Preconception care.

Division of Maternal-Fetal Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Obstetrical & gynecological survey (Impact Factor: 2.36). 02/2010; 65(2):119-31. DOI: 10.1097/OGX.0b013e3181d0c358
Source: PubMed

ABSTRACT Our objective was to provide the clinician with easy-to-use evidence-based guidelines, based on the best available literature, for offering effective preconception care, aimed at decreasing maternal and fetal/neonatal morbidity and mortality. We searched the Cochrane Library, MEDLINE, and PUBMED from 1966 until January 2009. We used the search terms "preconception," "preconception care," "prepregnancy," and "inter-pregnancy." We focused on level I publications, randomized studies, and meta-analyses of these studies in particular. We included non-English publications, if pertinent. We searched the reference lists of manuscripts identified, and selected those we judged relevant. Preconception care has been defined as a set of interventions that aim to identify and modify risks to a woman's health or pregnancy outcome through prevention and management. It should occur any time any healthcare provider sees a reproductive age woman. Personal and family history, physical exam, laboratory screening, reproductive plan, nutrition, supplements, weight, exercise, vaccinations, and injury prevention should be reviewed in all women. Folic acid 400 mcg per day, as well as proper diet and exercise should be encouraged. Women should receive the influenza vaccine if planning pregnancy during flu season; the rubella and varicella vaccines if there's no evidence of immunity to these viruses; and tetanus/diphtheria/pertussis if lacking adult vaccination. Specific interventions to reduce morbidity and mortality for both the woman and her baby should be offered to those identified with chronic diseases, or exposed to teratogens or illicit substances. There are several interventions that have been proven to effectively improve pregnancy outcome when provided as preconception care. These should be consistently provided to reproductive-age women. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEANING OBJECTIVES: After completion of this educational activity, the participant should be better able to assess potential benefits for women and their offspring that result from preconception care, translate specific evidence-based preconception strategies into clinical practice, and select resources for practitioners and patients that are print media or online related to preconception health.

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    ABSTRACT: Objective: To review the current knowledge and implementation of preconceptional care (PCC) in the Western world, focusing both on health care workers and the general population, and to analyze pathways to disseminate the influence of preconceptional care on pregnancy outcome. A systematic literature study was performed using OvidSP and Pubmed, searching for articles about PCC and its implementation, published between 1966 and October 2012. Only randomized controlled trials and systematic reviews dealing with PCC in the Western world were retained. Forty-six articles were identified for review. PCC might result in better pregnancy outcomes, including e.g. a reduction of congenital abnormalities. There are no proven disadvantages of PCC. Health care workers are in favor of the implementation of PCC, but claim that they don't have enough knowledge to do so. The general population shows interest in receiving PCC. The implementation of PCC should be improved by e.g. the development of guidelines and checklists. As PCC might improve pregnancy outcomes and is considered important by health care workers and the general population, its implementation should be improved, e.g. by the development of guidelines and checklists.
    01/2013; 5(1):13-25.
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    ABSTRACT: Background To date, there is a lack of evidence to suggest that a systematic and coordinated approach to prepregnancy care might make a difference.AimsTo evaluate whether women who receive preconception care through a structured approach will be more likely to be healthy around the time of conception compared with women who plan their pregnancy but have not been exposed to preconception care.MethodsA case control study was undertaken of women who attended the preconception care service and subsequently conceived, received maternity care and gave birth at Mater Health Services Brisbane between January 2010 and January 2013. Pregnancy information and birth outcomes for each woman who attended the service were matched with those of three women who reported that they had planned their pregnancy but did not attend the service. Records were matched for prepregnancy BMI, age, parity, prepregnancy smoking status and number of health conditions.ResultsPregnant women who attended preconception care were more likely to have received adequate peri-conceptual folate, to report being vaccinated against influenza and hepatitis B, to have consulted with a specialist with the specific aim of optimising a pre-existing health condition and to report less weight gain up until booking. Preterm birth and hypertensive disorders of pregnancy were less common amongst women who had attended preconception care, and there were trends towards a decreased incidence of gestational diabetes, LGA and fetal anomalies.Conclusion These preliminary data provide some optimism that a comprehensive preconception care service may positively influence maternal and neonatal outcomes.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 07/2014; 54(6). DOI:10.1111/ajo.12224 · 1.62 Impact Factor
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    ABSTRACT: This article is part of a supplement jointly funded by Save the Children's Saving Newborn Lives programme through a grant from The Bill & Melinda Gates Foundation and March of Dimes Foundation and published in collaboration with the World Health Organization (WHO). The original article was published in PDF format in the WHO Report "Born Too Soon: the global action report on preterm birth (ISBN 978 92 4 150343 30). The article has been reformatted for journal publication and has undergone peer review according to Reproductive Health's standard process for supplements and may feature some variations in content when compared to the original report. This co-publication makes the article available to the community in a full-text format.Providing care to adolescent girls and women before and between pregnancies improves their own health and wellbeing, as well as pregnancy and newborn outcomes, and can also reduce the rates of preterm birth. This paper has reviewed the evidence based interventions and services for preventing preterm births; reported the findings from research priority exercise; and prescribed actions for taking this call further. Certain factors in the preconception period have been shown to increase the risk for prematurity and, therefore, preconception care services for all women of reproductive age should address these risk factors through preventing adolescent pregnancy, preventing unintended pregnancies, promoting optimal birth spacing, optimizing pre-pregnancy weight and nutritional status (including a folic acid containing multivitamin supplement, and ensuring that all adolescent girls have received complete vaccination. Preconception care must also address risk factors that may be applicable to only some women. These include screening for and management of chronic diseases, especially diabetes; sexually-transmitted infections; tobacco and smoke exposure; mental health disorders, notably depression; and intimate partner violence. The approach to research in preconception care to prevent preterm births should include a cycle of development and delivery research that evaluates how best to scale up coverage of existing, evidence-based interventions, epidemiologic research that assesses the impact of implementing these interventions, and discovery science that better elucidates the complex causal pathway of preterm birth and helps to develop new screening and intervention tools. In addition to research, policy and financial investment is crucial to increasing opportunities to implement preconception care, and rates of prematurity should be included as a tracking indicator in global and national maternal child health assessments.
    Reproductive Health 11/2013; 10 Suppl 1(Suppl 1):S3. DOI:10.1186/1742-4755-10-S1-S3 · 1.62 Impact Factor