Understanding and provision of preconception care by general practitioners

Abstract

BACKGROUNDPreconception care (PCC) refers to health interventions delivered prior to conception that aim to improve pregnancy outcomes.Over the last few years, the focus on PCC has increased and health before conception is now recognised as a key determinant for maternal and child health. 1 Increasing evidence supports the benefits of preconception interventions on pregnancy outcomes, 2 influencing the development of national and international guidelines for the preconception period. 3,4 The Background: Preconception care (PCC) defines health interventions prior to conception aimed at improving pregnancy and infant outcomes. Aim: To explore the understanding and provision of PCC by general practitioners (GPs) within the Sydney Local Health District. Materials and Methods: A questionnaire developed with GPs assessed structure and content of PCC provided, attitudes toward PCC and perceived barriers and facilitators.Results: One hundred and ten GPs completed the survey: 84% reported that GPs should be the main providers of PCC; however, only 53% were aware of PCC guidelines. Seventy-five percent of responders initiated PCC discussion with women of reproductive age, 56% provided PCC to women at higher risk of adverse outcomes and 16% waited for the discussion to be initiated by the patient.Smoking, vaccination, alcohol and supplements/medication use were the most discussed PCC components, while serology, full blood count and blood pressure were the most performed assessments. Most respondents stated that PCC is essential for women with pre-existing diabetes, previous pregnancy complications or chronic illness. However, only 45% stated PCC was essential for women >35 years and 39% for women who were overweight. Importantly, weight and mental health were among the least discussed PCC components. Conclusion:General practitioners are key providers of PCC; however, only half are aware of PCC guidelines and most do not recognise overweight to be a significant preconception issue. The most common barriers to PCC delivery were time constraints, lack of knowledge and lack of resources for patients. Improved resources and education are required to support adequate PCC provision. K E Y W O R D Sgeneral practitioner, maternal health, preconception care, pregnancy, survey 21: 387-392.

Perceptions about preconception care among health care providers in Ibadan, southwest Nigeria - A qualitative study

“…Whereas previous studies show a low knowledge and awareness of PCC among health workers in other countries such as Australia [40], New Zealand [12], Iran [41], and Ethiopia [39], our study shows that knowledge and awareness of PCC and its primary components among health workers at all levels are high and in line with those described by the WHO and CDC [2][3][4]. This has major implications of facilitating access and acceptability of PCC at the population level and can improve reproductive health outcomes when integrated with routine maternal and child health services.…”

Perceptions about preconception care among health care providers in Ibadan, southwest Nigeria - A qualitative study

“…In addition, reproductive health planning and its benefits including financial readiness of the couple was mentioned. In comparison, studies among health workers in other places such as Australia [21], New Zealand [8], Iran [22] and Ethiopia [20] reported low knowledge and awareness of PCC, although these studies were quantitative in nature. On the other hand, a qualitative study among physicians in rural Pennsylvania, US showed awareness of the need for pregnancy planning and the importance of optimal maternal health prior to pregnancy and described its necessity for women with high risk conditions like hypertension, seizure disorder, depression and diabetes [6].…”

“…While some believed that every health care provider should be able to provide PCC at every contact with people in the reproductive age bracket, others felt family physicians or obstetricians/gynaecologists should be responsible. Studies in Australia [21], London [31] and Netherlands [7] have also shown that family physicians and general practitioners believe they should provide PCC. Another study among a different group of general practitioners in London found that the respondents believed that public health specialists should be the primary providers of PCC [9].…”

Preconception Care in a Remote Aboriginal Community Context: What, When and by Whom?

“…Health promotion may be considered more difficult, time consuming or lower on the priority list in a busy clinical environment. Obesity was under-recognised as an indication for PCC in another Australian primary care setting, where weight and mental health were the least common components of PCC delivered [52].…”