Preconception health and care (PHC)—a strategy for improved maternal and child health

Abstract

Maternal health status before pregnancy is a decisive factor for pregnancy outcomes and for risk for maternal and infant complications. Still, maternity care does not start until the pregnancy is established and in most low-income settings not until more than half of the pregnancy has passed, which often is too late to impact outcomes. In Western societies preconception care (PCC) is widely recognized as a way to optimize women’s health through biomedical and behavioural changes prior to conception with the aim of improving pregnancy outcomes. But the content of PCC is inconsistent and limited to single interventions or preconception counselling to women with chronic illnesses. It has been suggested that PCC should be extended to preconception health and care (PHC), including interventions prior to pregnancy in order to optimize women’s health in general, and thereby subsequent pregnancy outcomes, the well-being of the family, and the health of the future child. With this definition, almost every activity that can improve the health of girls and women can be included in the concept. In the World Health Report of 2005 a longitudinal approach to women’s wellness and reproductive health was highlighted, and the World Health Organization has proposed a more comprehensive maternal and child health care, also including psychosocial issues and intimate partner violence. The present article gives an overview of the recent literature and discusses contents and delivery of PCC/PHC in Western as well as low-income countries. The article puts special emphasis on why violence against women is an issue for PHC.

What do people know about fertility? A systematic review on fertility awareness and its associated factors

“…Having a reproductive plan results in better reproductive outcomes, as shown by our findings of higher FA among individuals who have planned their pregnancies than those who had unplanned pregnancies. While preconception care programmes are available in the majority of developed countries, there is no consensus about the content ( 126 , 127 ) and the target population that may benefit more from it (e.g. reproductive age, planning a pregnancy, high-risk of reproductive outcomes).…”

Effects of a gestational weight gain restriction program for obese women: Sibling pairs’ weight development during the first five years of life

“…During recent years, the value of a pre-conceptional life style change has been discussed [14,15]. In this extended analysis we therefore compared weight development and BMI among sibling pairs whose mothers participated in a weight gain restriction program during pregnancy.…”

“…Follow-up studies of the effect of a gestational intervention program on the offspring during childhood have also shown conflicting results [7][8][9][10][11][12][13]. In recent years, the question of whether it is too late to begin a life style intervention during pregnancy has arisen and the need for a pre-conceptional change has been suggested [14,15].…”

Do pregnant women want to know the sex of the expected child at routine ultrasound and are they interested in sex selection?

“…Other ethical aspects, such as justice and autonomy, have also been raised in relation to PCS ( 40 ). The expanding use of fetal diagnostics technology worldwide calls for increased access to high-quality counseling already before pregnancy—so-called preconception care ( 41 ). Such counseling can provide future parents with unbiased information so they can make well-informed decisions once a pregnancy has occurred.…”