Preconception Care: A Strategic Intervention for the Prevention of Neonatal and Birth Disorders

Application of theory of planned behavior to predictors of preconception care behavior in women of childbearing age

BACKGROUND

Preconception care is essential for all women of childbearing age because it is the primary key to determining future health and significantly reducing maternal and infant mortality. However, millions of women do not carry out treatment because awareness to behave is still low due to lack of intention. This study aimed to analyze the influence of the theory of planned behavior on preconception care behavior in women of childbearing age.

MATERIALS AND METHODS

This study was a quantitative analytical cross-sectional study conducted in 2023 on 341 women of childbearing age in four public health centers in Kuningan Regency, West Java, Indonesia. The sampling technique and sampling method used were the Lemeshow formula and stratified random sampling. Data were collected using a researcher-made questionnaire and analyzed using Stata software. Bivariate analysis used simple linear regression tests, and multivariate analysis used structural equation modeling.

RESULTS

Preconception behavior was directly and positively influenced by high intention (b = 0.33; CI 95% =0.22 to 0.45; P = 0.001), high perceived behavioral control (b = 0.23; CI 95% =0.12 to 0.35; P = 0.001), and high attitude (b = 0.22; CI 95% =0.11 to 0.36; P = 0.001). Preconception care behavior was indirectly and positively influenced by subjective norms (b = 0.11; CI 95% =0.01 to 0.21; P = 0.037), perceived behavioral control (b = 0.31; CI 95% =0.22 to 0.40; P = 0.001), and attitude (b = 0.31; CI 95% =0.22 to 0.40; P = 0.001).

CONCLUSION

The theory of planned behavior has a very important role in improving preconception behavior through intentions that have an impact on health and reducing maternal and infant mortality rates by implementing strategies to develop more appropriate and effective preconception health promotion models.

Preconception Care: A Concept Analysis of an Evolving Paradigm

AIM(S)

To clarify the concept of preconception care and develop a precise and inclusive definition to improve its implementation and impact on reproductive health outcomes.

DESIGN

This concept analysis paper employs Rodgers' evolutionary method to analyse the concept of preconception care, examining its historical evolution, attributes, antecedents and consequences.

METHODS

A comprehensive literature review was conducted using databases such as Cumulative Index to Nursing and Allied Health Literature, Scopus, MEDLINE and Google Scholar, covering publications from 2012 to 2024. Data extraction involved identifying surrogate and related terms, attributes, antecedents and consequences of preconception care. A total of 1520 publications were retrieved, with 166 meeting eligibility criteria. Using systematic random sampling, 40 articles were selected for in-depth analysis.

RESULTS

The analysis revealed that preconception care encompasses several attributes: period-related (biological, individual, public health and intergenerational), target population-related (individual, public and intergenerational) and pathway-related (universal, targeted and comprehensive). Antecedents include desires for a healthy baby and family planning decisions. Consequently, it improves pregnancy outcomes and health equity and enhances community and intergenerational health. The proposed operational definition highlights preconception care as a proactive strategy to optimise health before pregnancy through targeted and inclusive interventions.

CONCLUSION

Preconception care is a dynamic and multifaceted process that extends from immediate preconception periods to long-term health considerations. Addressing diverse needs and effectively improving health outcomes requires a tailored approach considering individual, public and intergenerational perspectives.

IMPLICATIONS FOR PROFESSIONS AND PATIENT CARE

A transparent and inclusive definition of preconception care will enable healthcare professionals, particularly nurses, to deliver more effective, culturally sensitive and equitable care. It will support advocacy for policy changes, resource allocation and educational initiatives to enhance preconception health.

IMPACT

Addressing preconception care's complexities and diverse needs will foster a more comprehensive understanding and implementation of preconception care, ultimately improving reproductive health outcomes and promoting health equity across generations.

PATIENT OR PUBLIC CONTRIBUTION

As this concept analysis was derived from published articles, patients or the public were not involved in the study's design, conduct or reporting.

Community Awareness and Perceptions of Genitourinary Malformations: A Cross-Sectional Survey Study

BACKGROUND AND OBJECTIVES

On a local and national scale, genitourinary malformations (GUMs) are the second most encountered congenital anomaly in children. GUMs are linked to several risk factors, including maternal co-morbidities and insufficient folic acid. They may also be related to maternal health and care during pregnancy. Expanding our knowledge about these factors is necessary for the development of preventative measures, which could reduce GUM incidence. This study evaluated the local youth's understanding and perceptions of genitourinary anomalies.

MATERIALS AND METHODS

This cross-sectional, qualitative, anonymous, questionnaire-based study involved members of the local population, aged 18 years or over. Based on a 5% type I error rate (α = 0.05) and an 80% response rate, a sample size of 481 was determined. The questionnaire was completed by 902 people. The data were analyzed using SPSS version 25 (IBM).

RESULTS

Over half (57%) of respondents believed that hormonal therapy during pregnancy could increase GUM risk. Moreover, 46% thought that maternal chronic diseases could be another risk factor, while 43% believed that pregnancy-related conditions, such as pre-eclampsia, increased GUM risk. Women had higher odds of high perception scores than men, according to the univariate and multivariate analyses. Most participants (74%) strongly agreed that proper and ongoing prenatal follow-ups are necessary, 69% agreed that premarital medical check-ups are necessary, and 67% believed that optimal nutrition throughout pregnancy is necessary to reduce GUM risk.

CONCLUSIONS

The results emphasize the necessity of developing healthcare strategies specifically designed to increase knowledge about GUMs and overcome incorrect community perceptions of risk factors that could also help improve attitudes towards prevention and ultimately reduce the incidence of GUMs.

Association between preconception care and family planning and previous adverse birth outcomes in Ethiopia: systematic review and meta-analysis

OBJECTIVES

Inconsistent findings on the associations of preconception care with the utilisation of family planning and previous adverse birth outcomes have not been systematically reviewed in Ethiopia. Thus, this review aims to estimate the pooled association of preconception care with the utilisation of family planning and previous adverse birth outcomes in Ethiopia.

DESIGN

Systematic review and meta-analysis of observational studies.

DATA SOURCES

MEDLINE Complete, CINAHL Complete, Scopus and Global Health were searched from inception to 28 July 2023.

ELIGIBILITY CRITERIA

Observational studies that reported preconception care as an outcome variable and the use of family planning before pregnancy or previous adverse birth outcomes as exposure variables were included.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently conducted study screening, data extraction and quality assessment. A fixed-effects model was used to determine the pooled association of preconception care with the utilisation of family planning and previous adverse birth outcomes.

RESULTS

Eight studies involving a total of 3829 participants were included in the review. The pooled meta-analysis found that women with a history of family planning use had a higher likelihood of using preconception care (OR 2.09, 95% CI 1.74 to 2.52) than those women who did not use family planning before their current pregnancy. Likewise, the pooled meta-analysis found that women with prior adverse birth outcomes had a higher chance of using preconception care (OR 3.38, 95% CI 1.06 to 10.74) than women with no history of prior adverse birth outcomes.

CONCLUSION

This review indicated that utilisation of preconception care had a positive association with previous use of family planning and prior adverse birth outcomes. Thus, policymakers and other relevant stakeholders should strengthen the integration of preconception care with family planning and other maternal healthcare services.

PROSPERO REGISTRATION NUMBER

CRD42023443855.

Self-reported Provision of Preconception Care and Associated Factors

Background

Preconception care (PCC) is the provision of health interventions to women and couples before conception occurs and is valuable in promoting healthy maternal, birth, and neonatal health outcomes. In Africa, more so in Kenya, maternal and neonatal health indicators have remained poor. The key constraint limiting progress is the gap between what is needed and what exists in terms of skills and availability of human resources & infrastructures in the face of increased demand. This gap was yet to be measured for PCC in Kenya, more so in Kisumu County.

Methods

Using a cross-sectional design, this study specifically sought to determine the rate of self-reported PCC provision and to illustrate how it is influenced by health provider characteristics. Structured interviews were conducted with health providers (n=476) to ascertain their knowledge, perceptions and practice of PCC care. The significance of the differences in means was determined by the Student's t test and linear regression were used to show the relationship between the health provider characteristics and the PCC provision rate.

Results

Self-reported PCC provision was estimated at 39%. There was a significant difference in the mean for cadres {nurses (M=70.04, SD=8.951) and non-nurses (M=71.90, SD=8.732); t (473) =-2.23, P=.026)}, years of experience up to 5 years (M=72.04, SD=8.417) and more than 5 years (M=69.89, SD=9.283); t (465) =2.63, P=.009, the mean provision per level (M=60.21, SD=4.902; t (26)=-5.06, P<.001) and type of service (M=69.36, SD=4.924; t (26) =4.63, P<.001). A significant regression model was found, and the model statistics were F (2,464) =5.97, P=.003, R2=.03. Only cadre (b=0.01, t (464) =2.23, P=.026) and years of experience (b=-0.13, t (464) =-2.79, P=.005) were significant determinants of PCC provision. The health workers felt PCC was an important service whose provision was low due to inadequate human capital investment.

Conclusion

Self-reported provision of PCC by health workers was relatively low and was influenced by the cadre of health workers and their years of experience. It specifically demonstrated the importance of various aspects of human capital, i.e., knowledge, perceptions, competence and adequacy of training in the provision of this care. Furthermore, it showed that the nursing cadre has a higher probability of providing this care. Investing in on-the-job training for health providers, especially nurses, and providing care in primary health facilities in rural areas can improve PCC service delivery.

The effect of pregnant women's status of receiving preconception care on pregnancy stress

In the study, we aimed to determine the effect of pregnant women's status of receiving preconception care on their pregnancy stress. This is a descriptive, correlational, and cross-sectional design study, we were conducted with the participation of 409 pregnant women between June-December 2019. The Pregnancy Stress Rating Scale total score mean was found to be 30.72 ± 20.26. Individuals who received medication and vitamins as part of preconceptional care had significantly higher scores (p < 0.05; p < 0.001) compared to those who did not receive them for total pregnancy stress, postpartum social support, infant health, and infant identity-care stress. Similarly, individuals who received medical treatment and regular checkups had significantly higher scores (p < 0.05) compared to those who did not for total pregnancy stress, postpartum social support, infant identity-care, body image and psychological state during pregnancy stress scores. In addition, individuals who maintained a healthy lifestyle had significantly higher scores (p < 0.05; p < 0.001) compared to others for infant health, infant identity-care, and psychological distress during pregnancy. It was determined that women who made preparations for their pregnancy experienced more stress related to their babies (baby's health, baby's identity and care), psychological status in pregnancy, prenatal and postnatal social support, and body image.

Navigating the Complexity: A Comprehensive Review of Managing Pregnancy in Complete Heart Block Cases

This review explores the comprehensive management of pregnancy in cases of complete heart block, a cardiac condition characterized by the dissociation between atrial and ventricular conduction. The review begins with a thorough examination of preconception counseling, emphasizing the assessment of maternal health, the evaluation of cardiac function, and the identification of potential risks. Subsequently, the medical management section delves into using beta-blockers, pacemakers, and antiarrhythmic drugs to monitor cardiac function during pregnancy and adjust medication regimens. Obstetric considerations highlight the importance of antenatal care, fetal monitoring, and thoughtful delivery planning, including the choice between vaginal delivery and cesarean section. The section on complications underscores the risks of arrhythmias, heart failure, premature birth, and neonatal cardiac issues. Looking ahead, the future directions and research section explores ongoing studies in genetics, pharmacology, and technological innovations, envisioning potential advancements in pacing technology and personalized medicine approaches. The conclusion synthesizes key findings, offering recommendations for clinical practice and reflecting on the challenges and opportunities inherent in managing pregnancy in complete heart block cases. The multidisciplinary approach emerges as paramount, with collaborative efforts paving the way for improved patient outcomes and advancements in the field.

Temporal Patterns of Diabetes in Pregnancy: Analyzing Pregestational and Gestational Diabetes Mellitus Among Women Aged 15-44 Years Using the United States Diabetes Surveillance System (USDDS) Database

BACKGROUND

Diabetes in pregnancy, including pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM), is a significant global health concern. Understanding its temporal patterns is crucial for effective healthcare planning and intervention strategies.

METHODS

This retrospective observational study utilized data from the United States Diabetes Surveillance System (USDDS) spanning 2000 to 2019. We conducted a comprehensive analysis of temporal trends in PGDM and GDM prevalence among people aged 15-44 years. Additionally, age and race-based subgroup analyses were performed to identify variations in diabetes patterns.

RESULTS

Over the two-decade study period, PGDM and GDM exhibited distinct temporal patterns. PGDM prevalence remained stable initially (1.1% per 100 deliveries) but gradually increased to 1.6% by 2019. In contrast, GDM prevalence showed a consistent rise, reaching 9.6% per 100 deliveries by 2019. Age-specific analysis revealed higher prevalence rates in older age groups, peaking at 40-44 years. Race-based analyses unveiled significant disparities, with Asians having the highest GDM rates and Black individuals having the highest PGDM rates.

CONCLUSION

The prevalence of diabetes in pregnancy in the United States has increased significantly from 2000 to 2019, emphasizing the need for continued surveillance and tailored interventions. Age and race-specific disparities highlight the importance of the growing impact of diabetes in pregnancy on maternal and fetal health.

Impact of the Social Marketing-Based Intervention on Preconception Healthy Behaviors of Women With Sickle Cell Disease

INTRODUCTION

A suggested method to improve the outcomes of pregnancy with sickle cell disease (SCD) is to engage more women at reproductive age in preconception healthy behavior (PCHB). Social marketing can be a suitable strategy to achieve this goal. We aimed to assess the impact of the social marketing-based intervention on women's engagement in PCHB.

METHODS

A quasi-experimental study was conducted in Bandar Abbas and Minab (the two largest cities of Hormozgan province in Iran with a high prevalence of SCD) from 2021 to 2022. A social marketing-based intervention with the main components (participation in PCHB as a "product," social media and traditional promotional channels as a "promotion," selecting healthcare centers as a "place" for implementing the intervention, and free access to medical experts and speciality as a "price") was designed based on formative research. The sample size was estimated at 140 participants in each intervention and control group. The study's main outcome was the level of engagement in PCHB, which was assessed according to the health belief model (HBM).

RESULTS

We compared the PCHB scores of both groups. Employing healthy behavior was more dominant in the intervention group. Awareness, perceived severity, perceived susceptibility, perceived benefits, and self-efficacy increased in both groups following intervention, while perceived barriers decreased. An analysis of covariance (ANCOVA) was performed to control and moderate the effect of scores in the pretest. As observed between the adjusted averages, awareness, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and engagement in the PCHB were significantly different between the control and intervention groups after the intervention. A multivariate linear regression analysis showed that awareness, perceived susceptibility, and self-efficacy were strong predictors of PCHB.

CONCLUSIONS

Social marketing-based intervention successfully increased PCHB among women of reproductive age with SCD.