Arguments for the introduction of preconception service as the new infrastructure of reproductive health

Abstract

To summarize the arguments for the introduction of preconception care based on the experience of the Hungarian Periconception Service (HPS), 1984–2011. This new health infrastructure, as part of primary health care is performed by qualified nurses/midwifes after their special training. Couples at risk selected by nurses are referred to specialists to reject or confirm the supposed risks, in addition to treat them if necessary as part of the secondary care. The HPS includes counseling, examinations and medical interventions in three steps: (I) Reproductive health check-up as a preconception screening of reproductive risk factors. (II) The 3-month preparation for conception because the beginning of life is at conception, and the major events of life such as conceptus' sex, health and/or disease are determined at that time, therefore it is necessary to prepare it. (III) Better protection of early pregnancy. In general pregnant women visit prenatal care clinics between the 8th and 12th gestational week though the embryo has passed through his/her most sensitive and vulnerable period, thus it is too late to protect them from congenital abnormalities that occur before the 8th week of pregnancy. The most important arguments for the introduction of pre/periconception care/service are the following: (1) The optimal infrastructure for periconception folic acid/multivitamin supplementation. (2) Preconception screening of sexually transmitted infections/disorders in women. (3) Avoidance of smoking and alcohol beverages. (4) Early diagnosis of infertility. (5) More effective participation in genetic counselling. (6) Selection of female participants at high risk. (7) Vaccination. (8) The benefits of early pregnancy diagnosis. (9) The more effective avoidance of teratogenic and other risks. (10) Long-term beneficial effects for children. Hungarian experiences show the feasibility and usefulness of pre/periconception care/service in the prevention of preterm births and congenital abnormalities.