Preconception Care Research Articles

The Effect of Preconception Counseling According to the Theory of Planned Behavior with the Presence of the Spouse on Preconception Health Behaviors – A Training Trial Study

Background and Objective: Preconception care consists of biomedical, behavioral, and social services, along with health interventions, for women and couples before conception to improve their health status and reduce individual and environmental high-risk behaviors. This study aimed to assess to preconception counseling according to the theory of planned behavior with the presence of the spouse on preconception care behaviors. Materials and Methods: This study was an educational trial. The researcher randomly divided women into two intervention and control groups. The control group only received routine preconception care in the presence of the spouse. The intervention group, according to the theory of planned behavior, received 60-minute face-to-face counseling weekly sessions. The main outcomes of behavior were divided into two categories: screening tests and vaccinations and individual lifestyle (exercise, nutrition, and smoking). The questions also focused on men’s check-up tests. The data normality was analyzed by group, variable type, and measurement stage using the Shapiro-Wilk test and the skewness and kurtosis results. Levene's and Mochli's tests were used to check the homogeneity of variances and assumption of sphericity, respectively. Data were analyzed using independent t-tests, chi-square, repeated measures test, and SPSS 26 software. Result: The previous lifestyle behaviors were respectively 15.22 + 2.836, 15.49 + 2.769, and 16.84 + 1.894 before, immediately, and 4 weeks after the intervention in control, and 12.70 + 3.69, 15.53 + 3.02, and 16.60 + 2.73 in the intervention group, indicating no significant differences (p=0.08). However, the two groups significantly increased healthy lifestyles over time(p=0.001). The results also showed that the mean of test and vaccination was respectively 4.44 ± 2.99, 2.75 ± 6.42, and 2.49 ± 8.31 before, immediately, and 4 weeks after the intervention in control, and 4.09 + 3, 6.74 + 2.87, and 8.35 + 2.37 in the intervention group, indicating no significant differences(p=0.99). Conclusion: Since the presence of the husband during the training of women's pre-pregnancy care can affect their health behaviors regardless of the type of intervention, men are suggested to attend prepregnancy training and consultations for at least one session.

Tackling inequalities in preconception health and care: barriers, facilitators and recommendations for action from the 2023 UK preconception EMCR network conference.

Reducing inequalities in preconception health and care is critical to improving the health and life chances of current and future generations. A hybrid workshop was held at the 2023 UK Preconception Early and Mid-Career Researchers (EMCR) Network conference to co-develop recommendations on ways to address inequalities in preconception health and care. The workshop engaged multi-disciplinary professionals across diverse career stages and people with lived experience (total n = 69). Interactive discussions explored barriers to achieving optimal preconception health, driving influences of inequalities and recommendations. The Socio-Ecological Model framed the identified themes, with recommendations structured at interpersonal (e.g. community engagement), institutional (e.g. integration of preconception care within existing services) and environmental/societal levels (e.g. education in schools). The co-developed recommendations provide a framework for addressing inequalities in preconception health, emphasising the importance of a whole-systems approach. Further research and evidence-based interventions are now needed to advance the advocacy and implementation of our recommendations.

Knowledge, Attitudes, and Practices Regarding Preconception Care Among Women in Saudi Arabia: A Cross-Sectional Study

Knowledge, Attitudes, and Practices Regarding Preconception Care Among Women in Saudi Arabia: A Cross-Sectional Study

Implementation of Genetic Carrier Screening at Gynecologic-Related Visits

ObjectiveTo increase patients’ knowledge and access to genetic carrier screening (GCS) in a gynecologic setting by implementing a protocol to universally offer GCS education and screening to reproductive-age women during the preconception period at gynecologic-related visits. DesignThe model for improvement quality improvement process model was used to guide this initiative. Local Problem/SettingScreening for genetic disease has been a part of preconception and genetic care for the past 50 years. Despite its longstanding presence and better accessibility and affordability of testing, there are no established protocols to universally offer screening to reproductive-age women during preconception care in the United States. The project was implemented at an outpatient gynecology clinic in Phoenix, Arizona. ParticipantsFifty-one women ages 18 to 51 years. Intervention/MeasurementsA protocol was implemented to universally offer expanded GCS and health education to reproductive-age women during the preconception period at gynecologic-related visits. Women’s responses to being offered GCS and the rationale for their response was documented on a spreadsheet. ResultsAll 51 participants were offered GCS during their visit. None of those 51 participants had any previous knowledge of GCS. All 51 participants declined GCS; reasons included the following: would consider it once closer to childbearing (53%), did not have any childbearing plans (31.3%), did not have any further childbearing plans (9.8%), or were not worried about the possibility of genetic disease (5.8%). None cited cost as a reason for declining GCS. After project completion, 3 of the 51 participants returned to the clinic to undergo GCS, and the clinic has adopted the intervention described here as its standard of care for patients who meet criteria for GCS. ConclusionIt is imperative to provide health education about GCS to women during preconception care so that they can make informed choices about family planning.

High Prevalence of Tobacco Consumption among Pregnant Women in a Southern European City (Seville): A Challenge for the Health System.

The prevalence of prenatal tobacco exposure remains high in many countries, particularly in southern Europe. The aims of this study were to estimate the prevalence of smoking among pregnant women in a southern Spanish city (Seville) and to identify the associated sociodemographic and obstetric characteristics. In a descriptive, cross-sectional study, a random sample of pregnant women who were scheduled to undergo a morphology scan at their public referral hospital in their 20th week of gestation were interviewed in person. At the start of pregnancy, 38.2% of the pregnant women were smokers. In the twentieth week, 19.1% continued to smoke, and the same percentage had quit. The prevalence of smoking in pregnant women was higher among those with a low level of education (60% among pregnant women with no studies and 30.4% in those with primary education) and among those who had had abortions (38.5%). Pregnant smokers with obesity were the least likely to have given up smoking during pregnancy. Women with a lower educational level should be a prime target for cross-sectoral interventions aimed at preventing prenatal tobacco exposure. Implementation of support measures for providing effective clinical advice in preconception and prenatal care regarding healthy lifestyles is particularly needed.

Effect of Structured Teaching Programme on Knowledge regarding Preconception Care among Reproductive women under Mukalmua Block PHC, Nalbari district, Assam

Background: Preconception care is a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management. The main goal of preconception care is to provide health promotion, screening and interventions for women of reproductive age to reduce the risk factor that might affect future pregnancies. Methodology: The research approach used for the study was quantitative evaluative research approach. The conceptual framework for the study was based on ‘General Systems Theory’ developed by Ludwig von Bertalanffy and modified by JW Kenny. A pre-experimental one-group pre-test post-test research design was used to evaluate the knowledge regarding preconception care among reproductive women. Multistage random sampling technique was used to select 60 reproductive women. Structured interview schedule was used to evaluate the knowledge regarding preconception care among reproductive women. Descriptive and inferential statistics were used to analyze the study data. Result: Findings revealed that out of 60 reproductive women; in the pre-test, majority 39(65%) of the participants had moderately adequate knowledge; 16(26.7%) of the participants had inadequate knowledge and only 5(8.3%) of the participants had adequate knowledge whereas in post-test, majority 53(88.3%) of the participants had adequate knowledge, only 7 (11.7%) had moderately adequate knowledge and none of them had inadequate knowledge regarding preconception care. The mean posttest knowledge scores 18.40 was significantly higher than the mean pre-test knowledge score 8.37 with mean difference 10.03 and 't' value 26.69 for df 59 at p< 0.05 level of significance. Socio-demographic variables such as educational status and use of contraceptive methods were found to be statistically significant at p<0.05 with pre-test level of knowledge regarding preconception care among reproductive women.

Knowledge, practices and associated factors of knowledge on Preconception Care Package among public health midwives in Colombo District, Sri Lanka

Knowledge, practices and associated factors of knowledge on Preconception Care Package among public health midwives in Colombo District, Sri Lanka

General practice preconception care invitations: a qualitative study of women’s acceptability and preferences

BackgroundIn general practice, primary care providers can potentially use electronic medical records (EMRs) to identify and invite reproductive-aged women with preconception health risk factors to increase their engagement in preconception...

Asthma and pregnancy: Understanding the dynamic relationship - A comprehensive review

The health of pregnant women and their developing fetuses can be greatly impacted by asthma, a prevalent chronic respiratory disease. Pregnancy-related asthma is a serious health risk. A potentially fatal condition that makes many pregnancies more difficult is asthma. The prevalence of asthma has increased within the past few decades. This comprehensive review explored the complex connection between asthma and pregnancy. Analyzing physiological alterations during pregnancy revealed dynamic interactions between immunological responses and respiratory function. These Important discoveries highlight the susceptibility to exacerbations of asthma. This discussion focuses on the links between poorly managed asthma and unfavourable - perinatal outcomes, with particular attention given to maternal and fetal outcomes, tracking and tailored treatment to provide the best possible management of asthma. This review emphasizes how important it is to manage asthma throughout pregnancy because it can have a positive impact on both the mothers and fetuses long-term health. Consequences for clinical practice emphasize the value of preconception care, ongoing surveillance, and joint obstetrician-pulmonologist efforts. This review also sheds light on how common asthma is in expectant mothers, and this field's future directions require further investigation. Low birth weights and small for gestational age are associated with a greater risk, especially in women who have moderate-to-severe asthma and have episodes of the condition during pregnancy. Additionally, there was a slight but statistically significant increase in the chance of congenital deformities. By preventing exacerbations, active management may lessen these risks. Ensuring optimal management of asthma during pregnancy is crucial for the welfare of the expectant mother and the unborn child. While poorly managed and undertreated asthma is linked to a number of dangers for both mothers and fetuses, well-controlled asthma reduces the risk of complications for both mothers and fetuses.

The Effectiveness of Bariatric Surgery on Treating Infertility in Women-A Systematic Review and Meta-Analysis.

Background/Objectives: Obesity is a growing global health concern, which increases the risk of various diseases and has seen a rising prevalence over time. The global prevalence of obesity among adults has doubled over time. Obesity significantly impacts health by increasing the risk of a range of severe medical conditions. Cardiovascular diseases, such as heart attacks and strokes, are more prevalent in individuals with obesity due to factors like high blood pressure and abnormal cholesterol levels. This systematic review and meta-analysis sought to establish the effectiveness of bariatric surgery in treating infertility in women. Methods: This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A broad electronic search was conducted through PubMed, Web Science, and Medline databases for studies published between April 2017 and October 2023. The search strategy used the following terms: bariatric surgery, metabolic surgery, bariatric surgical procedures, stomach stapling, infertility, and fertility issues. The data were analyzed using the Revman version 5.1.2 software. Results: The results of the study show that despite the heterogeneity found in the studies, irregular menstrual cycles were found to reduce significantly in patients who underwent bariatric surgery (p = 0.01), with an RR of 0.22, at a 95% CI (0.06, 0.74). With regards to infertility, the results indicate that bariatric surgery reduced the level of infertility among the patients significantly (p = 0.00001), with an RR of 0.55, at a 95% CI (0.45, 0.68). Further, the results show bariatric surgery reduced rate of miscarriages among patients (p = 0.01), with an RR of 0.51, at a 95% CI (0.30, 0.86). Moreover, bariatric surgery reduced the level of congenital malfunction, but the effect was not statistically significant (p = 0.16), with an RR of 0.39, at a 95% CI (0.10, 1.45). However, the overall effect of bariatric surgery on treating infertility was found to be significantly effective (p = 0.0001), with an RR of 0.54, at a 95% CI (0.43, 0.68). This implies that bariatric surgery helps in weight loss, which improves ovulatory dysfunction and irregular menstruation while boosting spontaneous conception. Conclusions: This study found that bariatric surgery helps infertile women of a reproductive age to lose weight, which improves ovulatory dysfunction and irregular menstruation while boosting spontaneous conception. On the other hand, the study noted that after bariatric surgery, spontaneous conception can occur because of a decreased rate of miscarriage, increased fertility, reduced levels of congenital malfunction, and the restoration of regular menstrual cycles. Therefore, this study highlights the need to offer adequate preconception care and counselling to women who are about to be pregnant, both before and after bariatric surgery. Further, based on the fact that this study focused on general bariatric surgery, future research should focus on specific types of bariatric surgery to establish the most effective type of bariatric surgery in treating infertility in women.

Infectious and obstetric determinants of anemia among pregnant women in Southwest Ethiopia.

Anaemia, characterized by low red blood cell or haemoglobin levels, impairs oxygen transport in the body and poses a major global public health issue, particularly affecting pregnant women and children. This study focuses on identifying the factors contributing to anaemia among pregnant women receiving antenatal care (ANC) at Mizan-Tepi University Teaching Hospital (MTUTH) in southwest Ethiopia. A hospital-based unmatched case-control study was conducted from July 1 to August 30, 2022, involving 370 pregnant women (90 with anaemia and 280 without). Data collection included questionnaires, laboratory tests (Hgb and stool examination), and anthropometric measurements. SPSS version 21 was used for data analysis, with binary logistic regression identifying factors associated with anaemia. The significance level was set at a p-value <0.05. The study achieved a 100% response rate for both cases and controls. Factors identified as determinants of anaemia among pregnant women included malaria infection (AOR = 7.83, 95% CI: 3.89-15.8), hookworm infection (AOR = 2.73, 95% CI: 1.39-5.34), short birth interval (AOR = 7.11, 95% CI: 3.59-14.2), and history of unsafe abortion (AOR = 5.40, 95% CI: 2.46-11.8). This study found that malaria infection, hookworm infection, birth interval <33 months, and a history of unsafe abortion are factors contributing to anaemia in pregnant women. Strategies such as distributing insecticide-treated bed nets (ITNs) to combat malaria, improving sanitation, anthelmintic drugs, promoting family planning to prevent unwanted pregnancies and unsafe abortions, and providing preconception care can help reduce the incidence of anaemia.

Adolescent pregnancy, maternal and child anaemia: Empirical analysis from India, Bangladesh, and Nigeria.

Early childbearing poses several potential risks to maternal and child health. This paper empirically analyses the association between teenage pregnancy and child nutritional status, maternal and child anaemia in three countries (Nigeria, India and Bangladesh) that account for the highest proportion of teenage births and/or total number of malnourished teenage mothers and children. Data were sourced from nine waves of Demographic and Health Surveys conducted in Bangladesh, India, and Nigeria from 2005-2018, covering a sample of 27,705 children from Bangladesh, 266,308 children from India and 54,719 children from Nigeria. Our outcome measures of maternal and child nutrition include (i) a composite measure of anthropometric failure for children (CIAF), (ii) maternal anaemia, (iii) childhood anaemia, and (iv) anaemia in maternal-child pairs. Using multivariate regression analysis, we examine the associations between early childbirth, child nutrition, and maternal and child anaemia, controlling for an array of household-level socioeconomic and demographic characteristics. Across all three countries, the prevalence of CIAF (childhood anthropometric failure) is significantly higher among children born to women aged below 17 at first birth. We further find that early pregnancy and childbearing are associated with significantly higher rates of severe/moderate anaemia among both mothers and children in Bangladesh and Nigeria. In the three countries studied, the proportions of teenage mothers with vulnerable socioeconomic status and suboptimal pre-conception care are relatively high, which raises the risk of maternal and child morbidity as well as mortality.

Pregnancy in women with mitochondrial disease-A literature review and suggested guidance for preconception and pregnancy care.

Mitochondrial donation to reduce the risk of primary mitochondrial disease transmission from mother to child is now permitted under Australian law as part of a clinical trial. The energy demands of pregnancy have the potential to worsen mitochondrial disease symptoms and severity in affected women. We conducted a systematic literature review on mitochondrial disease in pregnancy; five cohort studies and 19 case reports were included. For many women with mitochondrial disease, pregnancy does not have a negative effect on health status. However, serious adverse outcomes may occur. We provide suggested guidelines for preconception counselling and antenatal care.

Preterm birth, low birth weight, and their co-occurrence among women with preexisting chronic diseases prior to conception: a cross-sectional analysis of postpartum women in a low-resource setting in Ghana

BackgroundThe incidence of chronic diseases, which are significant contributors to maternal deaths and adverse new-born outcomes, is increasing among women of reproductive age in northern Ghana. This emerging health issue raises serious concerns about the potential exacerbation of adverse birth outcomes in this setting, given that it is one of the regions in the country with a high incidence of such outcomes. We investigated the risks of preterm birth (PTB), low birth weight (LBW), and concurrent PTB and LBW among women with preexisting chronic conditions prior to conception in the Tamale Metropolis of northern Ghana.MethodsA facility-based cross-sectional study was conducted among 420 postpartum women randomly selected from five public health facilities. Information was collected electronically on participants’ self-reported experience of chronic conditions, namely, hypertension, diabetes, asthma, heart disease, and sickle cell disease, prior to their most recent pregnancy. Information on gestational age at delivery and birth weight was also collected. Regression modeling was used to quantify the risk of adverse newborn outcomes among women who reported preexisting chronic conditions prior to pregnancy.ResultsChronic diseases affected 31.2% of our sample. Of these, 28.6% had a single chronic condition, while 2.6% had comorbid chronic conditions. The prevalence of PTB was 24.0% (95% CI: 20.2, 28.4), 27.6% (95% CI: 23.5, 32.1) of the newborns were born LBW, and 17.4% (95% CI: 14.0, 21.3) of the pregnancies resulted in both PTB and LBW. Compared with those without chronic conditions, women with chronic conditions prior to conception had a greater risk of PTB (aOR = 6.78, 95% CI: 3.36, 13.68), LBW (aOR = 5.75, 95% CI: 2.96, 11.18), and the co-occurrence of PTB and LBW (aOR = 7.55, 95% CI: 3.32, 17.18).ConclusionsWe observed significant rates of PTB, LBW, and the co-occurrence of PTB and LBW among women who were already aware that they had preexisting chronic conditions prior to conception. Our findings highlight a potential gap in the quality of prenatal care provided to these women before delivery. Preconception care may offer an opportunity to address preexisting chronic conditions in women before pregnancy and potentially improve maternal and newborn health outcomes.

Risk Factors and Profile of Congenital Anomalies Abnormalities in Central Morocco

Background: In Morocco, there is no official data on the prevalence of congenital anomalies (CAs). Available data are mostly derived from hospital-based retrospective epidemiological analyses. Objectives: This study aims to describe the prevalence, distribution, and risk factors of CAs in the Beni Mellal-Khenifra region of central Morocco. Methods: Epidemiological data were obtained from delivery files of 163,842 births recorded by local medical services from January 2017 to December 2021. Additionally, a case-control study was conducted to analyze the risk factors. Results: The prevalence of CAs in this study area was 6.18 per thousand births. Musculoskeletal system anomalies were the most common (32.88%), followed by nervous system anomalies (22.20%). Genital organ abnormalities represented 7.37%, and cleft lip and palate accounted for 7.03%. Analysis by type of CA revealed that clubfeet were the most commonly reported anomalies in the study area, with a prevalence of 18%, followed by spina bifida (9%), anencephaly (7%), and cleft lips and palate (7.9%). The sex ratio (males/females) for all CAs was 1.24. Risk factors identified in this study included rural residency, maternal age over 35 years, parity, consanguinity, family history of CA, medication use before and during pregnancy, and infection episodes during pregnancy. Conclusions: The relatively high prevalence of congenital abnormalities in the Beni Mellal-Khenifra region highlights the need for prevention strategies through preconception care counseling and pregnancy monitoring, especially in rural areas. It is urgent to establish a teratovigilance registry in Morocco.

Impact of maternal body mass index on delivery complications and recurrent pregnancy loss (RPL)

Maternal Body Mass Index (BMI) is a crucial predictor of obstetric and delivery-related complications, significantly affecting maternal and neonatal outcomes. As global obesity rates continue to rise, the impact of elevated maternal BMI on pregnancy has garnered increasing attention. This comprehensive review examines the association between maternal BMI and various pregnancy complications, including gestational diabetes mellitus (GDM), hypertensive disorders, labor dystocia, cesarean section (C-section), postpartum hemorrhage (PPH), and adverse neonatal outcomes such as macrosomia. The aim of this review is to examine the impact of maternal Body Mass Index (BMI) on pregnancy and delivery outcomes, with a focus on identifying key complications associated with elevated maternal BMI and exploring the underlying mechanisms. As global obesity rates continue to rise, understanding the influence of maternal BMI on obstetric and neonatal outcomes is crucial for developing effective management strategies. This review synthesizes current research on the relationship between maternal BMI and complications such as gestational diabetes mellitus (GDM), hypertensive disorders, labor dystocia, cesarean section (C-section), postpartum hemorrhage (PPH), and adverse neonatal outcomes, including macrosomia. The review also delves into the physiological mechanisms, including insulin resistance, chronic inflammation, and altered uterine contractility, that contribute to these complications. Clinical implications are discussed, emphasizing the importance of preconception counselling, individualized weight management during pregnancy, and interdisciplinary care to optimize outcomes. The conclusion highlights Maternal BMI is a critical factor influencing pregnancy outcomes. Obesity increases the risk of delivery complications and RPL, while underweight status is associated with preterm birth, LBW, and RPL. Addressing maternal BMI through preconception care and continuous monitoring during pregnancy is essential for improving maternal and fetal health outcomes.

Impact of a Stage-Based Classification on the Incidence of Fetal Growth Restriction, Preterm Birth Rates, and Birthweight in a Rural Community of Central India

Introduction: The objective of this study was to determine the impact of the stage-based classification of fetal growth restriction (FGR) on the magnitude of FGR, preterm births (PTBs), and birthweight (BW) in a rural population of Madhya Pradesh in Central India. Methods: The program covered 168 public sector centers for pregnant women and infants that provided services to nearly 220,000 people. The third-trimester assessments included fetal biometry, growth and environment assessments, and Doppler assessments. Fetal growth was staged using the Barcelona protocol as stages 1–4 FGR, small for gestational age, and no FGR. The data from the last ultrasound assessment before childbirth were considered. Regular training programs covering preconception care, antenatal and postnatal care were organized in the local language for the public sector community health workers of the program district. Childbirth outcomes were collected from the obstetric service of the local public sector hospital. Results: The analysis included 1,229 pregnancies from 2019 to 2023. The overall magnitude of FGR using estimated fetal weight <10th centile was 19.61% and reduced to 13.34% with the stage-based classification. The magnitude of FGR using the stage-based classification reduced from 27.59% in 2019 to 8.95% in 2023. The PTB in the stage-based FGR subgroup declined from 35.0% in 2019 to 3.45% in 2023 and 96.55% of the stage 1 FGR babies in 2023 were delivered at term. The overall mean BW in the program area improved from 2,772.41 (357.11) g in 2019 to 2,819.68 (377.31) g in 2023. The perinatal mortality rate (8.95 per 1,000 pregnancies) in the program area for 2019–2023 was much lower than the 31.9 per 1,000 pregnancies reported for Madhya Pradesh. Conclusion: The change to a stage-based classification of FGR integrated with low-dose aspirin and fetal Doppler studies reduced the incidence of FGR and PTB and perinatal mortality and increased BW in this rural community.

Concordant fatal congenital anomaly in twin pregnancy: a case report and review of the literature

BackgroundWhen a pregnant mother finds out she has a fetus with a congenital defect, the parents feel profound worry, anxiety, and melancholy. Anomalies can happen in singleton or twin pregnancies, though they are more common in twin pregnancies. In twins, several congenital defects are typically discordant.Case summaryWe present a rare case of concordant fatal anomaly in twin pregnancy in a 22-year-old African patient primigravida mother from Western Ethiopia who presented for routine antenatal care. An obstetric ultrasound scan showed anencephaly, meningomyelocele, and severe ventriculomegaly. After receiving the counseling, the patient was admitted to the ward, and the pregnancy was terminated with the medical option. Following a successful in-patient stay, she was given folic acid supplements and instructed to get preconception counseling before getting pregnant again.ConclusionThe case demonstrates the importance of early obstetric ultrasound examination and detailed anatomic scanning, in twin pregnancies in particular. This case also calls for routine preconceptional care.

Women's experiences with continuity for effective coordination during maternal and neonatal continuum in Kenya: An interpretive phenomenology.

Embracing women's experiences in decision-making is imperative for continuity in effective coordination of maternal and neonatal health (MNH); women are the end users within the care ecosystem. Through women's continuous feedback, skilled birth attendants (SBAs) and the healthcare system get to understand emerging issues based on their needs and preferences. The purpose of this article is to describe women's experiences of continuity for effective coordination of care through the transitions in the MNH continuum in Kenya. The study was conducted in selected counties of Kenya based on birth rates per woman as follows: Wajir (7.8) Narok (6.0) Kirinyaga (2.3) and Nairobi (2.7) (1). The clients were interviewed concerning their experiences of the MNH continuum of care in English and Kiswahili. An interpretive hermeneutic phenomenological approach was used to construct the experiences of women of continuity during transitions in the MNH continuum for effective care coordination. Twelve participants were interviewed between January and April 2023. Atlas ti 22 software was used for data analysis. Four women experiences were highlighted: Women unawareness of preconception care, use of prenatal care, labour, birthing and postpartum flow and the women's view on the MNH continuum. The women reported their segmental and transitional experience of the MNH continuum as one that did not consistently meet their needs and preferences in order for them to fully agree that the continuum enhanced continuity for effective coordination. They felt that they experienced continuity in some segments while in some they did not.Contribution:The embrace of women's experience of their needs and preferences through the MNH continuum (segments and transitional segments) through the lens of continuity for effective coordination is timely towards the improvement of maternal and neonatal care by 2030.

Normal menstrual flow volume range and its characteristics measured from sanitary napkins in Japanese women: Discrepancy between measured and subjective menstrual flow volume.

The 2018 International Federation of Gynecology and Obstetrics abnormal uterine bleeding System-1 defines menstrual flow volume on a 3-point scale based on subjective assessment. However, the normal flow range has not been established, and it is unclear whether subjective assessment is accurate. We investigated the normal menstrual flow volume range in Japanese women and whether the actual measured menstrual flow volume agreed with the subjective evaluation. We included female menstruating volunteers aged 18-49 years in this prospective observational study. Menstrual napkins were weighed before and after use for up to three cycles, and the values were recorded in an online diary. Overall, 211 participants were recruited. All items were completed by 167 participants, and 497 menstrual cycles were included in the analysis. The median total menstrual flow volume per cycle for 497 cycles was 56.7 g. The 5th-95th percentile values ranged from 15.7 to 166.4 g. The mean value was 77.6 ± 99.6 g, with no significant differences according to age group. In the 25 cycles corresponding to heavy flow, that is, above the 95th percentile of measured flow volume, 92% were underrated as "normal" by subjective evaluation, and only 8% were correctly rated as "heavy." Our results clarify the actual menstrual flow volume in the Japanese population; this will contribute toward making women aware of the normal range of menstrual flow volume, which may facilitate appropriate preconception care.