Preconception care: An essential preventive strategy to improve children's and women's health

A Scoping Review of Barriers and Facilitators for Preconception Care: Lessons for Global Health Policies and Programs

Preconception care (PCC) encompasses a set of actions taken before pregnancy to support the health and well-being of women before conception to improve maternal and child health (MCH) outcomes. The utilization of PCC services is influenced by multifaceted factors that can either enable or impede women's capacity to access and utilize them effectively. This scoping review examined the barriers and facilitators influencing the utilization of PCC services among women of reproductive age (15-49 years) at both individual and community levels. Through an extensive review of published articles from 2004 to 2021, including peer-reviewed sources, barriers and facilitators were identified. At the individual level, barriers included limited knowledge about PCC, neglect of self-health, and financial constraints. Community-level barriers encompassed insufficient supply of supplements, restricted access to health care, high health care costs, and setbacks due to delayed delivery of MCH services. Conversely, individuals reported that credible sources of information, such as friends, family, and community health volunteers, facilitated their engagement with PCC services. At the community level, facilitators included government-regulated supply chains for supplements and the involvement of community workers in health monitoring. Understanding and addressing these factors can help improve the utilization of PCC services among women of reproductive age (WRA) and improve MCH outcomes.

Racial and Socioeconomic Disparities in Preconception Health Risk Factors and Access to Care

Background: Black birthing people have significantly higher risks of maternal mortality and morbidity compared with White people. Preconception chronic conditions increase the risk of adverse pregnancy outcomes, yet little is known about disparities in preconception health. This study applies an intersectional framework to examine the simultaneous contributions of racial marginalization and economic deprivation in determining disparities in preconception risk factors and access to care. Methods: Using data from the Pregnancy Risk Assessment Monitoring System, 2016-2020 (N = 123,697), we evaluated disparities by race and income in self-reported preconception hypertension, diabetes, obesity, depression, and smoking, as well as preconception insurance coverage and utilization of health care. We estimated linear regression models and calculated predicted probabilities. Results: Black respondents experienced higher probabilities of preconception obesity and high blood pressure at every income level compared with White respondents. Higher income did not attenuate the probability of obesity for Black respondents (linear trend p = 0.21), as it did for White respondents (p < 0.001). Conversely, while White respondents with low income were at higher risk of preconception depression and smoking than their Black counterparts, higher income was strongly associated with reduced risk, with significantly steeper reductions for White compared with Black respondents (difference in trends p < 0.001 for both risk factors). White respondents had higher probabilities of utilizing preconception care across all income levels, despite similar probabilities of insurance coverage. Conclusions: Higher income does not protect against the risk of preconception obesity and other preconception risk factors for Black birthing people as it does for White birthing people. Results point to the need to consider multiple forms of intersecting structural factors in policy and intervention research to improve preconception and maternal health.

Family Planning and Preconception Care Service Management: The Key Role of Bulgarian GPs

Assisting women in attaining their reproductive goals is crucial for improving the well-being of families and children. As the first point of contact for healthcare, general practitioners (GPs) are ideal for family planning (FP) and preconception care (PCC). However, primary care interventions' efficacy is unclear. The aim of this study was to examine GPs' knowledge, attitudes, and perspectives on FP and PCC service management. Most GPs were aware of FP and PCC services and held a firm conviction that they should be primarily accountable together with obstetrician-gynaecologists. However, it is worth noting that less than 50% of respondents reported receiving thorough and comprehensive knowledge of their respective specialities. Those with general medicine qualifications demonstrated a high level of commitment to providing such services. The women's GPs and those with training in general medicine prescribed birth control pills and emergency contraception three times more frequently than the other doctors who suggested condoms or traditional methods or referred patients to another specialist (p < 0.05). In conclusion, PCC is of the utmost importance, and its effective implementation demands the collaboration of policymakers, healthcare providers, and individuals. GPs are essential in managing FP and PCC. They must incorporate more in-depth PCC into their clinical practice.

Preconception Care Interventions for Adolescents and Young Adults to Prevent Adverse Maternal and Child Health Outcomes: Protocol for an Evidence Gap Map

BACKGROUND

Preconception is the period before a young woman or woman conceives, which draws attention to understanding how her health condition and certain risk factors affect her and her baby's health once she becomes pregnant. Adolescence and youth represent a life-course continuum between childhood and adulthood, in which the prepregnancy phase lacks sufficient research.

OBJECTIVE

The aim of the study is to identify, map, and describe existing empirical evidence on preconception interventions that enhance health outcomes for adolescents, young adults, and their offspring.

METHODS

We will conduct an evidence gap map (EGM) activity following the Campbell guidelines by populating searches identified from electronic databases such as MEDLINE, Embase, CINAHL, and Cochrane Library. We will include interventional studies and reviews of interventional studies that report the impact of preconception interventions for adolescents and young adults (aged 10 to 25 years) on adverse maternal, perinatal, and child health outcomes. All studies will undergo title or abstract and full-text screening on Covidence software (Veritas Health Innovation). All included studies will be coded using the Evidence for Policy and Practice Information (EPPI) Reviewer software (EPPI Centre, UCL Social Research Institute, University College London). Cochrane Risk of Bias tool 2.0 and Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2) tool will be used to assess the quality of the included trials and reviews. A 2D graphical EGM will be developed using the EPPI Mapper software (version 2.2.4; EPPI Centre, UCL Social Research Institute, University College London).

RESULTS

This EGM exercise began in July 2023. Through electronic search, 131,031 publications were identified after deduplication, and after the full-text screening, 18 studies (124 papers) were included in the review. We plan to submit the paper to a peer-reviewed journal once it is finalized, with an expected completion date in May 2024.

CONCLUSIONS

This study will facilitate the prioritization of future research and allocation of funding while also suggesting interventions that may improve maternal, perinatal, and child health outcomes.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56052.

Maternal lipid levels in early pregnancy as a predictor of childhood lipid levels: a prospective cohort study

Background

Maternal lipid levels in early pregnancy are associated with maternal health and foetal growth. It is however unclear if maternal lipids in early pregnancy can be used to predict childhood lipid levels. The aim of this study is to assess the association between maternal and offspring childhood lipid levels, and to investigate the influence of maternal BMI and diet on these associations.

Methods

This study included 2692 women participating in the Generation R study, an ongoing population-based prospective cohort study from early life onwards. Women with an expected delivery date between 2002 and 2006 living in Rotterdam, the Netherlands were included. Total cholesterol, triglycerides and high-density lipoprotein cholesterol (HDL-c) were measured in early pregnancy (median 13.2 weeks [90% range 10.6; 17.1]). Low-density lipoprotein cholesterol (LDL-c), remnant cholesterol and non-HDL-c were calculated. Corresponding lipid measurements were determined in 2692 children at the age of 6 (median 6.0 years [90% range 5.7; 7.5]) and 1673 children 10 years (median 9.7 years [90% range 9.5; 10.3]). Multivariate linear regression analysis was used to examine the association between maternal lipid levels in early pregnancy and the corresponding childhood lipid measurements at the ages of 6 and 10 years while adjusting for confounders.

Results

Maternal lipid levels in early pregnancy are positively associated with corresponding childhood lipid levels 6 and 10 years after pregnancy, independent of maternal body mass index and diet.

Conclusions

Maternal lipid levels in early pregnancy may provide an insight to the lipid profile of children years later. Gestational lipid levels may therefore be used as an early predictor of children’s long-term health. Monitoring of these gestational lipid levels may give a window-of-opportunity to start early interventions to decrease offspring’s lipid levels and possibly diminish their cardiovascular risk later in life. Future studies are warranted to investigate the genetic contribution on maternal lipid levels in pregnancy and lipid levels of their offspring years later.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04905-7.

The effect of a locally tailored intervention on the uptake of preconception care in the Netherlands: a stepped-wedge cluster randomized trial (APROPOS-II study)

BACKGROUND

The preconception period provides a window of opportunity for interventions aiming to reduce unhealthy lifestyle behaviours and their negative effect on pregnancy outcomes. This study aimed to assess the effectiveness of a locally tailored preconception care (PCC) intervention in a hybrid-II effectiveness implementation design.

METHODS

A stepped-wedge cluster randomized controlled trial was performed in four Dutch municipalities. The intervention contained a social marketing strategy aiming to improve the uptake (prospective parents) and the provision (healthcare providers) of PCC. Prospective parents participated by administering a questionnaire in early pregnancy recalling their preconceptional behaviours. Experiences of healthcare providers were also evaluated through questionnaires. The composite primary outcome was adherence to at least three out of four preconceptional lifestyle recommendations (early initiation of folic acid supplements, healthy nutrition, no smoking or alcohol use). Secondary outcomes were preconceptional lifestyle behaviour change, (online) reach of the intervention and improved knowledge among healthcare providers.

RESULTS

A total of 850 women and 154 men participated in the control phase and 213 women and 39 men in the intervention phase. The composite primary outcome significantly improved among women participating in the municipality where the reach of the intervention was highest (Relative Risk (RR) 1.57 (95% Confidence Interval (CI) 1.11-2.22). Among women, vegetable intake had significantly improved in the intervention phase (RR 1.82 (95%CI 1.14-2.91)). The aimed online reach- and engagement rate of the intervention was achieved most of the time. Also, after the intervention, more healthcare providers were aware of PCC-risk factors (54.5% vs. 47.7%; p = 0.040) and more healthcare providers considered it easier to start a conversation about PCC (75.0% vs. 47.9%; p = 0.030).

CONCLUSION

The intervention showed some tentative positive effects on lifestyle behaviours among prospective parents. Primarily on vegetable intake and the knowledge and competence of healthcare providers. The results of this study contribute to the evidence regarding successfully implementing PCC-interventions to optimize the health of prospective parents and future generations.

TRIAL REGISTRATION

Dutch Trial Register: NL7784 (Registered 06/06/2019).

Factors Influencing Provider Behavior Around Delivery of Preconception Care

OBJECTIVE

Despite growing consensus about the clinical value of preconception care (PCC), gaps and disparities remain in its delivery. This study aimed to examine the factors influencing behavior of health care providers around PCC in outpatient clinical settings in the United States.

METHODS

Twenty health care providers who serve people of reproductive age were interviewed using semi-structured interviews. Data was coded based on a modified Theoretical Domains Framework and analyzed using deductive content analysis.

RESULTS

We interviewed eight family medicine physicians, four obstetricians/gynecologists, seven nurse practitioners, and one nurse midwife. Overall, we found a wide variety in practices and attitudes towards PCC. Barriers and challenges to delivering PCC were shared across sites. We identified six themes that influenced provider behavior around PCC: (1) lack of knowledge of PCC guidelines, (2) perception of lack of preconception patient contact, (3) pessimism around patient "compliance," (4) opinion about scope of practice, (5) clinical site structure, and (6) reliance on the patient/provider relationship.

CONCLUSIONS FOR PRACTICE

Overall, our findings call for improved provider understanding of PCC and creative incorporation into current health care culture and practice. Given that PCC-specific visits are perceived by some as outside the norm of clinical offerings, providers may need to incorporate PCC into other encounters, as many in this study reported doing. We amplify the call for providers to understand how structural inequities may influence patient behavior and the value of standardized screening, within and beyond PCC, as well as examination of implicit and explicit provider bias.

Knowledge of pre-conception health and planned pregnancy among married women in Jinka town, southern Ethiopia and factors influencing knowledge

Background

Optimizing women’s health and knowledge of preconception healthcare before conceiving a pregnancy decreases the risk of adverse pregnancy outcomes. However, preconception health care is one of the missing pillars in the continuum of maternal and child health care in Ethiopia. Therefore, this study aimed to assess knowledge of pre-conception health, its relation to planned pregnancy, parity, family planning use, and education among married women in Southern Ethiopia.

Methods

A community-based cross-sectional study was conducted with 337 married women recruited from March 25 to April 30, 2018 in Jinka town. A simple random sampling technique was employed and the data was collected using a structured questionnaire. Data analysis involved calculating frequencies, percentages, and logistic regression. Associations were assessed using odds ratios and 95% confidence intervals with statistical significance determined at a p-value < 0.05.

Results

The overall women’s preconception health care knowledge score in this study was 55.2%, which is a moderate score. In multivariable analyses, women’s secondary level of education [AOR = 2.3; 95% CI = 1.13–4.87], family planning use [AOR = 2.6, 95% CI = 1.37–4.87], planned pregnancy [AOR = 3.2, 95% CI = 1.35–7.44], Nullyparity [AOR = 21.2; 95% CI = 4.92–91.5], and market trade vendors [AOR = 2.5; 95%CI = 1.06–6.03], were significantly associated with knowledge of preconception health care.

Conclusion

The findings show that women’s knowledge of preconception health care is moderate. Women’s knowledge of preconception health care can be linked to their level of education, use of family planning methods, pregnancy planning, and Nullyparity. Therefore, the government and other key stakeholders need to develop a specific education package that improves women’s knowledge of preconception care and pregnancy planning, taking into account factors such as levels of education and literacy when designing implementation strategies.

Preconception and Diabetes Information (PADI) App for Women with Pregestational Diabetes: a Feasibility and Acceptability Study

Diabetes mellitus increases the risk of adverse maternal and fetal outcomes. Preconception care is vital to minimise complications; however, preconception care service provision is hindered by inadequate knowledge, resources and care fragmentation. Mobile health technology, particularly smartphone apps, could improve preconception care and pregnancy outcomes for women with diabetes. The aim of this study is to co-create a preconception and diabetes information app with healthcare professionals and women with diabetes and explore the feasibility, acceptability and preliminary effects of the app. A mixed-methods study design employing questionnaires and semi-structured interviews was used to assess preliminary outcome estimates (preconception care knowledge, attitudes and behaviours), and user acceptability. Data analysis included thematic analysis, descriptive statistics and non-parametric tests. Improvements were recorded in knowledge and attitudes to preconception care and patient activation measure following the 3-month app usage. Participants found the app acceptable (satisfaction rating was 72%), useful and informative. The app's usability and usefulness facilitated usage while manual data input and competing priorities were barriers which participants felt could be overcome via personalisation, automation and use of daily reminders. This is the first study to explore the acceptability and feasibility of a preconception and diabetes information app for women with diabetes. Triangulated data suggest that the app has potential to improve preconception care knowledge, attitudes and behaviours. However, in order for women with DM to realise the full potential of the app intervention, particularly improved maternal and fetal outcomes, further development and evaluation is required.

Health Agency and Perfectionism: The Case of Perinatal Health Inequalities

Poor pregnancy outcomes and inequalities in these outcomes remain a major challenge, even in prosperous societies that have high-quality health care and public health policy in place. In this article, we propose that justice demands the improvement of what we call the ‘health agency’ of parents-to-be as part of a response to these poor outcomes. We take health agency to have three aspects: (i) the capacity to form health-goals one has reason to value, (ii) the control one perceives to have over achieving those health-goals and (iii) the freedom(s) one has to achieve those health-goals. We will moreover argue that this demand of justice can be best based on a perfectionist rather than neutralist method of justification. Subsequently, we will argue that perfectionist policy may be paternalistic but not wrongfully paternalistic. This leads us to conclude that perfectionism should be adopted to inform and justify public health policy that is aimed at improving health agency in general and counteracting poor pregnancy outcomes and inequalities in perinatal health outcomes in particular.

Determinants of practice of preconception care among women of reproductive age group in southern Ethiopia, 2020: content analysis

BACKGROUND

Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for desired outcomes. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to assess the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020.

METHODS

A community-based cross-sectional study was conducted from February 1 to 30, 2020. A total of 600 mothers who have given birth in the last 12 months have been randomly selected. A two-stage sampling technique was employed. For data collection, a pre-tested, semi-structured questionnaire was used. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. Household wealth status was determined through the application of principal component analysis(PCA). The practice PCC was considered as a count variable and measured as a minimum score of 0 and a maximum of 10. A bivariable statistical analysis was performed through analysis of variance (ANOVA) and independent t-tests and variables with a p-value of < 0.05 were eligible for the generalized linear regression model. To see the weight of each explanatory variable on PCC utilization, generalized linear regression with a Poisson link was done.

RESULTS

Of the sampled 600 participants, 591 took part in the study, which yielded a response rate of 98.8%.The mean (± SD) score of the practice of PCC was 3.94 (± 1.98) with minimum and maximum scores of 0 and 10 respectively. Only 6.4% (95%CI: 4.6, 8.6) of mothers received all selected items of PCC services. Thecommonest item received by 67.2% of mothers was Folic acid supplementation, while 16.1% of mothers received the least item of optimizing psychological health. Education status of mother[AOR 0.74, 95%CI 0.63, 0.97], time spent to access nearby health facilities [AOR 0.69, 95%CI 0.58, 0.83], availability of PCC unit [AOR 1.46; 95%CI 1.17, 1.67], mother's knowledge on PCC [AOR 1.34, 95%CI 1.13, 1.65], being a model household [AOR 1.31, 95%CI 1.18, 1.52] and women's autonomy in decision making [AOR 0.75, 95%CI 0.64, 0.96] were identified as significant predictors of practice of PCC.

CONCLUSION

The uptake of WHO-recommended PCC service elements in the current study area was found to be unsatisfactory. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. Plain language summary Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for better endings. The main goal of the PCC is to improve maternal and child health outcomes, by-promoting wellness and providing preventive care. It can also be seen as an earlier chance for teenage girls, mothers, and children to live a better and longer-term healthy life. Pieces of PCC service packages suggested by the World Health Organization(WHO) are, micronutrient supplementation (Folate supplementation), infectious disease (STI/HIV) screening and testing, chronic disease screening and management, healthy diet therapy, vaccination, prevention of substance use (cessation of cigarette smoking and too much alcohol consumption), optimizing psychological health, counseling on the importance of exercise and reproductive health planning and implementation. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to evaluate the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Mothers who have given birth in the last 12 months have been randomly selected Household wealth status was determined through the application of principal component analysis(PCA). To see the weight of each explanatory variable on PCC, generalized linear regression with a Poisson type was done. Accordingly, the Education status of the mother, time spent to access nearby health facilities, availability of PCC unit, mother's knowledge on PCC, being a model household, and women's autonomy in decision making were identified as significant predictors of practice of PCC. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice.

Improving the health of young African American women in the preconception period using health information technology: a randomised controlled trial

BACKGROUND

Preconception care focuses on improving women's health before pregnancy as a means to improve their health and future pregnancy outcomes. How to effectively deliver such care is unknown. The aim of this research was to assess the impact of an embodied conversational agent system on preconception risks among African American and Black women.

METHODS

We did an open-label, randomised controlled trial of women aged 18-34 years, self-identified as African American or Black, or both, and not pregnant, recruited from 35 states in the USA. Sealed allocation envelopes (in permuted blocks of six and eight, prepared using a random number generator) were opened after enrolment. Intervention participants received an online conversational agent called Gabby that assessed 102 preconception risks and delivered 12 months of tailored dialogue using synthesised speech, non-verbal behaviour, visual aids, and health behaviour change techniques such as motivational interviewing. The control group received a letter listing their preconception risks and encouraging them to talk with a clinician. The primary outcome was the proportion of identified risks at the action or maintenance stage of change at months 6 and 12. The study is registered with ClinicalTrials.gov, NCT01827215.

FINDINGS

From March 11, 2014, through July 8, 2018, 528 women recruited from 35 states and 242 cities across the USA received the Gabby intervention (n=262) or were assigned to the control group (n=266). Participants identified a mean of 21 preconception risks per woman (SD 9·9). In the intention-to-treat analysis, at 6 months, intervention women reported reaching the action or maintenance stage of change for 50·0% (SD 28·9) of those preconception risks identified compared with 42·7% (28·3) in the control group (incidence rate ratio 1·16, 95% CI 1·07-1·26; p=0·0004). This result persisted at 12 months.

INTERPRETATION

The Gabby system has the potential to improve women's preconception health. Further research is needed to determine if improving preconception risks impacts outcomes such as preterm delivery.

FUNDING

National Institute for Minority Health and Health Disparities.

Why do women not prepare for pregnancy? Exploring women's and health care providers' views on barriers to uptake of preconception care in Mana District, Southwest Ethiopia: a qualitative study

Background

Preconception care has the potential to reduce maternal and child morbidities and mortalities. It is a window of opportunity to timely alter or eliminate risk factors for adverse pregnancy outcomes. However, despite strong evidence on the effectiveness of preconception care in safeguarding maternal and child health, its uptake remains low. Therefore, this study aimed to explore barriers to the uptake of preconception care.

Methods

A descriptive qualitative study was conducted in Mana district, Jimma Zone, Oromia region, Southwest Ethiopia from March 02 to April 10, 2019. A purposive sampling approach was used, and 13 key informant interviews (6 in rural and 7 in urban areas) were held with women of different age groups, health extension workers, and health care providers of different professions. In addition, 4 focused group discussions with women of reproductive age groups (two with rural women only and two with urban women only) were conducted. The data were collected by trained experts using semi-structured guides. An inductive process of thematic analysis was employed and the data were coded, categorized, and thematized using Atlas ti version 7.0.71 software.

Results

Four women of reproductive age groups, 1 older woman (grandmother), 2 health extension workers, and 6 health care providers of different professions were interviewed. In addition, a total of 38 women of reproductive age groups participated in the 4 focused group discussions: 20 in the two rural-focused group discussions and 18 in the two urban-focused group discussions. The findings indicated the presence of many barriers affecting the uptake of preconception care and organized into five themes: women-related barriers, husband-related barriers, community-related barriers, health-service-related barriers, and media-related barriers.

Conclusions

This study found a diverse array of potentially modifiable barriers to the uptake of preconception care. The findings imply the importance of scaling up health education and counseling, establishing preconception care strategies and functional units that can address all the components at all levels of health care facilities. Therefore, we recommend all stakeholders, such as program planners and managers, non-governmental organizations, media personnel, and health care providers to work in collaboration to increase the uptake of preconception care.

Promotion of Preconception Care Among Adolescents and Young Adults by Conversational Agent

PURPOSE

Preconception care is important for all women to improve infant and maternal health outcomes and may be especially important for adolescents and young adults. This study assesses the acceptance, usability, and use of an automated intervention to screen women on 108 preconception care risks and address them over the course of a year via a Web-based virtual animated health counselor and compares these measures for the adolescent and young adult users aged 18-25 years with those of users aged 26-34 years. We hypothesize that the younger cohort will have significantly greater use of and satisfaction with the online intervention.

METHODS

A randomized controlled trial involving a national sample of 528 women was conducted. We present a secondary data analysis on the system use and self-reported usability and satisfaction of the 79 women aged 18-25 years randomized to the intervention group, compared with the 183 women aged 26-34 years in the intervention group. Participants were required to self-identify as female, black or African American, aged 18-34 years, not pregnant, and English-speaking and were recruited through a variety of advertisements and outreach activities.

RESULTS

Of the adolescent and young adult participants (aged 18-25 years) enrolled and randomized to the intervention, 20.25% of participants accessed the system 0 times; 29.11%, 1-3 times; and 50.63%, >3 times over the course of a year. At the end of the year, almost all (96.4%) indicated they had either acted on recommendations made by the agent or planned to. Most (75.0%) said they would recommend the system to someone they knew. There were no significant differences between the two age groups on intervention use or satisfaction.

CONCLUSIONS

Web-based conversational agents are a viable medium for delivering longitudinal preconception care counseling to adolescents and young adults.

What do women know before getting pregnant? Knowledge of preconception care and associated factors among pregnant women in Mana district, Southwest Ethiopia: a community-based cross-sectional study

OBJECTIVE

To assess knowledge of preconception care and associated factors among pregnant women in Mana district, Jimma zone, Oromia Region, Southwest Ethiopia, in 2019.

DESIGN

A community-based cross-sectional study was conducted from 2 March to 10 April 2019.

SETTING

The study was conducted in Mana district. Eight rural Gandas and one urban Ganda were included in the study.

PARTICIPANTS

Out of 715 pregnant women in the selected rural Gandas, 553 participated in the study, whereas 70 out of 88 were recruited from the urban Ganda. A total of 623 pregnant women participated in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Women's knowledge of preconception care was determined. Descriptive statistics were calculated as necessary. Logistic and linear regression analyses were used to identify the association of women's knowledge of preconception care with explanatory variables.

RESULTS

Among 623 respondents, 133 (21.3%) of pregnant women had good knowledge of preconception care. Multivariable linear regression analysis showed that women who attended secondary and above education (β=3.6; p<0.001) and those for whom their husbands attended secondary and above education (β=2.3; p=0.001), planned pregnancy status (β=1.2; p=0.005), being on follow-up for pre-existing medical illnesses (β=1.5; p=0.014) and having four or more antenatal care visits (β=0.4; p=0.016) were significantly associated with women's knowledge of preconception care.

CONCLUSION

The findings imply that providing health education and health promotion for women is important to improve their level of knowledge of preconception care.

Relationship between stunting in children 6 to 36 months of age and maternal employment status in Peru: A sub-analysis of the Peruvian Demographic and Health Survey

Objectives

This study aimed to determine the relationship between stunting in children 6 to 36 months old and maternal employment status in Peru.

Methods

A secondary data analysis was conducted using information from the Demographic and Health Survey (DHS) in Peru. We used a representative sample of 4637 mother-child binomials to determine the association between stunting in children 6 to 36 months of age and the employment status of their mothers.

Results

The prevalence of stunting among children was 15.9% (95% CI: 13.9–16.7). The prevalence of working mothers was 63.7%. No association was found between maternal employment status and the presence of stunting in children [prevalence ratio (PR) = 1.04; 95% confidence interval (95% CI): 0.9 to 1.2; p = 0.627). However, on multivariate analysis we found that the prevalence of stunting was significantly higher among children of mothers performing unpaid work (12.4%) (PR = 1.38; 95% CI: 1.2–1.6; p < 0.001) compared with those of paid working mothers.

Conclusion

No significant association was found between maternal employment status and the presence of stunting in children 6 to 36 months of age. However, children of mothers doing unpaid work are at higher risk of stunting. These findings support the implementation of educational programs and labour policies to reduce the prevalence of stunting among children.

Barriers in the Uptake and Delivery of Preconception Care: Exploring the Views of Care Providers

Objectives To examine health care professionals’ views of their role and responsibilities in providing preconception care and identify barriers that affect the delivery and uptake of preconception care. Methods Twenty health care professionals who provide preconception care on a regular basis were interviewed using semi-structured interviews. Results We interviewed twelve community midwives, three General Practitioners, three obstetricians, one cardiologist specialized in congenital heart diseases and one gastroenterologist.We identified four barriers affecting the uptake and delivery of preconception care (PCC): (1) lack of a comprehensive preconception care program; (2) limited awareness of most future parents about the benefits of preconception care, hesitance of GP’s about the necessity and effectiveness of PCC; (3) poor coordination and organization of preconception care; (4) conflicting views of health care professionals on pregnancy, reproductive autonomy of patients and professional responsibility. Conclusion We have identified four barriers in the uptake and delivery of preconception care. Our findings support the timely implementation of a comprehensive program of PCC (already advocated by the Health Council of the Netherlands) and increasing awareness and knowledge of PCC from care providers and future parents. We emphasize the need for further research on how organizational barriers lead to suboptimal PCC and how interdisciplinary collaboration and referral can lead to optimally tailored intervention approaches.

The effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care

PURPOSE

The objective of this study was to investigate the effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care (PCC).

MATERIAL AND METHODS

This quasi-comparative study was carried out between February 2015 and February 2016 at a community midwifery practice in the Netherlands. The intervention consisted of a dual track approach (i) a promotional campaign for couples who wish to conceive and (ii) a PCC pathway for health care providers. Questionnaires were collected from a sample of women who received antenatal care during the pre-intervention (n = 283) and post-intervention (n = 257) period. Main outcome measures were preconceptional lifestyle changes and PCC use (defined as searching for information and/or consulting a health care provider).

RESULTS

Women who were exposed to the intervention were significantly more likely to make at least one lifestyle change during the preconception period [adjusted OR 1.56 (95% CI 1.02-2.39)]. Women were especially more likely to preconceptionally reduce or quit [adjusted OR 1.72 (95% CI 1.05-2.83)] their alcohol consumption after exposure to the intervention. Although non-significant, it appeared that women who were exposed to the intervention more often prepared themselves for pregnancy by means of independently searching for preconception health information [adjusted OR 1.13 (95% CI 0.77-1.65)] or consulting a health care provider regarding their wish to conceive [adjusted OR 1.24 (95% CI 0.81-1.92)].

CONCLUSIONS

Exposure to a local promotional campaign targeted at preconceptional health was associated with improved preconceptional lifestyle behaviours, especially with regard to alcohol consumption, and has the potential to improve the use of PCC.

A systematic review of women's and health professional's attitudes and experience of preconception care service delivery

BACKGROUND

The value and importance of preconception care (PCC) have been acknowledged by leading health organizations as a vital element within preventive medicine and health promotion for the wider population. The translation of PCC from position statement to relevant service and programme delivery is essential for the benefits of PCC to be realized and relies on insights from health services research. This article aims to review contemporary health services research literature examining women's and health professionals' perceptions and experiences of PCC services.

METHODS

A systematic review of original research published between 2003 and 2015 was conducted in November 2015. Multiple databases (PubMed, CINAHL, AMED and Maternity and Infant Care) were searched through two distinct searches to capture research literature reporting the perspective of health professionals and women towards PCC service delivery.

RESULTS

The search identified 13 papers (4 reported the perceptions of women, 11 described the views of health professionals [2 papers reported findings from both groups]). The analyses of the contemporary literature revealed five broad areas of focus: women's service needs regarding PCC, PCC training and education requirements, role delineation around PCC, priority and value of PCC and barriers and obstacles to PCC.

CONCLUSIONS

Despite the mounting evidence supporting the value and importance of PCC, there is insufficient research attention given to the clinical reality of PCC service and programme delivery. The transfer of PCC guidelines from broad policy to grass roots practice requires a more detailed consideration of the practicalities of implementing PCC within contemporary women's health care.

The Relationship between Constitution of Traditional Chinese Medicine in the First Trimester and Pregnancy Symptoms: A Longitudinal Observational Study

Objective. We report on the distribution of traditional Chinese medicine (TCM) constitution in the first trimester and on the association between TCM constitution and maternal symptoms related to pregnancy. Methods. Participants were followed up until delivery to observe primary measures (gestational hypertension and gestational diabetes mellitus) and secondary measures (signs of miscarriage, miscarriage, nausea and vomiting, and sleepiness and defecation during pregnancy). Descriptive analysis, t-tests, chi-square tests, and logistic regression analysis were used in this study. Results. 61.8% of the participants had unbalanced constitutions. We did not find a significant association between the TCM constitution and gestational hypertension, gestational diabetes, miscarriage, signs of miscarriage, and defecation during pregnancy. And we found that women with unbalanced constitutions in early pregnancy had a greater likelihood of severe nausea and vomiting and poor sleep during pregnancy in the logistic regression analysis. Conclusions. These results have implications for female health care providers and policy makers. Identification of TCM constitution may be helpful for understanding nausea and vomiting and poor sleepiness during pregnancy, especially in the condition that can not be explained by modern medical science, and be helpful for making program to improve these uncomfortable symptoms.

Knowledge on preconceptional folic acid supplementation and intention to seek for preconception care among men and women in an urban city: a population-based cross-sectional study

Background

To study the knowledge of a large city population on preconception folic acid supplementation and intention to seek for preconception care within an urban perinatal health program.

Methods

Cross-sectional surveys run in Rotterdam, the Netherlands, in 2007 and annually from 2009 to 2014. A random sample of residents aged between 16 and 85 years was taken each year from the municipal population register. Bivariate analysis, interaction analysis, trend analysis and logistic regression were performed.

Results

Knowledge on preconceptional folic acid supplementation significantly improved (+20 %) between 2007 and 2009, and the intention to consult a GP or midwife in the preconception period significantly increased (+53 %) from 2007 to 2012. Logistic regression analyses showed that low socio-economic status was significantly associated with low preconceptional folic acid knowledge, but with higher intention to seek out preconception care. An interaction effect was found between educational level and ethnicity, showing that the higher the educational level the lower the gap of level of knowledge between the different ethnic groups.

Conclusion

Despite campaigns about folic acid supplementation knowledge on this supplement remains low. The intention amongst men and women to seek out preconception care is still insufficient. Structural interventions to increase and maintain awareness on folic acid supplementation, especially among high-risk groups, are needed.

Effectiveness of general preconception care accompanied by a recruitment approach: protocol of a community-based cohort study (the Healthy Pregnancy 4 All study)

INTRODUCTION

Promotion of healthy pregnancies has gained high priority in the Netherlands because of the relative unfavourable perinatal outcomes. In response, a nationwide study Healthy Pregnancy 4 All (HP4ALL) has been initiated. One of the substudies within HP4ALL focuses on preconception care (PCC). PCC is an opportunity to detect and eliminate risk factors before conception to optimise health before organogenesis and placentation. The main objectives of the PCC substudy are (1) to assess the effectiveness of a recruitment strategy for the PCC health services and (2) to assess the effectiveness of individual PCC consultations.

METHODS/ANALYSIS

Prospective cohort study in neighbourhoods of 14 municipalities with perinatal mortality and morbidity rates exceeding the nation's average. The theoretical framework of the PCC substudy is based on Andersen's model of healthcare utilisation (a model that evaluates the utilisation of healthcare services from a sociological perspective). Women aged 18 up to and including 41 years are targeted for utilisation of the PCC health service by a four armed recruitment strategy. The PCC health service consists of an individual PCC consultation consisting of (1) initial risk assessment and risk management and (2) a follow-up consultation to assess adherence to the management plan. The primary outcomes regarding the effectiveness of consultations is behavioural change regarding folic acid supplementation, smoking cessation, cessation of alcohol consumption and illicit substance use. The primary outcome regarding the effectiveness of the recruitment strategy is the number of women successfully recruited and the outreach in terms of which population is reached in comparison to the approached population. Data collection consists of registration in the database of women that enrol for a visit to the individual PCC consultations (women successfully recruited), and preconsultation and postconsultation measurements among the included study population (by questionnaires, anthropometric measurements and biomarkers). Sample size calculation resulted in a sample size of n=839 women.

ETHICS AND DISSEMINATION

Approval for this study has been obtained from the Medical Ethical Committee of the Erasmus Medical Center of Rotterdam (MEC 2012-425). Results will be published and presented at international conferences.

Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom

OBJECTIVES

Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries.

METHODS

In 2013, an electronic search and investigation was undertaken of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. Findings were compared within five categories: Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites.

RESULTS

All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations for healthy women and men were fragmented and inconsistent. Preconception guidance was often included in antenatal and pregnancy guidelines. Differences between countries were seen with regard to nutritional and lifestyle advice particularly in relation to fish, caffeine and alcohol consumption, and vitamin supplementation.

CONCLUSIONS

Current guidelines are heterogeneous. Collaborative research across Europe is required in order to develop evidence-based guidelines for preconception health and care. There is a need to establish a clear strategy for promoting advice and guidance within the European childbearing population.

Early developmental conditioning of later health and disease: physiology or pathophysiology?

Extensive experimental animal studies and epidemiological observations have shown that environmental influences during early development affect the risk of later pathophysiological processes associated with chronic, especially noncommunicable, disease (NCD). This field is recognized as the developmental origins of health and disease (DOHaD). We discuss the extent to which DOHaD represents the result of the physiological processes of developmental plasticity, which may have potential adverse consequences in terms of NCD risk later, or whether it is the manifestation of pathophysiological processes acting in early life but only becoming apparent as disease later. We argue that the evidence suggests the former, through the operation of conditioning processes induced across the normal range of developmental environments, and we summarize current knowledge of the physiological processes involved. The adaptive pathway to later risk accords with current concepts in evolutionary developmental biology, especially those concerning parental effects. Outside the normal range, effects on development can result in nonadaptive processes, and we review their underlying mechanisms and consequences. New concepts concerning the underlying epigenetic and other mechanisms involved in both disruptive and nondisruptive pathways to disease are reviewed, including the evidence for transgenerational passage of risk from both maternal and paternal lines. These concepts have wider implications for understanding the causes and possible prevention of NCDs such as type 2 diabetes and cardiovascular disease, for broader social policy and for the increasing attention paid in public health to the lifecourse approach to NCD prevention.

Design and outline of the Healthy Pregnancy 4 All study

Background

Promotion of healthy pregnancies has gained high priority in the Netherlands because of the relatively unfavourable perinatal health outcomes. In response a nationwide study Healthy Pregnancy 4 All was initiated. This study combines public health and epidemiologic research to evaluate the effectiveness of two obstetric interventions before and during pregnancy: (1) programmatic preconception care (PCC) and (2) systematic antenatal risk assessment (including both medical and non-medical risk factors) followed by patient-tailored multidisciplinary care pathways. In this paper we present an overview of the study setting and outlines. We describe the selection of geographical areas and introduce the design and outline of the preconception care and the antenatal risk assessment studies.

Methods/design

A thorough analysis was performed to identify geographical areas in which adverse perinatal outcomes were high. These areas were regarded as eligible for either or both sub-studies as we hypothesised studies to have maximal effect there. This selection of municipalities was based on multiple criteria relevant to either the preconception care intervention or the antenatal risk assessment intervention, or to both. The preconception care intervention was designed as a prospective community-based cohort study. The antenatal risk assessment intervention was designed as a cluster randomised controlled trial – where municipalities are randomly allocated to intervention and control.

Discussion

Optimal linkage is sought between curative and preventive care, public health, government, and social welfare organisations. To our knowledge, this is the first study in which these elements are combined.

Perceptions of preconception counselling among women planning a pregnancy: a qualitative study

BACKGROUND

Preconception care is a promising new approach to improve the health of future children through primary intervention. Although most women have a positive attitude towards preconception care, women often do not seek preconception care for themselves.

OBJECTIVE

To explore women's hesitancy to seek preconception counselling.

METHODS

An empirical-analytic approach was used to explore women's hesitation to seek preconception counselling. In-depth, semi-structured, face-to-face interviews (n = 16) of women desiring to conceive were conducted, and responses were analysed using the determinants 'attitude' and 'subjective norms' of the Theory of Planned Behaviour of Ajzen.

RESULTS

The interviewed women expressed a positive attitude towards preconception care in general but were hesitant about seeking preconception care themselves. Women seemed to regard themselves as not being in the target group for preconception care. Additionally, we identified the following four subthemes of subjective norms around the process of becoming pregnant: planning, publicity, information on fertility and artificiality.

CONCLUSIONS

Women do not consider themselves to be part of the target group for preconception care. In some aspects, subjective norms around the process of becoming pregnant may conflict with the current practice of preconception care. Recommendations are provided.

Informing on prenatal screening for Down syndrome prior to conception. An empirical and ethical perspective

In most Western countries, information on prenatal screening for Down syndrome is provided in the first-trimester of pregnancy. The purpose of this study was to examine whether this information should additionally be provided before pregnancy to improve the informed decision-making process. In an empirical study, we obtained data from pregnant women with respect to their preferences regarding information on prenatal screening preconceptionally. Questionnaire data (n = 510) showed that 55.7% of responding women considered participating in prenatal screening for Down syndrome before pregnancy. 28.0% of women possessed information on prenatal screening preconceptionally. 84.6% preferred not to receive information preconceptionally in retrospect. In an ethical analysis, we elaborated on these preferences by weighing pros and cons. We considered two arguments against the provision of information on prenatal screening preconceptionally: women's preference to receive information in a step-by-step manner, and the risk of providing a directive message. We identified three reasons supporting its provision preconceptionally: the likelihood of making an informed decision could, firstly, be increased by "unchaining" the initial information from possible subsequent decisions, and, secondly, by providing women sufficient time to deliberate. Thirdly, the probability of equal access to prenatal screening may increase. To conclude with, we propose to incorporate an information offer on prenatal screening for Down syndrome in preconception care consultations. By offering information, instead of providing information, prospective parents are enabled to either accept or decline the information, which respects both their right to know and their right not-to-know.