Results of a Dutch national and subsequent international expert meeting on interconception care

Lifestyle risk reduction engagement during interconception: a qualitative descriptive study of women's preferences

BACKGROUND

Prevention and self-management of lifestyle risks can reduce non-communicable disease risks and improve the health of mothers and their children. We explored Australian women's preferences for lifestyle risk reduction engagement during the interconception period.

METHODS

We conducted a qualitative descriptive interview study between February and May 2022. Women and people who have been pregnant and intended to have more children were recruited. We asked participants about their preferences for lifestyle risk reduction between pregnancies. Following reflexive thematic analysis, we conceptualised findings using the COM-B system.

RESULTS

Among 17 participants, most had given birth to one child and intended to have another child in 1 to 2 years. Our analysis found that most described lifestyle risk reduction engagement through nutrition and exercise, informed by personal experiences and their health goals for a future pregnancy/child. Key attributes affecting engagement in lifestyle risk reduction activities included their feasibility and practicality, habits and routines, motivation, pregnancy planning, and the source and quality of information. Participants' capacity and capability to engage in lifestyles supportive of interconception health were varied and influenced by juggling the routines of work, finances, health and evolving caring responsibilities. Community-based influences, including the availability of recreational infrastructure, the level of support provided by partners/family/peers and culture, also influenced participants' engagement in lifestyle risk reduction activities.

CONCLUSIONS

For lifestyles that encourage interconception health, maximising participants' capability and opportunities required motivation and access to infrastructure supportive of healthy meal options and exercise, health services and community networks.

Interconception care in Australian general practice: a qualitative study

BACKGROUND

GPs provide care for women across the lifespan. This care currently includes preconception and postpartum phases of a woman's life. Interconception care (ICC) addresses women's health issues between pregnancies that then have impact on maternal and infant outcomes, such as lifestyle and biomedical risks, interpregnancy intervals, and contraception provision. However, ICC in general practice is not well established.

AIM

To explore GP perspectives about ICC.

DESIGN AND SETTING

Qualitative interviews were undertaken with GPs between May and July 2018.

METHOD

Eighteen GPs were purposively recruited from South-Eastern Australia. Audiorecorded semi- structured interviews were transcribed verbatim and analysed thematically using the Framework Method.

RESULTS

Most participants were unfamiliar with the concept of ICC. Delivery was mainly opportunistic, depending on the woman's presenting need. Rather than a distinct and required intervention, participants conceptualised components of ICC as forming part of routine practice. GPs described many challenges including lack of clarity about recommended ICC content and timing, lack of engagement and perceived value from mothers, and time constraints during consultations. Facilitators included care continuity and the availability of patient education material.

CONCLUSION

Findings indicate that ICC is not a familiar concept for GPs, who feel that they have limited capacity to deliver such care. Further research to evaluate patient perspectives and potential models of care is required before ICC improvements can be developed, trialled, and evaluated. These models could include the colocation of multidisciplinary services and services in combination with well-child visits.

Women's needs for lifestyle risk reduction engagement during the interconception period: a scoping review

BACKGROUND

Unhealthy lifestyle is responsible for many chronic conditions, and antenatal engagement with women about lifestyle behaviours can be too late to prevent some adverse pregnancy outcomes and subsequent childhood risks. To reduce the risk of future adverse outcomes, the interconception period is an opportunity to implement positive health changes. The aim of this scoping review was to explore women's needs for lifestyle risk reduction engagement during the interconception period.

METHODS

The JBI methodology guided our scoping review. Six databases were searched for peer-reviewed, English-language research papers published between 2010 and 2021 on topics including perceptions, attitudes, lifestyle, postpartum, preconception and interconception. Title-abstract and full text screening was independently undertaken by two authors. Included papers' reference lists were searched to find additional papers. The main concepts were then identified using a descriptive and tabular approach.

RESULTS

A total of 1734 papers were screened and 33 met our inclusion criteria. Most included papers (82%, n=27) reported on nutrition and/or physical activity. Papers identified interconception through postpartum and/or preconception. Women's self-management needs for lifestyle risk reduction engagement during interconception included: informational needs, managing competing priorities, physical and mental health, self-perception and motivation, access to services and professional support, and family and peer networks.

CONCLUSIONS

There is a range of challenges for women to engage in lifestyle risk reduction during interconception. To enable women's preferences for how lifestyle risk reduction activities can be enacted, issues including childcare, ongoing and tailored health professional support, domestic support, cost and health literacy need to be addressed.

Facilitators and barriers of preconception care in women with inflammatory bowel disease and rheumatic diseases: an explorative survey study in a secondary and tertiary hospital

Background

Preconception care (PCC) is care prior to conception to optimize parental health, and health of the future child, through biomedical and behavioral changes. Providing PCC to all women with a wish to conceive will improve perinatal health. PCC is especially important for women with a chronic disease, such as inflammatory bowel disease (IBD) and rheumatic diseases (RD). At present PCC is not part of routine care for these women. The aim of this study is to identify facilitators and barriers on a patient and professional level regarding the provision of PCC in women with IBD and RD.

Methods

An explorative survey study among women with IBD and RD, their treating physicians and obstetric professionals was performed. Patients with a wish to conceive, pregnant women or those with a recent pregnancy (< 1 year ago) visiting the outpatient clinic of a secondary and tertiary hospital and involved physicians and obstetric professionals were eligible.

Results

A total of 71% of the IBD patients (n = 22/31) and 35% of the RD patients (n = 20/58) received a PCC consultation. PCC consultation was considered easy to enter, short in time and patients felt comfortable. Patients (71% IBD; 62% RD) preferred a personal PCC consultation with their disease specific specialist together with an obstetrician. Patients specifically wanted to receive information about the safety of medication use and disease activity following delivery. Of the included healthcare professionals 67% (n = 31) agreed PCC was applicable to their patients. Main barrier to providing PCC was lack of time and unavailability of professionals. In total 41% (n = 16) of obstetric professionals felt they had the knowledge and skills to provide PCC compared to 33% (n = 1) and 75% (n = 3) of gastroenterologists and rheumatologists, respectively.

Conclusion

Lack of awareness and urgency for the effectuation can be seen as important barriers for implementation of PCC. Due to the explorative nature generalisation of the results is not allowed. In the future, adaptation of the curricula of healthcare professionals by implementing interventions for pregnancy planning and preparation will generate awareness. Modelling of the impact of PCC might prove useful in resolving the lack of urgency for PCC realization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04560-y.