Norita Hussein1, Joe Kai2, Nadeem Qureshi2. 1. a Department of Primary Care Medicine, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia ; 2. b Division of Primary Care, School of Medicine , University of Nottingham , Nottingham , UK.
Abstract
BACKGROUND: Reproductive health and pregnancy outcomes may be improved if the reproductive risk assessment is moved from the antenatal to the preconception period. Primary care has been highlighted as an ideal setting to offer preconception assessment, yet the effectiveness in this setting is still unclear. OBJECTIVES: To evaluate the effectiveness of preconception interventions on improving reproductive health and pregnancy outcomes in primary care. METHODS: MEDLINE, CINAHL, EMBASE and PsycINFO databases were searched from July 1999 to the end of July 2015. Only interventional studies with a comparator were included, analysed and appraised systematically, taking into consideration the similarities and differences of the participants, the nature of interventions and settings. RESULTS: Eight randomized controlled trials were eligible. Preconception interventions involved multifactorial or single reproductive health risk assessment, education and counselling and the intensity ranged from brief, involving a single session within a day to intensive, involving more than one session over several weeks. Five studies recruited women planning a pregnancy. Four studies involved multifactorial risks interventions; two were brief and the others were intensive. Four studies involved single risk intervention, addressing folate or alcohol. There was some evidence that both multifactorial and single risk interventions improved maternal knowledge; self-efficacy and health locus of control; and risk behaviour, irrespective of whether brief or intensive. There was no evidence to support reduced adverse pregnancy outcomes. One study reported no undue anxiety. The quality of the studies was moderate to poor. CONCLUSION: The evidence from eligible studies is limited to inform future practice in primary care. Nevertheless, this review has highlighted that women who received preconception education and counselling were more likely to have improved knowledge, self-efficacy and health locus of control and risk behaviour. More studies are needed to evaluate the effects on adverse pregnancy outcomes.
BACKGROUND: Reproductive health and pregnancy outcomes may be improved if the reproductive risk assessment is moved from the antenatal to the preconception period. Primary care has been highlighted as an ideal setting to offer preconception assessment, yet the effectiveness in this setting is still unclear. OBJECTIVES: To evaluate the effectiveness of preconception interventions on improving reproductive health and pregnancy outcomes in primary care. METHODS: MEDLINE, CINAHL, EMBASE and PsycINFO databases were searched from July 1999 to the end of July 2015. Only interventional studies with a comparator were included, analysed and appraised systematically, taking into consideration the similarities and differences of the participants, the nature of interventions and settings. RESULTS: Eight randomized controlled trials were eligible. Preconception interventions involved multifactorial or single reproductive health risk assessment, education and counselling and the intensity ranged from brief, involving a single session within a day to intensive, involving more than one session over several weeks. Five studies recruited women planning a pregnancy. Four studies involved multifactorial risks interventions; two were brief and the others were intensive. Four studies involved single risk intervention, addressing folate or alcohol. There was some evidence that both multifactorial and single risk interventions improved maternal knowledge; self-efficacy and health locus of control; and risk behaviour, irrespective of whether brief or intensive. There was no evidence to support reduced adverse pregnancy outcomes. One study reported no undue anxiety. The quality of the studies was moderate to poor. CONCLUSION: The evidence from eligible studies is limited to inform future practice in primary care. Nevertheless, this review has highlighted that women who received preconception education and counselling were more likely to have improved knowledge, self-efficacy and health locus of control and risk behaviour. More studies are needed to evaluate the effects on adverse pregnancy outcomes.
Entities:
Keywords:
Preconception care; general practice; pregnancy outcomes; primary healthcare
Authors: Harpreet S Chahal; Bizu Gelaye; Elizabeth Mostofsky; Sixto E Sanchez; Juan F Mere; Francisco G Mercado; Percy Pacora; Michelle A Williams Journal: Epidemiology Date: 2019-07 Impact factor: 4.822
Authors: Mary Barker; Stephan U Dombrowski; Tim Colbourn; Caroline H D Fall; Natasha M Kriznik; Wendy T Lawrence; Shane A Norris; Gloria Ngaiza; Dilisha Patel; Jolene Skordis-Worrall; Falko F Sniehotta; Régine Steegers-Theunissen; Christina Vogel; Kathryn Woods-Townsend; Judith Stephenson Journal: Lancet Date: 2018-04-16 Impact factor: 79.321
Authors: Laura Lorenz; Franziska Krebs; Farah Nawabi; Adrienne Alayli; Stephanie Stock Journal: Int J Environ Res Public Health Date: 2022-05-18 Impact factor: 4.614
Authors: Veronique Y F Maas; Maria P H Koster; Erwin Ista; Kim L H Vanden Auweele; Renate W A de Bie; Denhard J de Smit; Bianca C Visser; Elsbeth H van Vliet-Lachotzki; Arie Franx; Marjolein Poels Journal: BMC Public Health Date: 2020-02-14 Impact factor: 3.295
Authors: Lucy C Barker; Cindy-Lee Dennis; Neesha Hussain-Shamsy; Donna E Stewart; Sophie Grigoriadis; Kelly Metcalfe; Tim F Oberlander; Carrie Schram; Valerie H Taylor; Simone N Vigod Journal: BMC Psychiatry Date: 2020-02-07 Impact factor: 3.630