A Systematic Review of Clinical Guidelines for Preconception Care

Abstract

Preconception care (PCC) involves a wide-ranging set of interventions to optimize health prior to pregnancy. These interventions seek to enhance conception rates, pregnancy outcomes, childhood health, and the health of future generations. To assist health care providers to exercise high-quality clinical care in this domain, clinical practice guidelines from a range of settings have been published. This systematic review sought to identify existing freely accessible international guidelines, assess these in terms of their quality using the AGREE II tool, and assess the summary recommendations and the evidence level on which they are based. We identified 11 guidelines that focused on PCC. Ten of these were classified as moderate quality (scores ranging from 3.5 to 4.5 out of 7) and only one was classified as very high quality, scoring 6.5. The levels of evidence for recommendations ranged from the lowest possible level of evidence (III) to the highest (I-a): the highest quality evidence available is for folic acid supplementation to reduce risk of neural tube defects and the role of antiviral medication to prevent HIV transmission. This systematic review identified that high-quality guidelines on PCC are lacking and that few domains of PCC recommendations are supported by high-quality evidence.

Setting Preconception Care Priorities in Australia Using a Delphi Technique

“…32 The selection of PCC priorities and underpinning values was based on peer-reviewed evidence from existing preconception guidelines. 33 The priorities and values were ranked by participants with expertise in preconception health from range of sectors and Australian states and a community advisor. Multiple opportunities for engagement, including face-to-face discussions via videoconference, facilitated robust discussion regarding the priorities, key strategies and values and all Delphi participants had time to consider and then re-consider their views.…”

“…This Delphi technique to identify and rank health care priorities for PCC in Australia can be used to direct key stakeholders including research, health care, education, social care, and government in their efforts to improve preconception health and pregnancy outcomes. The technique was based on peer-reviewed evidence from existing preconception guidelines 33 and expert opinion across a range of sectors. After ranking activities, discussion, and debate, ten priority areas were identified, with health behaviors (nutrition, physical activity, prenatal supplementation), medical history (including optimization of pre-existing medical conditions, obstetric history, medications, genetic history), and reproductive health (reproductive life planning, contraception) ranked most highly.…”

“…The scoping review 33 that informed this Delphi technique revealed gaps in the scope, content, presentation, and availability of PCC guidelines in Australia and New Zealand. Comprehensive PCC guidelines that target a range of health and social care professions, and are developed with input from key stakeholders and community advisors are needed.…”

“…The Delphi technique was divided into three sections: i) PCC priority setting, ii) key strategies for addressing the priorities, and iii) underpinning values ( Table 1 ). A scoping review 33 of preconception guidelines in Australia informed the PCC priority setting section and the underpinning values section. For this review, a working party of Network members (JB, KB, KC, ED, KH, RW) reviewed national and state-based preconception guidelines available in Australia and New Zealand.…”

“…For this review, a working party of Network members (JB, KB, KC, ED, KH, RW) reviewed national and state-based preconception guidelines available in Australia and New Zealand. 33 Delphi participants were asked to rank the health care priorities for PCC identified in this review, from most important to least important. Participants were then asked to draw on their expertise to identify key strategies for addressing the health care priorities for PCC in Australia.…”