Preconception care: A 2008 update

Centers for Disease Control and Prevention, NCBDDD, Atlanta, Georgia 30333, USA.
Current opinion in obstetrics & gynecology (Impact Factor: 2.07). 01/2009; 20(6):581-9. DOI: 10.1097/GCO.0b013e328317a27c
Source: PubMed


This study reviews what we know about preconception care, its definition, goals, and content; the science behind the recommended interventions; opportunities for implementing preconception care; and the challenges facing its implementation.
There is solid scientific evidence that many interventions will improve pregnancy outcomes if delivered before pregnancy or early in pregnancy. Experts continue to explore the most effective means for implementing preconception care, taking into consideration issues related to policy, finance, public health practice, research/surveillance, and consumer and provider education.
Over the past 4 years, there has been renewed interest and a great emphasis on preconception health and healthcare as alternative and additional approaches to counter the persistent increasing incidence in adverse pregnancy outcomes in the United States. Following the publication of the 'Recommendations to Improve Preconception Health and Healthcare' in 2006, many state and local health departments initiated programs to implement the recommendations. Several countries such as Canada, Belgium, and the Netherlands have also started to implement preconception care programs. There are many opportunities for promoting preconception health and providing preconception care; however, making preconception care a standard practice continues to face many barriers.

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    • "The sole indication for preconception care is the wish or consideration to become pregnant. PCC may focus on lifestyle and work and living environment issues, medicine use and advice to use folic acid supplements, advanced parental age, consanguinity, smoking/alcohol/drugs (ab)use, teratogens, infectious diseases, chronic disease of the woman, previous gynaecological problems (miscarriages, labour problems), congenital anomalies or hereditary disease of the woman or man, a previous child with a congenital anomaly or hereditary disease, family history with a congenital anomaly or a (possible) hereditary disease (Atrash et al. 2008). Thirty couples receiving PCC in a Dutch trial had an average of six risk factors per couple (De Jong-Potjer et al. 2003). "
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    ABSTRACT: To date, little is known about the psychosocial aspects of preconception consultation (PCC) in primary care. PCC in primary care is appropriate for couples and individuals with a reproductive wish. In PCC, non-genetic and genetic risk factors may be identified. Focusing on non-genetic and genetic risk factors in PCC requires the use of different counselling strategies and tools in optimizing the outcome of pregnancy. Addressing lifestyle alterations requires directive counselling, whereas addressing increased genetic risk and its subsequent reproductive options requires non-directiveness. When an increased genetic risk is detected, couples should be informed about their possibilities for not passing on a disease allele. Depending upon the various modes of inheritance and reproductive options, couples may face a variety of psychosocial challenges. This paper aims to provide insights into the psychosocial impact of the genetic aspects of PCC by drawing upon literature and clinical experience in the Clinical Genetics department. Furthermore, this paper provides consideration for future developments regarding preconception genetic screening.
    Full-text · Article · May 2012 · Journal of community genetics
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    • "Preconception care aims to provide prospective parents information and support with regard to preconception measures that are conducive to a healthy pregnancy-outcome for mother and child (Health Council of the Netherlands 2007; Atrash et al. 2008). Experience with preconception care as a systematic approach to promoting reproductive health is still limited, as is ethical thinking about conditions and implications. "
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    ABSTRACT: Preconception care to address genetic risks in reproduction may be offered either individually to couples with a known or suspected increased risk of having a child with a genetic disorder, or systematically to couples or individuals of reproductive age. The identification of couples at risk of transmitting a (serious) genetic disorder allows those couples to refrain from having children or to adapt their reproductive plans (using prenatal or preimplantation diagnosis, donor gametes, or adoption). Ethical issues concern the possible objectives of providing these options through preconception genetic counseling or screening, objections to abortion and embryo-selection, concerns about eugenics and medicalization, and issues arising in the professional-client relationship and/or in the light of the normative framework for population screening. Although enhancing reproductive autonomy rather than prevention should be regarded as the primary aim of preconception care for genetic risks, directive counseling may well be acceptable in exceptional cases, and prevention in the sense of avoiding serious suffering may be an appropriate objective of specific community-based preconception screening programmes. The seemingly unavoidable prospect of comprehensive preconception screening raises further ethical issues.
    Full-text · Article · Dec 2011 · Journal of community genetics
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    • "During these visits, using electronic technology can enhance communication between nurses and patients. A model that emphasizes primary care services, assists with coordination of specialty services, and is linked to new information technologies o¡ers the best potential to assist health care providers with reproductive life planning (Atrash et al., 2008). Information technology is now available to build infrastructure to support communication of information and data between providers in di¡erent settings to coordinate care over a period of time. "
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    ABSTRACT: The purpose of this article is to discuss the importance of implementing a life course perspective model that includes a reproductive life plan to improve health outcomes, especially in populations at risk for adverse outcomes. A reproductive life plan is a comprehensive strategy that can be incorporated into nursing practice at all levels to improve birth outcomes. Health care providers, especially nurses, should incorporate reproductive life planning into their daily encounters with patients. © 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
    Full-text · Article · Jan 2011 · Journal of Obstetric Gynecologic & Neonatal Nursing
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