and fathers) and to prevent harmful exposures from affecting the developing fetus. These interventions include birth spacing and preventing teenage pregnancy, promotion of contraceptive use, optimization of weight and micronutrient status, prevention and management of infectious diseases, and screening for and managing chronic conditions. Given existing interventions and the need to organize services to optimize delivery of care in a logical and effective manner, interventions are frequently co-packaged or bundled together. This paper highlights packages of preconception interventions that can be combined and co-delivered to women through various delivery channels and provides a logical framework for development of such packages in varying contexts.
Topics: Delivery of Health Care, Integrated; Female; Health Promotion; Humans; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Reproductive Health
PubMed: 25415178
DOI: 10.1186/1742-4755-11-S3-S7 -
Journal of Obstetrics and Gynaecology... Jul 2018To provide a comprehensive review and evidence-based recommendations for the delivery of fertility care to women with obesity.
OBJECTIVE
To provide a comprehensive review and evidence-based recommendations for the delivery of fertility care to women with obesity.
OUTCOMES
The impact of obesity on fertility, fertility treatments, and both short and long-term maternal fetal outcomes was carefully considered.
EVIDENCE
Published literature was reviewed through searches of MEDLINE and CINAHL using appropriate vocabulary and key words. Results included systematic reviews, clinical trials, observational studies, clinical practice guidelines, and expert opinions.
VALUES
The Canadian Fertility & Andrology Society (CFAS) is a multidisciplinary, national non-profit society that serves as the voice of reproductive specialists, scientists, and allied health professionals working in the field of assisted reproduction in Canada. The evidence obtained for this guideline was reviewed and evaluated by the Clinical Practice Guideline (CPG) Committee of the CFAS under the leadership of the principal authors.
BENEFITS, HARMS, AND COSTS
The implementation of these recommendations should assist clinicians and other health care providers in counselling and providing reproductive care to women with obesity.
VALIDATION
This guideline and its recommendations have been reviewed and approved by the membership, the CPG Committee and the Board of Directors of the CFAS.
SPONSORS
Canadian Fertility & Andrology Society.
RECOMMENDATIONS
Twenty-one evidence based recommendations are provided. These recommendations specifically evaluate the impact of obesity on natural fertility, fertility treatments, and maternal-fetal outcomes. Strategies to lose weight and BMI cut-offs are also addressed.
Topics: Canada; Female; Humans; Obesity; Preconception Care; Pregnancy; Pregnancy Complications; Reproductive Techniques, Assisted; Societies, Medical
PubMed: 29921431
DOI: 10.1016/j.jogc.2018.04.030 -
Cold Spring Harbor Perspectives in... Feb 2013The thalassemias are among the most common inherited diseases worldwide, affecting individuals originating from the Mediterranean area, Middle East, Transcaucasia,... (Review)
Review
The thalassemias are among the most common inherited diseases worldwide, affecting individuals originating from the Mediterranean area, Middle East, Transcaucasia, Central Asia, Indian subcontinent, and Southeast Asia. As the diseases require long-term care, prevention of the homozygous state constitutes a major armament in the management. This article discusses the major prevention programs that are set up in many countries in Europe, Asia, and Australia, often drawing from the experience in Sardinia. These comprehensive programs involve carrier detections, molecular diagnostics, genetic counseling, and prenatal diagnosis. Variability of clinical severity can be attributable to interactions with α-thalassemia and mutations that increase fetal productions. Special methods that are currently quite expensive and not widely applicable are preimplantation and preconception diagnosis. The recent successful studies of fetal DNA in maternal plasma may allow future prenatal diagnosis that is noninvasive for the fetus.
Topics: Cost of Illness; Female; Forecasting; Genetic Counseling; Genetic Testing; Global Health; Health Education; Health Promotion; Humans; Molecular Diagnostic Techniques; Phenotype; Preconception Care; Pregnancy; Prenatal Diagnosis; Prognosis; Thalassemia
PubMed: 23378598
DOI: 10.1101/cshperspect.a011775 -
Reproductive Health Sep 2014Infections can impact the reproductive health of women and hence may influence pregnancy related outcomes for both the mother and the child. These infections range from... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Infections can impact the reproductive health of women and hence may influence pregnancy related outcomes for both the mother and the child. These infections range from sexually transmitted infections (STIs) to TORCHS infections to periodontal disease to systemic infections and may be transmitted to the fetus during pregnancy, labor, delivery or breastfeeding.
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
Preconception behavioral interventions significantly declines re-infection or new STI rates by 35% (95% CI: 20-47%). Further, condom use has been shown to be the most effective way to prevent HIV infection (85% protection in prospective studies) through sexual intercourse. Intervention trials showed that preconception vaccination against tetanus averted a significant number of neonatal deaths (including those specifically due to tetanus) when compared to placebo in women receiving more than 1 dose of the vaccine (OR 0.28; 95% CI: 0.15-0.52); (OR 0.02; 95% CI: 0.00-0.28) respectively.
CONCLUSION
Preconception counseling should be offered to women of reproductive age as soon as they test HIV-positive, and conversely women of reproductive age should be screened with their partners before pregnancy. Risk assessment, screening, and treatment for specific infections should be a component of preconception care because there is convincing evidence that treatment of these infections before pregnancy prevents neonatal infections.
Topics: Female; HIV Infections; Humans; Preconception Care; Pregnancy; Pregnancy Complications, Infectious; Sexually Transmitted Diseases; Vaccination
PubMed: 25415557
DOI: 10.1186/1742-4755-11-S3-S4 -
Seminars in Reproductive Medicine Jul 2022Preconception health affects fertility, pregnancy, and future health outcomes but public awareness of this is low. Our aims were to rank priorities for preconception... (Review)
Review
Preconception health affects fertility, pregnancy, and future health outcomes but public awareness of this is low. Our aims were to rank priorities for preconception care (PCC), develop strategies to address these priorities, and establish values to guide future work in preconception healthcare in Australia. A Delphi technique involved two rounds of online voting and mid-round workshops. Inputs were a scoping review of PCC guidelines, a priority setting framework and existing networks that focus on health. During July and August, 2021, 23 multidisciplinary experts in PCC or social care, including a consumer advocate, completed the Delphi technique. Ten priority areas were identified, with health behaviors, medical history, weight, and reproductive health ranked most highly. Six strategies were identified. Underpinning values encompassed engagement with stakeholders, a life course view of preconception health, an integrated multi-sectorial approach and a need for large scale collaboration to implement interventions that deliver impact across health care, social care, policy and population health. Priority populations were considered within the social determinants of health. Health behaviors, medical history, weight, and reproductive health were ranked highly as PCC priorities. Key strategies to address priorities should be implemented with consideration of values that improve the preconception health of all Australians.
Topics: Australia; Delivery of Health Care; Delphi Technique; Female; Humans; Preconception Care; Pregnancy; Reproductive Health
PubMed: 35760312
DOI: 10.1055/s-0042-1749683 -
The Cochrane Database of Systematic... Aug 2017Infants born to mothers with pre-existing type 1 or type 2 diabetes mellitus are at greater risk of congenital anomalies, perinatal mortality and significant morbidity... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Infants born to mothers with pre-existing type 1 or type 2 diabetes mellitus are at greater risk of congenital anomalies, perinatal mortality and significant morbidity in the short and long term. Pregnant women with pre-existing diabetes are at greater risk of perinatal morbidity and diabetic complications. The relationship between glycaemic control and health outcomes for both mothers and infants indicates the potential for preconception care for these women to be of benefit. This is an update of the original review, which was first published in 2010.
OBJECTIVES
To assess the effects of preconception care in women with diabetes on health outcomes for mothers and their infants.
SEARCH METHODS
We searched Cochrane Pregnancy and Childbirth's Trials Register (31 January 2017) and reference lists of retrieved articles.
SELECTION CRITERIA
Randomised controlled trials (RCTs) assessing the effects of preconception care for diabetic women. Cluster-RCTs and quasi-RCTs were eligible for inclusion but none were identified.
DATA COLLECTION AND ANALYSIS
Two reviewers independently assessed study eligibility, extracted data and assessed the risk of bias of the included studies. We checked data for accuracy and assessed the quality of the evidence using the GRADE approach.
MAIN RESULTS
We included three trials involving 254 adolescent girls with type 1 or type 2 diabetes, with an overall unclear to high risk of bias. The three trials were conducted at diabetes clinics in the USA, and assessed the READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls) programme versus standard care.Considering primary outcomes, one trial reported no pregnancies in the trial period (12 months) (very low-quality evidence, with downgrading based on study limitations (risk of bias) and imprecision); in the other two trials, pregnancy was an exclusion criterion, or was not clearly reported on. None of the trials reported on the other primary maternal outcomes, hypertensive disorders of pregnancy and caesarean section; or primary infant outcomes, large-for-gestational age, perinatal mortality, death or morbidity composite, or congenital malformations. Similarly, none of the trials reported on the secondary outcomes, for which we had planned to assess the quality of the evidence using the GRADE approach (maternal: induction of labour; perineal trauma; gestational weight gain; long-term cardiovascular health; infant: adiposity; type 1 or 2 diabetes; neurosensory disability).The majority of secondary maternal and infant outcomes, and outcomes relating to the use and costs of health services were not reported by the three included trials. Regarding behaviour changes associated with the intervention, in one trial, participants in the preconception care group had a slightly higher score for the actual initiation of discussion regarding preconception care with healthcare providers at follow-up (nine months), compared with those in the standard care group (mean difference 0.40, 95% confidence interval -0.02 to 0.82 (on a scale of 0 to 4 points); participants = 87) (a summation of four dichotomous items; possible range 0 to 4, with 0 being no discussion).
AUTHORS' CONCLUSIONS
There are insufficient RCT data available to assess the effects of preconception care for diabetic women on health outcomes for mothers and their infants.More high-quality evidence is needed to determine the effects of different protocols of preconception care for diabetic women. Future trials should be powered to evaluate effects on short- and long-term maternal and infant outcomes, and outcomes relating to the use and costs of health services. We have identified three ongoing studies that we will consider in the next review update.
Topics: Adolescent; CD-ROM; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Glycated Hemoglobin; Humans; Intention to Treat Analysis; Patient Education as Topic; Preconception Care; Pregnancy; Randomized Controlled Trials as Topic; Young Adult
PubMed: 28799164
DOI: 10.1002/14651858.CD007776.pub3 -
Sexual & Reproductive Healthcare :... Dec 2017Pregnancy is often framed as a "window of opportunity" for intervening on a variety of health practices such as alcohol and tobacco use. However, there is evidence that... (Review)
Review
Pregnancy is often framed as a "window of opportunity" for intervening on a variety of health practices such as alcohol and tobacco use. However, there is evidence that interventions focusing solely on the time of pregnancy can be too narrow and potentially stigmatizing. Indeed, health risks observed in the preconception period often continue during pregnancy. Using a scoping review methodology, this study consolidates knowledge and information related to current preconception and interconception health care interventions published in the academic literature. We identified a total of 29 intervention evaluations, and summarized these narratively. Findings suggest that there has been some progress in intervening on preconception health, with the majority of interventions offering assessment or screening followed by brief intervention or counselling. Overall, these interventions demonstrated improvements in at least some of the outcomes measured. However, further preconception care research and intervention design is needed. In particular, the integration of gender transformative principles into preconception care is needed, along with further intervention design for partners/ men, and more investigation on how best to deliver preconception care.
Topics: Adult; Female; Humans; Patient Education as Topic; Preconception Care; Pregnancy; Pregnancy Complications; Primary Health Care; Reproductive Health
PubMed: 29195631
DOI: 10.1016/j.srhc.2017.08.004 -
PloS One 2022There is substantial body of evidence that portrays gap in the existing maternal and child health continuum of care; one is less attention given to adolescent girls and... (Clinical Trial)
Clinical Trial
INTRODUCTION
There is substantial body of evidence that portrays gap in the existing maternal and child health continuum of care; one is less attention given to adolescent girls and young women until they get pregnant. Besides, antenatal care is too late to reduce the harmful effects that a woman's may have on the fetus during the critical period of organogenesis. Fortunately, preconception care can fill these gaps, enhance well-being of women and couples and improve subsequent pregnancy and child health outcomes. Therefore, the main aim of the current study was to assess preconception care utilization and associated factors among pregnant women attending antenatal care clinics of public health facilities in Hosanna town.
METHODS
A facility based cross-sectional study design was carried out from July 30, 2020 to August 30, 2020. Data were collected through face-to-face interview among 400 eligible pregnant women through systematic sampling technique. Epi-data version 3.1 and SPSS version 24 was used for data entry and analysis respectively. Both bivariable and multivariable logistic regression analysis was conducted to identify association between dependent and independent variables. Crude and adjusted odds ratio with respective 95% confidence intervals was computed and statistical significance was declared at p-value <0.05.
RESULT
This study revealed that 76 (19%, 95% Cl (15.3, 23.2) study participants had utilized preconception care. History of family planning use before the current pregnancy (AOR = 2.45; 95% Cl (1.270, 4.741), previous history of adverse birth outcomes (AOR = 3.15; 95% Cl (1.650, 6.005), poor knowledge on preconception care (AOR = 0.18; 95% Cl (0.084, 0.379) and receiving counseling on preconception care previously (AOR = 2.82; 95% Cl (1.221, 6.493) were significantly associated with preconception care utilization.
CONCLUSIONS
The present study revealed that nearly one-fifth of pregnant women have utilized preconception care services. History of family planning use before the current pregnancy, previous history of adverse birth outcomes, poor knowledge on preconception care and receiving counseling on preconception care previously were significantly associated with preconception care utilization. Integrating preconception care services with other maternal neonatal child health, improving women's/couples knowledge & strengthening counseling services is pivotal.
Topics: Adolescent; Adult; Cross-Sectional Studies; Delivery of Health Care; Ethiopia; Family Planning Services; Female; Health Knowledge, Attitudes, Practice; Humans; Preconception Care
PubMed: 34995291
DOI: 10.1371/journal.pone.0261895