Preconception Care to Improve Pregnancy Outcomes: The Science
Keywords:preconception care, preconception health, women’s health, maternal health, infant health
Introduction: In the last decades, improvements in the care of pregnancy and child development have been observed worldwide. However, pregnancy problems remain high in most countries. There was a concentration of care in the prenatal period as the primary approach for improving pregnancy results. Currently, attention to the care of pregnant women, women who have recently given birth, and newborns are focused on the care of preconception to improve the results of pregnancy and improve the outcomes of child growth and development.
Objective: Describe the evidence for preconception care (PCC) and information to the health care provider, as well as describe instruments to present health care providers with PCC, its definition, its components, recommended interventions, and the scientific basis for recommendations.
Methods: There was a search for published and unpublished literature related to scientific evidence for the effectiveness of PCC in improving pregnancy results. The search was carried out based on Pubmed and using data scraping techniques, in the material available on the internet and disseminated by international organizations, such as the World Health Organization and reports by government agencies.
Results: It is reported that the literature on the scientific basis for PCC is fragmented, and most publications discuss evidence of one or a few interventions, with the majority of reports considering PCC for specific populations, such as women with chronic health problems and couples with infertility. However, these publications do not offer a realistic view of the proposed PCC interventions, with the scientific evidence that supports them. The general aspects of the existing literature and the recommended preconceived care interventions are described, together with the quality of the scientific evidence and the strength of the recommendations behind each of these interventions.
Conclusion: Many clinical interventions have been identified that could be offered to women before conception to help avoid adverse outcomes. Most of these interventions have scientific evidence to support their role in improving pregnancy outcomes. Therefore, it is recommended that clinical care providers incorporate evidence-based prejudice services in their daily care of women of reproductive age, in an effort to improve women’s health before and during pregnancy, as well as improve pregnancy outcomes for women and their children.
World Health Organization (WHO). Global Health Observatory data repository. Antenatal care coverage data by country [internet] 2020. [cited 2020 Jun 09] Available from: https://apps.who.int/gho/data/node.main.ANTENATALCARECOVERAGE4?lang=en
UNFPA, World Health Organization, UNICEF, World Bank Group, the United Nations Population Division. Trends in maternal mortality: 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division [internet] 2019. [cited 2020 Jun 09] Available from: https://www.who.int /news-room/fact-sheets/detail/maternal-mortality
World Health Organization (WHO). Global Health Observatory data repository. Probability of dying per 1000 live births data by country [internet] 2020. [cited 2020 Jun 09] Available from: https://apps.who.int/gho/data/view.main.182
Christianson A, Howson CP, Modell B. March of Dimes Global Report on Birth Defects. The hidden toll of dying and disabled children. White Plains, New York: White Plains, 2006.
Osterman MJK, Martin JA. Timing and Adequacy of Prenatal Care in the United States, 2016. Natl Vital Stat Rep. 2018;67(3):1-14.
National Center for Health Statistics (US). Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville. 2017.
Chang HH, Larson J, Blencowe H, Spong CY, Howson CP, Cairns-Smith S, et al. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet. 2013;381(9862):223-34. DOI: http://doi.org/10.1016/S0140-6736(12)61856-X
Goossens J, De Roose M, Hecke AV, Goemaes R, Verhaeghe S, Beeckman D. Barriers and facilitators to the provision of preconception care by healthcare providers: A systematic review. Int J Nurse Stud. 2018;87:113-30. DOI: http://doi.org/10.1016/j.ijnurstu.2018.06.009
Dewees WP. A Treatise on the physical and medical treatment of children (Classic Reprint). Forgotten Books, 2017.
Chamberlain G. The prepregnancy clinic. Br Med J 1981;281(6232):29-30.
Committee to Study the Prevention of Low Birth Weight, Institute of Medicine. Preventing low birthweight. Washington: National Academy Press, 1985.
National Institutes of Health. Caring for our future: the content of prenatal care. A report of the Public Health Service Expert Panel on the Content of Prenatal Care. Washington: National Institutes of Health,1989.
Johnson K, Posner SF, Bierman J, Cordero JF, Atrash HK, Parker CS, et al. Recommendations to Improve Preconception Health and Health Care - United States. A Report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Reconn Rep. 2006;55(RR-6):1-23.
Public Health Agency of Canada. Family-Centered Maternity and Newborn Care: National Guidelines. In: Chapter 2 - Preconception care [internet] 2020. [cited 2020 Jun 09] Available from: https://www.canada.ca/en/public-health/services/maternity-newborn-care-guidelines.html
Sheldon T. Netherlands considers introducing preconception care. BMJ. 2007;335(7622):686-7. DOI: http://doi.org/10.1136/bmj.39353.518067.DB
Ebrahim SH, Lo SST, Zhuo J, Han JY, Delvoye P, Han JY, Zhu L. Models of Preconception Care Implementation in Selected Countries. Matern Child Health J. 200610(Suppl 1):37-42. DOI: http://doi.org/10.1007/s10995-006-0096-9
World Health Organization (WHO). Preconception care: Maximizing the gains for maternal and child health [internet] 2013 [cited 2020 Jun 09] Available from: https://www.who.int/maternal_child_adolescent/documents/preconception_care_policy_brief.pdf
World Health Organization (WHO). Meeting to Develop a Global Consensus on Preconception Care to Reduce Maternal and Childhood Mortality and Morbidity. Geneva: WHO, 2013.
Jack BW, Atrash H, Coonrod DV, Moos MK, O’Donnell J, Johnson K. The Clinical Content of Preconception Care: An Overview and Preparation of This Supplement. Am J Obstetr Ginecol. 2008;199(6 Suppl 2): S266-79. DOI: http://doi.org/10.1016/j.ajog.2008.07.067
Jack B, Atrash HK. Preconception Health and Health Care: The Clinical Content of Preconception Care. Am J Obstetr Ginecol. 2008;199(6 Suppl B):S257-396.
Thomas P. Guide to Clinical Preventive Services: Report of the US Preventive Services Task Force. JAMA. 1996;276(11):923-4. DOI: http://doi.org/10.1001/jama.1996.03540110077039
South Australian Perinatal Practice Guidelines. Preconception Advice [internet 2015. [cited 2020 Jun 09] Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/1f11de804eed8cb5afbeaf6a7ac0d6e4/Preconception +Advice_Sept2015.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-1f11de804eed8cb5afbea f6a7ac0d6e4-n5jkcsW
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