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Preconception care

Introduction

The periconception period is a crucial period for gene-environment interactions and forthcoming fertilization, implantation, embryogenesis and placentation: many adverse pregnancy outcomes originate in this period.  Preconception health care is widely recognized as a critical component of maternal and child health promotion. It is broadly defined as the provision of biomedical and behavioural interventions prior to conception in order to optimize women’s health to reduce adverse pregnancy outcomes. Preconception care (PCC) must be evidence based to generate resources and assure sustainability, and it must be flexible enough to accommodate local priorities. 
Currently, no consensus exists on the content of PCC and how the care should be delivered. Furthermore there are significant barriers to implement this care including the organizational and financial restrains. Hence, it is important to coordinate different resources related to PCC in order to establish a uniform policy and intervention programs of PCC to further improve the health of women and future children.

Definition

“A set of interventions and/or programmes that aims to identify and enable informed decision-making to modify biomedical, behavioural, and (psycho)social risks to parental health and the health of their future child, through counselling, prevention and management, emphasizing those factors that must be acted on before conception or early in pregnancy to have maximal impact and/or choice.

* Preconception care may be a good opportunity to reduce mortality and morbidity.” Dutch Consensus on the key elements of Preconception Care,  The Rotterdam Erasmus MC Consensus Meeting 2012.

Core components

The core components of PCC consist of risk assessment, health promotion and intervention. PCC should be part of an interlinked chain starting with PCC through prenatal, neonatal, child, and youth care. Health authorities, Non-Governmental Organizations (NGO’s) and health-care disciplines should be involved, such as general practitioners, midwives, obstetricians, clinical geneticists, and other maternal and child health professionals.
PCC is meant to improve the health of mother and child in various ways. Some ways are aimed at the general population at large, some at both future parents individually, others at all women of reproductive age.

Categories

The core components of PCC consist of risk assessment, health promotion and intervention. PCC should be part of an interlinked chain starting with PCC through prenatal, neonatal, child, and youth care. Health authorities, Non-Governmental Organizations (NGO’s) and health-care disciplines should be involved, such as general practitioners, midwives, obstetricians, clinical geneticists, and other maternal and child health professionals.
PCC is meant to improve the health of mother and child in various ways. Some ways are aimed at the general population at large, some at both future parents individually, others at all women of reproductive age.

PCC can be categorized into different forms:

  • Collective measures are aimed at the general population to improve preconceptional health. Examples are rubella vaccination of children, iodisation of salt, radiological protection of all women of reproductive age, cigarette package labelling for preventing low birth weight singletons and education campaigns on the use of folic acid. Some of them are not primarily undertaken to improve preconception health (e.g., iodisation of salt), but benefit the health of mother and child.
  • General individual PCC is provided by primary care workers (a general practitioner, midwife or community health care worker) to all couples planning pregnancy. Community health care workers can reach people through their network with information to promote healthy behaviour and preventive actions (e.g. individual advice on smoking cessation). By informing people of the necessity of PCC they can mobilize the patients demand for proper services. They can form a link between the community or the population at large and the formal health care services.
  • Specialist individual PCC is provided for a) couples who are already known to be at risk for adverse pregnancy outcomes (e.g. due to prior complications during pregnancy or chronic illness) or b) couples who are referred from general individual PCCC after risk assessment (including medication use, genetic disorders in the family, specific working conditions of women). Depending on the medical history, consultation by medical specialists might be needed. If so, coordination by a single healthcare professional is crucial.

Recognition of the different forms of PCC is important in the implementation of PCC. Worldwide various professional organisations of nurses, midwives and gynaecologists and general practitioners have developed recommendations and guidelines for the provision of PCC to women in general and to targeted groups. For guidelines to be implemented there is a need for more consensus on:

1.standardised risk assessment tools;
2.protocols to ensure care in a uniform manner;
3.training of professionals in the provision of PCC;
4.standardised communication tools and strategies which can be adapted to the local situation;
5.a clear distribution of tasks and responsibilities between the professionals who provide individual care;
6.involvement of municipal public health institutions, schools, employers, etc.

An option to facilitate implementation of PCC is through care pathways. Care pathways are multidisciplinary organized and efficient shared care, based on evidence based medicine, which can be used for referral for (psycho)social and socio-economic risk factors to professionals in local authorities, social welfare services and public health. These care pathways should be in line with local guidelines.

Structure

The chart below shows an overview of the organisational structure of the initiative. The arrows represent the communication channels between the mutual groups. To learn more about the structure of our initiative, click on this link.

Information for Corporations