Preconception Care For Women Research Articles

Awareness of the Importance of Lifestyle Modification on the Prevention of Gestational Complications in Preconception Care of Women

Background: Preconception care mainly depends on minimising the risks faced before conception, collecting all possible information before conception, and using all sources to improve the reproductive health of pregnant women. Preconception is a great opportunity for early determination of any health risk and to optimise the health of implicit moms and protect the unborn foetus from any type of health risk as well as birth defect. This study presents the best scientific approach method for developing preconception intervention packages under different conditions. Objective: To determine the awareness of the importance of lifestyle modification in the prevention of gestational complications during the preconception period. Methods: This study was approved by the Ethical Committee and Protocol Committee (protocol no. 600/2022-2023). The subjects of this observational study were women who are primigravidae and reside in Karad, India. Using random sampling, 93 participants who were primigravidae were included. A questionnaire was distributed to individuals within the age range of 21 to 30 years, based on preconception care, lifestyle modification, family support and precautionary measures. Results: It was found that out of 91 participants, only 4.3% had excellent knowledge, 8.6% had very good knowledge, 27.96% had good knowledge, 53.76% had fair knowledge and 5.38% had poor education regarding preconception care. Conclusion: The awareness among women regarding the importance of lifestyle modification in the prevention of gestational complications during the preconception period was significantly lower.

Promoting REproductive Planning And REadiness in Diabetes (PREPARED) Study protocol: a clinic-randomised controlled trial testing a technology-based strategy to promote preconception care for women with type 2 diabetes

IntroductionWomen with type 2 diabetes (T2DM) are more likely to experience adverse reproductive outcomes, yet preconception care can significantly reduce these risks. For women with T2DM, preconception care includes reproductive...

Facilitators and barriers of preconception care in women with inflammatory bowel disease and rheumatic diseases: an explorative survey study in a secondary and tertiary hospital

BackgroundPreconception care (PCC) is care prior to conception to optimize parental health, and health of the future child, through biomedical and behavioral changes. Providing PCC to all women with a wish to conceive will improve perinatal health. PCC is especially important for women with a chronic disease, such as inflammatory bowel disease (IBD) and rheumatic diseases (RD). At present PCC is not part of routine care for these women. The aim of this study is to identify facilitators and barriers on a patient and professional level regarding the provision of PCC in women with IBD and RD.MethodsAn explorative survey study among women with IBD and RD, their treating physicians and obstetric professionals was performed. Patients with a wish to conceive, pregnant women or those with a recent pregnancy (< 1 year ago) visiting the outpatient clinic of a secondary and tertiary hospital and involved physicians and obstetric professionals were eligible.ResultsA total of 71% of the IBD patients (n = 22/31) and 35% of the RD patients (n = 20/58) received a PCC consultation. PCC consultation was considered easy to enter, short in time and patients felt comfortable. Patients (71% IBD; 62% RD) preferred a personal PCC consultation with their disease specific specialist together with an obstetrician. Patients specifically wanted to receive information about the safety of medication use and disease activity following delivery. Of the included healthcare professionals 67% (n = 31) agreed PCC was applicable to their patients. Main barrier to providing PCC was lack of time and unavailability of professionals. In total 41% (n = 16) of obstetric professionals felt they had the knowledge and skills to provide PCC compared to 33% (n = 1) and 75% (n = 3) of gastroenterologists and rheumatologists, respectively.ConclusionLack of awareness and urgency for the effectuation can be seen as important barriers for implementation of PCC. Due to the explorative nature generalisation of the results is not allowed. In the future, adaptation of the curricula of healthcare professionals by implementing interventions for pregnancy planning and preparation will generate awareness. Modelling of the impact of PCC might prove useful in resolving the lack of urgency for PCC realization.

Management of patients with herpes-associated recurrent vulvovaginal candidiasis

Objective. To develop a diagnostic algorithm, a rational method of treatment, and principles of preconception care in women with herpes-associated recurrent vulvovaginal candidiasis (RVVC).Materials and methods. We examined 68 patients with herpes-associated RVVC and 20 gynecologically healthy women.Results. It has been found that in RVVC it is necessary to study vaginal swab culture with the determination of the microorganism and its biofilm-forming ability in combination with viral DNA detection by the polymerase chain reaction (PCR) in vaginal secretion, determination of the IgG titer to the herpes simplex virus (HSV), the avidity index to HSV I and II. In the presence of laboratory-confirmed RVVC and HSV infection, it is necessary to assume the presence of an atypical course of HSV infection followed by complex antiviral and antimycotic therapy.Conclusion. The use of the developed algorithm of diagnostic and treatment interventions as preconception care makes it possible to address symptoms, reduce relapse rates and extend a non-relapse interval, prepare women with the mixed-infection for favorable pregnancy outcomes.

Gestation in patients with a combination of antiphospholipid and torch syndromes

Aim. To study the features of gestation in women with a combination of antiphospholipid and TORCH syndromes in relation to preconception care.Materials and Methods. We analyzed 137 medical records of women with a past medical history of pregnancy loss and antiphospholipid syndrome (APS), focusing on the presence or absence of plasmapheresis in the preconception period, and further ranking the patients into 2 subgroups (with and without TORCH syndrome). As a control group, we included 28 pregnant women without both syndromes.Results. Gestation in women with combined APS and TORCH syndromes was accompanied by a 10-fold higher risk of threatened abortion in the first trimester and 3-fold higher risk of placental insufficiency as compared to those without both syndromes. Notably, the combination of the syndromes doubled the risk of placental insufficiency in comparison with APS alone. The lack of plasmapheresis in patients with APS and TORCH syndrome was associated with &gt; 2-fold higher risk of threatened abortion. Further, in patients with APS and TORCH syndrome, lack of plasmapheresis increased the likelihood of developing fetal hypoxia by a factor of 2 and 3 in comparison with those diagnosed with APS alone or control patients.Conclusions. TORCH syndrome is a major risk factor of adverse outcome in pregnant women with APS. Inclusion of plasmapheresis into the preconception care in women with APS and TORCH syndrome significantly reduced the development of pregnancy complications.

Maternal and Fetal Outcome in Pregnancy with diabetes mellitus: Study in a district hospital, Jamalpur, Bangladesh

Introduction: Cardiac disease is an important cause of maternal mortality and morbidity in antepartum and postpartum period. Objectives of our study was to determine maternal and fetal outcome in pregnant women in Bangladesh. &#x0D; Material &amp; Methods: This was a cross-sectional analytical study was conducted in the department of Obstretics &amp; Gynecology in 250 bedded General Hospital, Jamalpur, Bangladesh during the period from January 2018 to in December 2018. The aim of this study was to find out the maternal and fetal outcome of the pregnancies complicated by pre-gestational and gestational diabetes mellitus. In this study, a total of 225 patients were selected using purposive sampling technique. There were three groups of pre-gestational diabetic, gestational diabetic and non-diabetic control, designated as Group A, Group B, Group C accordingly; and each consists of 75 patients. Information collected from all pregnant women (After 28 weeks of gestation) with diagnosed GDM and Pre-GDM and symptoms signs suggestive of GDM and Pre-GDM later confirmed by relevant investigation (FBS, 2h PPBS &amp; HbA1C) using a questionnaire made for recoding all relevant parameters under study, after proper counseling and taking written consent of the patient or her legal guardian admitted during the study period in obstetric ward in Rangpur Medical College &amp; Hospital, Rangpur. &#x0D; Results: History of GDM was significantly more common among patients with pre-GDM (38%) and GDM (18%) compared to controls. History of abortion, IUFD and congenital anomaly were significantly higher among pre-GDM mothers than GDM mothers and controls (p&lt;0.05). History of deliveries with macrosomia and still birth was distributed similarly across the groups (p&gt;0.05). Pre–GDM and GDM patients had significantly higher number of patients with HbA1C &gt;6.5% than controls. Mean FBS and PPBS was significantly higher in pre-GDM &amp; GDM patients than control (p&lt;0.05). APGAR score was &lt;7 in significantly higher number of pre–GDM and GDM babies than controls (p &lt;0.05). Mean Weight of the babies was significantly lower among pre–GDM patients than GDM patients (p &lt;0.05). Among pre–GDM patients and GDM patient’s cases of birth asphyxia, Hypoglycemia, hyperbilirubinemia and congenital anomalies were significantly higher than controls (p&lt; 0.05).&#x0D; Conclusion: Interventions such as preconception care for women with pre-gestational diabetes, screening for early diagnosis, patient education, multidisciplinary approach and good metabolic control maintained throughout the pregnancy is the key to successful fetomaternal outcome

Current practice and perspectives of healthcare providers regarding preconception care for women with type 1 diabetes in China.

We aimed to investigate the current practice and perspectives of healthcare providers (HCPs) regarding preconception care (PCC) for women with type 1 diabetes (T1D) in China. A questionnaire based on in-depth interviews with HCPs involved in PCC was released online and advertised via doctor unions in China. The data were categorical variables and were analysed by multivariable logistic regression, Chi-square test, or Wilcoxon rank-sum test. From November 2016 to January 2017, 992 responses from 31 provinces of China were received (77.3% doctors and 22.7% nurses). Regarding the current status of PCC for T1D, 62.5% of HCPs treated ≤1 woman with T1D monthly on average. Only 16.5% thought they provided proper PCC, and 29.6% reported having sufficient knowledge. Regarding attitudes towards pregnancy with T1D, 92.2% were in favour of women with T1D getting pregnant after proper glycaemic control, and 94.7% perceived their worries regarding pregnancy. Regarding doctor-patient communication, 56.6% spent <10min per visit, while 58.3% thought ≥20min was required for adequate communication. HCPs emphasised the importance of multidisciplinary PCC, professional training, and social support. PCC practice was associated with hospital level (OR=2.450, 95%CI: 1.580-3.799, p<0.001), HCPs' experience of treating women with T1D (OR=2.196, 95%CI: 1.516-3.180, p<0.001), and their communication sufficiency (OR=3.706, 95%CI: 2.550-5.387, p<0.001). The current PCC practice for T1D in China was suboptimal and it was associated with hospital level, HCPs' experience and communication. It is necessary to reinforce professional training and appeal for social resources to improve PCC.

Preconception care for women with epilepsy: a mixed methods review

Preconception care for women with epilepsy: a mixed methods review

Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes.

Pre-gestational diabetes mellitus is associated with increased risk of maternal and perinatal adverse outcomes. This systematic review was conducted to evaluate the effectiveness and safety of pre-conception care (PCC) in improving maternal and perinatal outcomes. Databases from MEDLINE, EMBASE, WEB OF SCIENCE, and Cochrane Library were searched, including the CENTRAL register of controlled trials, and CINHAL up until March 2019, without any language restrictions, for any pre-pregnancy care aiming at health promotion, glycemic control, and screening and treatment of diabetes complications in women with type I or type II pre-gestational diabetes. Trials and observational studies were included in the review. Newcastle-Ottawa scale and the Cochrane collaboration methodology for data synthesis and analysis were used, along with the GRADE tool to evaluate the body of evidence. The search identified 8500 potentially relevant citations of which 40 reports of 36 studies were included. The meta-analysis results show that PCC reduced congenital malformations risk by 71%, (Risk ratio (RR) 0.29; 95% CI: 0.21-0.40, 25 studies; 5903 women; high-certainty evidence). The results also show that PCC may lower HbA1c in the first trimester of pregnancy by an average of 1.27% (Mean difference (MD) 1.27; 95% CI: 1.33-1.22; 4927 women; 24 studies, moderate-certainty evidence). Furthermore, the results suggest that PCC may lead to a slight reduction in the risk of preterm delivery of 15%, (RR 0.85; 95% CI: 0.73-0.99; nine studies, 2414 women; moderate-certainty evidence). Moreover, PCC may result in risk reduction of perinatal mortality by 54%, (RR 0.46; 95% CI: 0.30-0.73; ten studies; 3071 women; moderate-certainty evidence). There is uncertainty about the effects of PCC on the early booking for antenatal care (MD 1.31; 95% CI: 1.40-1.23; five studies, 1081 women; very low-certainty evidence) and maternal hypoglycemia in the first trimester, (RR 1.38; 95% CI: 1.07-1.79; three studies; 686 women; very low- certainty evidence). In addition, results of the meta-analysis indicate that PCC may lead to 48% reduction in the risk of small for gestational age (SGA) (RR 0.52; 95% CI: 0.37-0.75; six studies, 2261 women; moderate-certainty evidence). PCC may reduce the risk of neonatal admission to intensive care unit (NICU) by 25% (RR 0.75; 95% CI: 0.67-0.84; four studies; 1322 women; moderate-certainty evidence). However, PCC may have little or no effect in reducing the cesarean section rate (RR 1.02; 95% CI: 0.96-1.07; 14 studies; 3641 women; low-certainty evidence); miscarriage rate (RR 0.86; 95% CI: 0.70-1.06; 11 studies; 2698 women; low-certainty evidence); macrosomia rate (RR 1.06; 95% CI: 0.97-1.15; nine studies; 2787 women, low-certainty evidence); neonatal hypoglycemia (RR 0.93; 95% CI: 0.74-1.18; five studies; 880 women; low-certainty evidence); respiratory distress syndrome (RR 0.78; 95% CI: 0.47-1.29; four studies; 466 women; very low-certainty evidence); or shoulder dystocia (RR 0.28; 95% CI: 0.07-1.12; 2 studies; 530 women; very low-certainty evidence). PCC for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations. In addition, it may improve the risk of preterm delivery and admission to NICU. PCC probably reduces maternal HbA1C in the first trimester of pregnancy, perinatal mortality and SGA. There is uncertainty regarding the effects of PCC on early booking for antenatal care or maternal hypoglycemia during the first trimester of pregnancy. PCC has little or no effect on other maternal and perinatal outcomes.

Diabetes During Pregnancy: Surveillance, Preconception Care, and Postpartum Care.

Diabetes during pregnancy can adversely affect the health of women and infants. In this report, we provide an overview of the state of the science, and highlight Centers for Disease Control and Prevention (CDC) activities related to (1) surveillance of preexisting and gestational diabetes mellitus (GDM); (2) preconception care for women with preexisting diabetes; (3) postpartum diabetes screening among women with GDM-affected pregnancies; and (4) preventing the progression to Type 2 diabetes among women with GDM-affected pregnancies through lifestyle intervention programs. Improving preconception care, increasing postpartum diabetes screening rates, and promoting lifestyle interventions in the postpartum period all provide opportunities to improve the health of women and their infants.

Diabetes and Pregnancy

Diabetes and Pregnancy

Preconception care for diabetic women for improving maternal and infant health.

Infants born to mothers with pre-existing type 1 or type 2 diabetes mellitus are at greater risk of congenital anomalies, perinatal mortality and significant morbidity in the short and long term. Pregnant women with pre-existing diabetes are at greater risk of perinatal morbidity and diabetic complications. The relationship between glycaemic control and health outcomes for both mothers and infants indicates the potential for preconception care for these women to be of benefit. This is an update of the original review, which was first published in 2010. To assess the effects of preconception care in women with diabetes on health outcomes for mothers and their infants. We searched Cochrane Pregnancy and Childbirth's Trials Register (31 January 2017) and reference lists of retrieved articles. Randomised controlled trials (RCTs) assessing the effects of preconception care for diabetic women. Cluster-RCTs and quasi-RCTs were eligible for inclusion but none were identified. Two reviewers independently assessed study eligibility, extracted data and assessed the risk of bias of the included studies. We checked data for accuracy and assessed the quality of the evidence using the GRADE approach. We included three trials involving 254 adolescent girls with type 1 or type 2 diabetes, with an overall unclear to high risk of bias. The three trials were conducted at diabetes clinics in the USA, and assessed the READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls) programme versus standard care.Considering primary outcomes, one trial reported no pregnancies in the trial period (12 months) (very low-quality evidence, with downgrading based on study limitations (risk of bias) and imprecision); in the other two trials, pregnancy was an exclusion criterion, or was not clearly reported on. None of the trials reported on the other primary maternal outcomes, hypertensive disorders of pregnancy and caesarean section; or primary infant outcomes, large-for-gestational age, perinatal mortality, death or morbidity composite, or congenital malformations. Similarly, none of the trials reported on the secondary outcomes, for which we had planned to assess the quality of the evidence using the GRADE approach (maternal: induction of labour; perineal trauma; gestational weight gain; long-term cardiovascular health; infant: adiposity; type 1 or 2 diabetes; neurosensory disability).The majority of secondary maternal and infant outcomes, and outcomes relating to the use and costs of health services were not reported by the three included trials. Regarding behaviour changes associated with the intervention, in one trial, participants in the preconception care group had a slightly higher score for the actual initiation of discussion regarding preconception care with healthcare providers at follow-up (nine months), compared with those in the standard care group (mean difference 0.40, 95% confidence interval -0.02 to 0.82 (on a scale of 0 to 4 points); participants = 87) (a summation of four dichotomous items; possible range 0 to 4, with 0 being no discussion). There are insufficient RCT data available to assess the effects of preconception care for diabetic women on health outcomes for mothers and their infants.More high-quality evidence is needed to determine the effects of different protocols of preconception care for diabetic women. Future trials should be powered to evaluate effects on short- and long-term maternal and infant outcomes, and outcomes relating to the use and costs of health services. We have identified three ongoing studies that we will consider in the next review update.

Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice.

Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.

Preconception Care in Women with Diabetes

For women of reproductive age preconception care is a crucial component. The main goal of preconception care is to provide screening, detection and management of medical conditions that might affect future pregnancies. Preconception care is defined as a care that aim to identify and modify risks during pregnancy and improves pregnancy outcome through prevention and management. It is not only a single visit to a health-care provider but it will include full facilities of preventive and primary care services for women before a pregnancy or between pregnancies Improved preconception care is also a mandatory component for women with diabetes. Not only for women but men also need improvement of the knowledge, attitudes and behaviors related to reproductive health to maintain an ideal preconception health. For a good pregnancy out come proper preconception counseling, good glycemic control, screening and management of diabetic complications is essential.Birdem Med J 2017; 7(2): 164-167

Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care.

Diabetes mellitus is a global health problem and one of the most common medical conditions in pregnancy. A wide range of modifiable risk factors are associated with diabetes mellitus in pregnancy, and it is widely acknowledged that preconception care (PCC) is beneficial for women with pre-existing diabetes mellitus. However, uptake of PCC services is low. To systematically review qualitative research on PCC for women with pre-existing diabetes mellitus of childbearing age, identify facilitators of and barriers to uptake of PCC and establish themes and gaps in knowledge. Through qualitative interviews explore views on the provision of, and facilitators of and barriers to the uptake of, PCC. Mixed methods encompassing a systematic review and qualitative interviews. Two secondary care sites and 11 primary care sites. Women of childbearing age with pre-existing type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) of white British or Pakistani origin. None. A narrative synthesis of the literature using thematic analysis and a thematic analysis of the qualitative interview data using the method of constant comparison. Eighteen qualitative studies were included in the systematic review and a quality appraisal was carried out using relevant criteria for qualitative research appraisal, including a narrative summary of study quality. Twelve interviews with women with pre-existing T1DM or T2DM were carried out. This fell short of the original aim of interviewing 48 women owing to challenges in recruitment, especially in primary care. A synthesis of these data shows that uptake of PCC is influenced by a range of factors, including the complexity of pregnancy planning, the skill and expertise of health professionals who provide care to women with diabetes mellitus, the role of health professionals in the delivery of PCC, and the quality of relationships between women and health professionals. Owing to significant challenges with recruitment of participants, particularly in primary care, 12 interviews with women with pre-existing T1DM or T2DM were carried out, which fell short of the a priori sample size. Reconceptualising PCC to place greater emphasis on pregnancy planning, fertility and contraception would lower some of the existing barriers to uptake of care. It is important to clarify who is responsible for the delivery of PCC to women with pre-existing diabetes mellitus and to ensure that the correct expertise is available so that opportunities for advice giving are maximised. Relationships between women and health professionals should be based on a partnership approach that encourages mutual trust and respect, focusing on positive change rather than negative outcomes. Further research is needed to investigate the views and experiences of stakeholders that commission, design and deliver PCC services for women with pre-existing diabetes mellitus; to explore experiences of women from minority or ethnically diverse backgrounds; to investigate the role of family support in contraception, pregnancy planning and PCC; and to investigate the management of diabetes mellitus in neonatal care and its role in breastfeeding. This study is registered as PROSPERO CRD42014015592 and ISRCTN12983949. The National Institute for Health Research Health Technology Assessment programme.

Women\u2019s knowledge and associated factors in preconception care in adet, west gojjam, northwest Ethiopia: a community based cross sectional study

BackgroundPreconception care is the provision of biomedical, behavioural and social health interventions to women and couples before the occurrence of conception to improve their health status. There is poor maternal and child health and lack of knowledge in developing countries about preconception care. Therefore, this study aimed to assess women’s knowledge and associated factors in preconception care in Adet Town, Gojjam, Northwestern Ethiopia.MethodsA community based cross-sectional study was conducted among 422 systematically selected reproductive age group women who are living in the Adet town from March 1 to 30, 2016. The data were collected using pre tested and structured questionnaires through face-to-face interviews. The data were entered into Epi-Info version 3.5, and cleaned and analysed using SPSS version 20. Descriptive summary of the data and logistic regression were used to identify possible predictors using odds ratio with 95% confidence interval and P-value of 0.05.ResultsThe study revealed that the overall knowledge of preconception care was 27.5% (95% CI: 23.2, 32.0). Women who attended secondary educational and whose age is from 25 to 34 years were more likely to have better knowledge on preconception care than their counterparts were; (AOR 6.52, CI 2.55, 16.69) and (AOR 4.10, CI 1.78, 9.44) respectively. However, Women who had no history of family planning use were 85% less knowledgeable than those who had a history of family planning use (AOR: 0.15; 95% CI: 0.05, 0.44).ConclusionsIn this finding level of women’s knowledge of preconception care is relatively low. Having a history of family planning use, having high levels of educational status, and being older age were associated with good knowledge. This finding suggests that there is a need to give emphasis and deliver health education about preconception care for women in order to increase their knowledge.

Rethinking Preconception Care: A Critical, Women’s Health Perspective

Objectives Preconception care aims to provide care to reproductive aged individuals in order to improve pregnancy and birth outcomes. Given that preconception care is a public health priority, it is important to evaluate the evolution of this health paradigm and the promotion of preconception messages that are obtained by the public. We identified online preconception health messages, which were critically assessed through a women's health perspective. Methods We searched for "preconception care" on three major search engines. Websites were included if they were U.S.-based, provided content in English, and mentioned preconception care. Blogs and journal articles were excluded. The final sample included 52 websites. Using a content analysis approach, we assessed the presence of gender bias and identified other emergent themes. Results The majority of websites focused on preconception care for women only (67%). The recommendations centered on: (1) health behaviors for women (e.g., folic acid, drinking, smoking); (2) visiting healthcare providers; and (3) evaluating medical risks. Moreover, most content implied that women desired, or should desire, pregnancy. Overall, the messages used biomedical language and rarely mentioned other important health topics, such as social support and violence. Conclusions The primary messages presented on preconception care websites emphasized biomedical aspects of women's health. The current context of preconception care medicalizes this pre-pregnancy period by defining it as a biomedical condition requiring lifestyle changes and interventions. Additionally, the biases presented in these messages assumed women want and are capable of pregnancies and excluded an integral factor for heteronormative reproduction-men.

Prepregnancy diabetes, hyperglycaemic status, and adverse pregnancy outcomes in Chinese women: a population-based mega-cohort study

BackgroundGestational diabetes is a well established risk factor for adverse pregnancy outcomes including preterm birth, low birthweight, and macrosomia. However, few studies have assessed the association of prepregnancy diabetes and fasting glucose levels with risk of adverse pregnancy outcomes. We aimed to examine the relations of prepregnancy diabetes and impaired fasting glucose with preterm birth, low birthweight, and macrosomia, using data from a mega cohort of women of reproductive age. MethodsThe China National Free Preconception Health Examination Project, established in 2010, included 1 464 523 couples from 220 counties who planned to conceive within 4–6 months of study entry to assess prepregnancy risk factors for birth defects. Participants had comprehensive physical examinations, responded to structured questions, and provided fasting blood samples for biomarker (including glucose) measurements before pregnancy and were followed up until 42 days after delivery. Diabetes was defined as self-reported diagnosed diabetes or fasting glucose concentrations of at least 7·0 mmol/L, and impaired fasting glucose as fasting glucose concentrations 6·1–7·0 mmol/L. Pregnancy outcomes were collected from 1 095 316 mothers between Jan 10, 2010 and Dec 31, 2015. Preterm birth was defined as live birth at 28–37 weeks gestational age, low birthweight as less than 2500 g regardless of gestational age, and macrosomia as birthweight of more than 4000 g. We used multivariate logistic regression models to estimate the odds ratios (ORs) and 95% CIs, with adjustment for covariates using normal live births as the denominators. This study was approved by the Institutional Research Review Board at the National Health and Family Planning Commission and National Research Institute for Family Planning. Written informed consent in Chinese was obtained from all participants or their legal representatives. Findings79 686 preterm births, 15 354 cases of low birthweight, and 33 667 cases of macrosomia were recorded. Compared with women whose blood glucose was less than 6·1 mmol/L before pregnancy, the risk of preterm birth was increased for those with impaired fasting glucose (OR 1·08, 95% CI 1·03–1·13) and those with diabetes (1·15, 1·08–1·22; ptrend<0·0001). The ORs of low birthweight were 1·16 (1·06–1·27) for women with impaired fasting glucose and 1·10 (0·97–1·26) for those with diabetes (ptrend=0·0023). The ORs of macrosomia were 1·00 (0·93–1·08) for those with impaired fasting glucose and 1·20 (1·09–1·31) for those with diabetes (ptrend<0·0001). InterpretationPrepregnancy diabetes and impaired fasting glucose are associated with an increased risk of adverse pregnancy outcomes. Therefore, early screening and preconception care for women with diabetes and impaired fasting glucose are important for optimisation of pregnancy outcomes. FundingFive-twelfth National Science and Technology Support Program.

Pre-conception care for women with diabetes: A public health issue

Pre-conception care is recognised to be an effective strategy for addressing many health behaviours, particularly for women with diabetes, who carry a higher risk of morbidity and mortality. However, there is a lack of evidence of the most effective approaches for promoting pre-conception health and encouraging women to access services. This article explores this challenging issue and suggests a number of strategies that health professionals may consider in relation to promoting health in this area.

Diabetes and congenital heart defects: a systematic review, meta-analysis, and modeling project.

Maternal pregestational diabetes (PGDM) is a risk factor for development of congenital heart defects (CHDs). Glycemic control before pregnancy reduces the risk of CHDs. A meta-analysis was used to estimate summary ORs and mathematical modeling was used to estimate population attributable fractions (PAFs) and the annual number of CHDs in the U.S. potentially preventable by establishing glycemic control before pregnancy. A systematic search of the literature through December 2012 was conducted in 2012 and 2013. Case-control or cohort studies were included. Data were abstracted from 12 studies for a meta-analysis of all CHDs. Summary estimates of the association between PGDM and CHDs and 95% credible intervals (95% CrIs) were developed using Bayesian random-effects meta-analyses for all CHDs and specific CHD subtypes. Posterior estimates of this association were combined with estimates of CHD prevalence to produce estimates of PAFs and annual prevented cases. Ninety-five percent uncertainty intervals (95% UIs) for estimates of the annual number of preventable cases were developed using Monte Carlo simulation. Analyses were conducted in 2013. The summary OR estimate for the association between PGDM and CHDs was 3.8 (95% CrI=3.0, 4.9). Approximately 2670 (95% UI=1795, 3795) cases of CHDs could potentially be prevented annually if all women in the U.S. with PGDM achieved glycemic control before pregnancy. Estimates from this analysis suggest that preconception care of women with PGDM could have a measureable impact by reducing the number of infants born with CHDs.