The Past and Present Practices and Continuing Controversies of Preconception Care

Weerd, Sabina de; Steegers, Eric A.P.

doi:10.1159/000064631

Cited by 39 publications

(35 citation statements)

References 37 publications

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“…Therefore, the most effective strategy for tackling educational inequalities in preterm birth is probably by nesting these programs in preconception care. 38 …”

Section: Discussionmentioning

confidence: 99%

Explaining educational inequalities in birthweight: the Generation R Study

Jansen

Tiemeier

Looman³

et al. 2009

Paediatric Perinatal Epid

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“…Therefore, the most effective strategy for tackling educational inequalities in preterm birth is probably by nesting these programs in preconception care. 38 …”

Section: Discussionmentioning

confidence: 99%

Explaining educational inequalities in birthweight: the Generation R Study

Jansen

Tiemeier

Looman³

et al. 2009

Paediatric Perinatal Epid

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“…The introduction of preconceptional care settings, where people who are planning a pregnancy are informed about risk factors in pregnancy (e.g., alco- hol, smoking, hereditary disorders) and health promotion (e.g., folic acid supplementation), may therefore be of interest to the target population (Czeizel, 1999;De Weerd et al, 2002a). Although evidence for the effectiveness of preconceptional care is growing, some implementation barriers exist: (1) the allocation of such care in the health service systems is not clear, (2) in some countries the rates of unintended pregnancies are high, and (3) most health-care providers currently lack the appropriate knowledge (Allaire and Cefalo, 1998;De Weerd and Steegers, 2002b). As expected, high perceived positive consequences of test results were associated with a positive intention to participate.…”

Section: Factors Associated With Intentionmentioning

confidence: 99%

Preconceptional Cystic Fibrosis Carrier Screening: Attitudes and Intentions of the Target Population

et al. 2004

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The aim of this study was to assess the attitudes and intentions of individuals planning a pregnancy with regard to preconceptional cystic fibrosis (CF) carrier screening and to determine factors associated with a positive and negative/neutral intention to have the test. A survey, based on a questionnaire, was conducted among a stratified random sample of 303 recently married couples (606 individuals). Of the eligible individuals, 70% (n = 380) participated. Of the respondents, 73% had a positive attitude toward a routine offer of preconceptional CF carrier screening, and 56% had the intention to participate in a screening program. A positive intention to have the test was associated with high perceived anticipation of regret, intended preconceptional behavior, high perceived pressure from experts, high perceived consequences of the test results, low perceived barriers, and low perceived negative consequences for family members. These results suggest that the offer of routine preconceptional CF carrier screening would lead to substantial acceptance among couples planning a pregnancy. Several variables related with intention were identified.

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“…The goals of preconception care are to optimize the health of the future child and mother through primary intervention and to increase reproductive autonomy by providing information on reproductive options [de Weerd and Steegers, 2002; Health Council of the Netherlands, 2007a] The offer of prenatal screening information during this counseling could be regarded as a reproductive option, thereby serving the second goal. In our view, the information offer would therefore fit appropriately in a preconception care consultation.…”

Section: Discussionmentioning

confidence: 99%

Informing on prenatal screening for Down syndrome prior to conception. An empirical and ethical perspective

Schoonen

Zee

Wildschut

et al. 2012

American J of Med Genetics Pt A

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In most Western countries, information on prenatal screening for Down syndrome is provided in the first-trimester of pregnancy. The purpose of this study was to examine whether this information should additionally be provided before pregnancy to improve the informed decision-making process. In an empirical study, we obtained data from pregnant women with respect to their preferences regarding information on prenatal screening preconceptionally. Questionnaire data (n ¼ 510) showed that 55.7% of responding women considered participating in prenatal screening for Down syndrome before pregnancy. 28.0% of women possessed information on prenatal screening preconceptionally. 84.6% preferred not to receive information preconceptionally in retrospect. In an ethical analysis, we elaborated on these preferences by weighing pros and cons. We considered two arguments against the provision of information on prenatal screening preconceptionally: women's preference to receive information in a step-by-step manner, and the risk of providing a directive message. We identified three reasons supporting its provision preconceptionally: the likelihood of making an informed decision could, firstly, be increased by ''unchaining'' the initial information from possible subsequent decisions, and, secondly, by providing women sufficient time to deliberate. Thirdly, the probability of equal access to prenatal screening may increase. To conclude with, we propose to incorporate an information offer on prenatal screening for Down syndrome in preconception care consultations. By offering information, instead of providing information, prospective parents are enabled to either accept or decline the information, which respects both their right to know and their right not-to-know. Key words: information on prenatal screening; down syndrome; preconception care consultation; informed decision-making; medical ethics; right not-to-know INTRODUCTIONPreconception care is a set of primary interventions that identify and modify biomedical, behavioral, and social risks to a woman's health and future pregnancies [Centers for Disease Control and Prevention (CDC). National Center on Birth Defects and Developmental Disabilities, 2006] Preconception care aims to optimize the health of the future child and to improve maternal health 485 [Health Council of the Netherlands, 2007b]. Information on prenatal screening for Down syndrome is commonly provided after conception, during the first-trimester of pregnancy. Many Western countries have policies or recommendations for prenatal screening for Down syndrome, in which either women of advanced age are offered invasive diagnostic testing (chorionic villus sampling or amniocentesis), or in which women, irrespective of their age, are offered non-invasive risk-assessment tests in the firsttrimester of pregnancy (nuchal scan, often combined with maternal serum evaluation) [Boyd et al., 2008;EUROCAT, 2010]. The latter screening tests provide an individual risk estimate of carrying a child with Down syndrome, and may be foll...

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The Past and Present Practices and Continuing Controversies of Preconception Care

Cited by 39 publications

References 37 publications

Explaining educational inequalities in birthweight: the Generation R Study

Explaining educational inequalities in birthweight: the Generation R Study

Preconceptional Cystic Fibrosis Carrier Screening: Attitudes and Intentions of the Target Population

Informing on prenatal screening for Down syndrome prior to conception. An empirical and ethical perspective

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