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PubMed2002

The past and present practices and continuing controversies of preconception care.

Preconception care, a long-established concept for primary prevention of maternal and perinatal morbidity and mortality through detection and reduction of modifiable risks, has been widely propagated for the last decades. This article provides an overview of the various goals and practices described in the literature in different parts of the world, including issues and controversies pertaining to the provision and implementation of preconception care in different health care settings.

Journal Article↗
PubMed2001

Preconception care: "VITAL MOM"--a guide for the primary care provider.

Preconception care is an important aspect of pregnancy-related care. Unfortunately, it is often ignored or minimized by both the patient and the provider. This article provides a framework for preconception care by offering the mnemonic "VITAL MOM." It is hoped that this offering will assist the clinician in optimizing pregnancy outcome.

Female↗
PubMed2005

Preconception care in diabetes.

Preconception care is key to improving the outcome of diabetic pregnancy. Despite evidence showing that preconception care reduces congenital malformation in the offspring of diabetic mothers, most women do not plan their pregnancies with their diabetes team. Issues around managing this complex behaviour include the quality of the relationship with health care providers and the woman's health care beliefs. The elements of good preconception care have recently been defined, but there are problems around access to preconception services. There is a small number of preconception services within England, Wales and Northern Ireland; provision of these services needs to be increased if the goal set by the NSF for diabetes is to be achieved.

Diabetes Complications↗
PubMedDate not supplied

Preconception care. An integral part of primary care for women.

Preconception health care should be an integral part of primary health care services for all women with the potential for childbearing. This article delineates those aspects of preconception care that should be included in a well woman visit. Specific interventions for risks identified in the preconception health care visit are reviewed. Finally, the importance of preconception health care in reducing poor perinatal outcome and promoting overall good health is discussed.

Female↗
PubMed1999

Preconception care: challenge of the new millennium?

Couples who plan their pregnancies can elect anticipatory care with the aim of improved health for mother and child. While it has proved to be beneficial in such specific disorders as maternal diabetes mellitus, preconception care is not yet established as a part of primary care. Preconception care is a form of community genetics and consists of three main components: risk assessment, health promotion, and intervention. Intake of folic acid during the time surrounding conception is important in preventing neural tube defects and other congenital anomalies. Primary care health professionals may be involved in providing preconception care, as may be gynecologists, midwives, nurses, clinical geneticists, and genetic counselors. Several questions arose from a Dutch pilot study. Is there a need for preconception care? Do women want this care? Can positive effects (and cost-effectiveness) be documented? How best are the parents-to-be contacted? Last, but not least, who should provide the care?

Cost-Benefit Analysis↗
PubMed2006

Do we practice what we preach? A review of actual clinical practice with regards to preconception care guidelines.

OBJECTIVES: To review what past studies have found with regard to existing clinical practices and approaches to providing preconception care. METHODS: A literature review between 1966 and September 2005 was performed using Medline. Key words included preconception care, preconception counseling, preconception surveys, practice patterns, pregnancy outcomes, prepregnancy planning, and prepregnancy surveys. RESULTS: There are no current national recommendations that fully address preconception care; as a result, there is wide variability in what is provided clinically under the rubric of preconception care. CONCLUSIONS: In 2005, the Centers for Disease Control and Prevention sponsored a national summit regarding preconception care and efforts are underway to develop a uniform set of national recommendations and guidelines for preconception care. Understanding how preconception care is presently incorporated and manifested in current medical practices should help in the development of these national guidelines. Knowing where, how, and why some specific preconception recommendations have been successfully adopted and translated into clinical practice, as well as barriers to implementation of other recommendations or guidelines, is vitally important in developing an overarching set of national guidelines. Ultimately, the success of these recommendations rests on their ability to influence and shape women's health policy.

Female↗
PubMed2000

Improving preconception care.

OBJECTIVE: To improve the documentation and delivery of preconception care to all women of reproductive age attending an inner city hospital's outpatient gynecology clinic. A secondary goal was to evaluate the knowledge and awareness of providers regarding preconception care. STUDY DESIGN: A preintervention chart review of a convenience sample of non-pregnant women with reproductive potential who attend an inner city hospital gynecology clinic (n = 100) was conducted to evaluate delivery of preconception care. Items screened for included: family planning services, domestic violence, nutrition and medical risk factors, medication use, appropriate counseling and use of referral services. All providers in the clinic were surveyed to assess their knowledge of and attitudes toward preconception care. A two-part intervention was then carried out: (1) a one-hour lecture for all providers, and (2) a standardized preconception care form inserted in all charts. A postintervention chart review of a second convenience sample (n = 100) and repeat provider survey were then conducted to evaluate the effectiveness of the two interventions. RESULTS: Following the two-pronged intervention, there was evidence of improved documentation of the delivery of preconception care. Documentation of screening in almost all categories was significantly improved (P < .05). The greatest improvements were noted in complete screening for medical risk factors (from 15% to 44%), for over-the-counter and prescription medication use (from 10% to 70% and 30% to 77%, respectively), domestic violence (from 10% to 57%) and nutrition (from 9% to 50%). However, provider knowledge of and attitudes toward preconception care were not significantly changed. CONCLUSION: The combination of education about preconception care and insertion of a standardized form into a patient's chart led to a clear improvement in the documentation of preconception care. Given the significance of preconception care, insertion of a standardized form should be considered to help providers complete and appropriate care to their patients.

Adult↗
PubMed2005

Preconception care by family physicians and general practitioners in Japan.

BACKGROUND: Preconception care provided by family physicians/general practitioners (FP/GPs) can provide predictable benefits to mothers and infants. The objective of this study was to elucidate knowledge of, attitudes about, and practices of preconception care by FP/GPs in Japan. METHODS: A survey was distributed to physician members of the Japanese Academy of Family Medicine. The questionnaire addressed experiences of preconception education in medical school and residency, frequency of preconception care in clinical practice, attitudes about providing preconception care, and perceived need for preconception education to medical students and residents. RESULTS: Two hundred and sixty-eight of 347 (77%) eligible physicians responded. The most common education they reported receiving was about smoking cessation (71%), and the least was about folic acid supplementation (12%). Many participants reported providing smoking cessation in their practice (60%), though only about one third of respondents advise restricting alcohol intake. Few reported advising calcium supplementation (10%) or folic acid supplementation (4%). About 70% reported their willingness to provide preconception care. Almost all participants believe medical students and residents should have education about preconception care. CONCLUSION: FP/GPs in Japan report little training in preconception care and few currently provide it. With training, most participants are willing to provide preconception care themselves and think medical students and residents should receive this education.

Adult↗
PubMed2006

Family planning services: an essential component of preconception care.

Family planning services are necessary for the widespread adoption of preconception care for two reasons. First, preconception care is more likely if pregnancies are planned, and family planning services encourage pregnancy planning. Second, family planning services usually include counseling, and counseling provides an opportunity to discuss the advantages of preconception care. However, the potential of family planning services to promote preconception care is limited by underutilization of these services and inadequate attention to preconception care during family planning visits. This article suggests ways to reduce these problems.

Adolescent↗
PubMed2005

ACOG Committee Opinion number 313, September 2005. The importance of preconception care in the continuum of women's health care.

The goal of preconception care is to reduce the risk of adverse health effects for the woman, fetus, or neonate by optimizing the woman's health and knowledge before planning and conceiving a pregnancy. Because reproductive capacity spans almost four decades for most women, optimizing women's health before and between pregnancies is an ongoing process that requires access to and the full participation of all segments of the health care system.

Continuity of Patient Care↗
PubMed2006

Public finance policy strategies to increase access to preconception care.

Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15-44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states' experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs.

Adolescent↗
PubMed2005

Dutch community midwives' views on preconception care.

OBJECTIVE: to explore the opinions of midwives on the desirability of preconception care for all couples contemplating pregnancy, their willingness to introduce preconception care to midwifery practice and, if it were to be implemented, the necessary conditions, including knowledge, postgraduate education and referral possibilities for successful implementation in the community. PARTICIPANTS: all community midwives (n = 129) working in 49 midwifery practices that refer their high-risk clients to the Erasmus University Medical Centre, Rotterdam (the Netherlands). SETTING: Rotterdam and its immediate surrounding communities. DESIGN: midwives working at the midwifery practices were recruited by telephone. All agreed to participate, and subsequently received a questionnaire by post. FINDINGS: 102 (79%) questionnaires were returned. Ninety-five (93%) of the 102 midwives were familiar with the concept of preconception care, and 71 (70%) of them already provided it to some extent. Of the 102 respondents, 84 (83%) seemed to be willing to provide such care in the future, and 56 (55%) felt that preconception care should be part of their professional domain. Midwives, however, lack time and knowledge to do so. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: community midwives already provide counselling, although not on a structural basis, and usually not earlier than in the first trimester of pregnancy. Midwives seem willing to play an active role in the provision of preconception care in the future. There is, however, great need for postgraduate training.

Community Health Nursing↗
PubMed1993

Cost-benefit analysis of preconception care for women with established diabetes mellitus.

OBJECTIVE: To determine whether the additional costs of preconception care are balanced by the savings from averted complications. Several studies have demonstrated the efficacy of preconception care in reducing congenital anomalies in infants born of mothers with pre-existing diabetes mellitus. RESEARCH DESIGN AND METHODS: This study used literature review, consensus development among an expert panel of physicians, and surveys of medical care personnel to obtain information about the costs and consequences of preconception plus prenatal care compared with prenatal care only for women with established diabetes. Preconception care involves close interaction between the patient and an interdisciplinary health-care team as well as intensified evaluation, follow-up, testing, and monitoring. The outcome measures assessed in this study are the medical costs of preconception care versus prenatal care only and the benefit-cost ratio. RESULTS: The costs of preconception plus prenatal care are $17,519/delivery, whereas the costs of prenatal care only are $13,843/delivery. Taking into account maternal and neonatal adverse outcomes, the net savings of preconception care are $1720/enrollee over prenatal care only and the benefit-cost ratio is 1.86. The preconception care program remained cost saving across a wide range of assumptions regarding incidence of adverse outcomes and program cost components. CONCLUSIONS: Despite significantly higher per delivery costs for participants in a hypothetical preconception care program, intensive medical care before conception resulted in cost savings compared with prenatal care only. Third-party payers can expect to realize cost savings by reimbursing preconception care in this high-risk population.

Blood Glucose↗
PubMed1996

Preconception care: a health promotion opportunity.

Prenatal care is recognized as a valuable intervention to improve pregnancy outcomes. Preconception care can further enhance pregnancy outcomes by optimizing health during the most critical period of organogenesis, the 17 to 56 days after conception. The goal of preconception care is to reduce perinatal mortality and morbidity. The research data supporting preconception care is limited, but it has been proven to reduce perinatal mortality and morbidity in certain populations. Preconception care is most cost-effectively provided as an integral part of primary care services during routine health promotion. It may be introduced during routine health screening, through patient education literature, and in group health promotion classes. Preconception care includes a comprehensive health history and physical exam with initiation of health promotion interventions prior to conception. Outlined in this paper are guidelines for preconception care with a table summarizing assessment, interventions, and patient education. A preconception assessment tool and patient handout are also included.

Cost-Benefit Analysis↗
PubMed2006

The business case for preconception care: methods and issues.

Only a limited number of economic evaluations have addressed the costs and benefits of preconception care. In order to persuade health care providers, payers, or purchasers to become actively involved in promoting preconception care, it is important to demonstrate the value of doing so through development of a "business case". Perceived benefits in terms of organizational reputation and market share can be influential in forming a business case. In addition, it is standard to include an economic analysis of financial costs and benefits from the perspective of the provider practice, payer, or purchaser in a business case. The methods, data needs, and other issues involved with preparing an economic analysis of the likely financial return on investment in preconception care are presented here. This is accompanied by a review or case study of economic evaluations of preconception care for women with recognized diabetes. Although the data are not sufficient to draw firm conclusions, there are indications that such care may yield positive financial benefits to health care organizations through reduction in maternal and infant hospitalizations. More work is needed to establish how costs and economic benefits are distributed among different types of organizations. Also, the optimum methods of delivering preconception care for women with diabetes need to be evaluated. Similar assessments should also be conducted for other forms of preconception care, including comprehensive care.

Congenital Abnormalities↗
PubMedDate not supplied

Preconception care. An opportunity to maximize health in pregnancy.

In 1990, the United States Public Health Service published Healthy People 2000: National Health Promotion and Disease Prevention Objectives. One of the objectives included in the family planning priority area and repeated in the maternal and infant health priority area is the following: "Increase to at least 60 percent the proportion of primary care providers who provide age-appropriate preconception care and counseling." Drawing on the guidelines proposed by the Public Health Service Expert Panel on the Content of Prenatal Care, this article describes the components of preconception care: 1) appropriate and ongoing risk assessment, 2) health promotion, and 3) medical and psychological interventions and follow-up. The organization of this article is based on a preconception class outline developed by the authors; recommendations included in the article are consistent with those of the Expert Panel. After discussing opportunities for providing preconception care, this article addresses: 1) helping women evaluate their psychological readiness; 2) evaluating physical readiness; 3) the examination and concerns of the father; 4) evaluating the need for genetic counseling; 5) creating a positive environment for conception; 6) discontinuing family planning methods and timing conception; and 7) choosing a provider and birth place.

Aftercare↗
PubMedDate not supplied

Preconception care of women with diabetes.

Preconception care in women with diabetes reduces the risk of spontaneous abortion and congenital malformations as a result of improved glycemic control before and during organogenesis. Prepregnancy planning encompasses optimizing glycemic control and also affording the opportunity for genetic counseling, contraceptive selection, management of diabetes complications, and evaluation of psychosocial aspects of pregnancy, childbearing, and diabetes care. The purpose of this article is to provide nurses with current clinical assessment and management strategies of women with diabetes in order to implement a comprehensive individualized preconception plan of care.

Abortion, Spontaneous↗
PubMed2006

[Preconception care: an essential part of the care for mother and child].

Despite the modernisation of antenatal care in the Western world, the incidence of a number of adverse pregnancy outcomes, such as birth defects, low birth weight and preterm birth, has not decreased over the past few decades. Since its inception at the beginning of the last century, the concept of antenatal care has not changed. The first antenatal visit typically starts at the end of the first trimester. By this stage of pregnancy organogenesis and early placentation have been completed making it almost impossible to reverse any unfavourable exposure on the foetus. Preconception care addresses risk factors that are present prior to pregnancy. By either eliminating or altering risk factors during this period, pregnancy outcome may improve. The goal of preconception care is to optimise the quality of foetal, newborn and infant life through primary prevention. With regard to genetic conditions the aims of preconception care are more nuanced. The principle components of preconception care include (a) risk assessment, (b) information and advice on health promotion, (c) specific counselling and (d) intervention. The effectiveness of preconception care has been demonstrated in women who are at increased risk of adverse pregnancy outcome. In women at low-risk, however, the usefulness of preconception care has yet to be established. The concept of preconception care is relatively simple, logical and promises much. For preconception care to be a success, it is crucial to make this form of preventive care available to all prospective parents. The Internet could play a major part in the dissemination of information that is relevant to a successful outcome of pregnancy.

Female↗