Making a case for preconception care—the pregnancy experiences of women with pre-existing medical conditions in Ibadan, Nigeria

Abstract

BackgroundFactors that predispose to poor maternal and child health outcomes in most low and middle income countries include the presence of pre-existing medical conditions that are amenable to preconception care (PCC). Nigeria has an increasing pool of women of reproductive age with pre-existing medical conditions but PCC services are not provided routinely in the maternal and child health framework. This study explores the pregnancy experiences of women with pre-existing medical conditions to make a case for PCC as a routine service.MethodsNine women purposively selected because they has pre-existing medical conditions participated in in-depth interviews (IDIs) in this qualitative study. The IDIs were held in the obstetric outpatient clinics and lying-in wards of two referral hospitals for maternal and child health services in Ibadan North LGA of Oyo State, southwest Nigeria. The interviews lasted an average of 30 minutes, were digitally recorded and transcribed verbatim. Thematic analysis using a hybrid of inductive and deductive coding was done using MAXQDA 2018.ResultsAmong the nine participants, seven were pregnant and two non-pregnant with pre-existing medical conditions including hypertension, diabetes mellitus, sickle cell disorder, chronic hepatitis, HIV, previous pregnancy loss of unknown cause and secondary infertility. None of the participants were aware of PCC and although they all desired their current pregnancy, there was no active preparation. None of the pregnant participants notified their health care providers about their desire for pregnancy and their medications were not adjusted or changed till after pregnancy. All except one of the participants believed they could have benefitted from PCC if they had been aware before pregnancy.ConclusionThe regular contact with the health system afforded by their pre-existing medical conditions is an opportunity for them to have been adequately prepared for pregnancy through counselling and adjustment or change in treatment regimen to prevent complications. This opportunity was missed among the study participants. Health care providers need to be proactive and ask women of reproductive age about their pregnancy desires during routine clinic visits in order to make adequate preparation.

Factors Related to the Implementation of Preconception Care Recommendations in Selected Districts of Limpopo Province: A Qualitative Study

“…The results also revealed that general assessment, genetic counselling or referral for genetic service, risk assessment, referral to the doctor for adjustment of treatment and giving of supplements was not performed. These findings are similar to the findings of Ojifinni and Ibisomi [ 19 ], where it was found that most clients, even those with chronic conditions such as hypertension, were not offered PCC even though it was indicated. Women who were advised about the importance of postponing pregnancy until their viral load was low or undetectable were not given any supplements.…”

“…The participants in this study indicated that women with chronic conditions were referred to high-risk clinics when they are pregnant. Ojifinni and Ibisomi [19] supported the above findings.…”

Mothers’ utilization and associated factors of preconception care in Africa, a systematic review and meta-analysis

“…this might be explained as those having pre-existing medical conditions entirely worry about their medical condition than using preconception care service. Also, a study conducted in Nigeria showed that none of the participants with pre-existing medical conditions had awareness of PCC [63].…”

Perception of men's need for preconception care—A qualitative exploration among health care providers and community members

“…Although there is some evidence that men who are preparing to be fathers may be concerned about their health, they may not be receiving adequate information about risk factors and critical issues because health care providers are not aware or trained to provide the service ( 10 , 46 ). A study among Nigerian women with pre-existing medical conditions showed missed opportunities for PCC services despite regular contact with the health system on account of their past medical history ( 47 ). These factors, coupled with a lack of awareness among health care workers as described in this study may explain the reluctance with which men approach reproductive health services.…”