Preconception Women Research Articles

Effectiveness of pocketbook as the media of preconception nutrition education

Nutrition improvement in preconception women is a new paradigm in dealing with nutritional problems. Preconception nutrition intervention is a strategic way to break the phenomenon of stunting between generations. This study aimed to compare the effectiveness of nutrition education through pocketbooks and lectures on knowledge and attitudes. This study was used as a quasi-experiment with a pretest-posttest control group design. The population in this study were all pharmaceutical students and health analysts at Politeknik Kesehatan Medan. The minimum sample is using Hypothesis tests for two proportions (n=100). Sample selection used a simple random sampling technique. The intervention group was given a pocketbook and the control group was given a lecture. Respondents’ knowledge and attitudes were measured before and after treatment using a questionnaire. Data were analyzed by paired t-test and independent t-test. Nutrition education through pocketbooks and lectures had a significant effect on knowledge and attitudes about preconception nutrition (p<0.001), but the pocketbook was more effective than the lecture method in increasing knowledge (p<0.001) and attitudes (p=0.017). Preconception nutrition education by providing pocketbooks is effectively used as a preconception nutrition intervention with a wider target range, and time efficiency, and does not depend on material providers.

Assessing preconception health in Australia to support better outcomes in the first 2000 days - A critical need for building a core indicator framework.

In 2021, the Preconception Health Network Australia co-developed preconception health core indicators identified as critical to ensuring optimal maternal and child outcomes following conception. We conducted an audit of perinatal databases across each state and territory to identify whether preconception core indicator data were available. Seven health domains co-developed by the Preconception Health Network were mapped against the data collected in the perinatal databases. Indicator data were lacking across all seven health domains, with data missing for social determinants of health indicators. Better data linkage and developing a national evidence-based framework would allow ongoing monitoring of women's preconception health nationally.

Evaluating the progression to abnormal thyrotropin in euthyroid preconception women: a population-based study

Background Abnormal preconception thyrotropin levels were associated with fecundability and adverse fetomaternal outcomes, however, little is known regarding the natural change of serum thyrotropin in euthyroid preconception women. Thus, we performed a population-based study to evaluate the progression to abnormal thyrotropin in euthyroid preconception women.Methods This retrospective cohort study used data from the National Free Prepregnancy Checkups Project (NFPCP) collected between 2010 and 2020. Female Han Chinese participants aged 20–49 years who had two repeated NFPCP participations with a time interval of 1.5–3.0 years, confirmed non-pregnant status within this duration, and normal thyrotropin levels during their first participation were included for the analysis of thyrotropin abnormalities during the second NFPCP examination. Data were analyzed between June 1 and October 1, 2023.ResultsThis study included 186,095 euthyroid women of reproductive age (mean ± SD, 26.72 ± 4.70 years) whose preconception thyrotropin levels were between 0.37 and 4.87 mIU/L. The median follow-up time was 2.13 (IQR, 1.85–2.54) years. A total of 8,497 (4.57%) women developed abnormal thyrotropin, including 4,118 (2.21%) subnormal thyrotropin and 4,379 (2.35%) supranormal thyrotropin. Compared with the reference group (thyrotropin 1.01–2.00 mIU/L), the lower baseline thyrotropin group had greater risk of developing subnormal thyrotropin, and the higher baseline thyrotropin group had greater risk of developing supranormal thyrotropin. Moreover, the restricted cubic spline analysis revealed a U-shaped dose–response association of baseline thyrotropin levels or thyrotropin multiples of the median (MOM) levels against risk of subnormal thyrotropin in the follow-up, and a J-shaped dose–response association against risk of supranormal thyrotropin levels in the follow-up. We further found that baseline thyrotropin outside of 1.43–1.93 mIU/L or baseline thyrotropin MOM outside 0.59–1.36 would hava a higher risk of developing of abnormal thyrotropin.ConclusionsBoth low and high baseline thyrotropin were associated with a significantly increased risk of developing abnormal thyrotropin outcomes. The optimal preconception baseline thyrotropin levels may be between 1.43 mIU/L and 1.93 mIU/L or baseline thyrotropin MoM between 0.59 and 1.36 to minimize progression toward abnormal thyrotropin after 1.5–3.0 years. These findings may help with counseling of preconception thyroid function monitoring.

Vedolizumab and Ustekinumab Levels in Pregnant Women With Inflammatory Bowel Disease and Infants Exposed In Utero

Vedolizumab and ustekinumab pharmacokinetics in pregnancy and the infant after in utero exposure remain incompletely defined. We aim to define the antenatal stability of ustekinumab and vedolizumab levels and the time at which infant drug levels become undetectable. This multicenter prospective observational cohort study recruited pregnant or preconception women with inflammatory bowel disease receiving vedolizumab or ustekinumab. Trough drug levels, clinical data, and biochemical data were documented preconception, during each trimester of pregnancy, and postpartum. Maternal and cord blood drug levels were measured at delivery and in infants until undetectable. Infant outcomes were assessed until 2 years of age. A total of 102 participants (vedolizumab, n= 58) were included. The majority of mothers were, and remained, in clinical and biochemical remission. Maternal vedolizumab levels decreased over the course of pregnancy in association with increasing weight, rather than increasing gestation. Maternal ustekinumab levels remained stable. The median time to drug becoming undetectable in the infant was shorter for vedolizumab (11 wk; range, 5-19 wk; n= 32) than ustekinumab (14 wk; range, 9-36 wk; n= 17) and correlated positively with infant delivery level. Thirty-two of 41 (88%) and 17 of 30 (67%) vedolizumab- and ustekinumab-exposed infants had undetectable drug levels by 15 weeks of age, respectively. Pregnancy and infant outcomes were favorable. Twenty infants with undetectable drug levels received the rotavirus vaccine, with no adverse reactions reported. Maternal vedolizumab levels decreased, whereas ustekinumab levels remained stable over the course of pregnancy. Most vedolizumab- and approximately half of ustekinumab-exposed infants had undetectable drug levels by 15 weeks of age. No concerning maternal or infant safety signals were identified.

Women's preconception psychological stress and birth outcomes in a fertility clinic: the EARTH study.

The epidemiologic literature on women's perceived stress in relation to perinatal outcomes has been inconclusive and does not consider the preconception window of exposure. To evaluate whether women's preconception perceived stress is related to live birth, gestational age, and birthweight in a cohort receiving fertility treatment. This observational study included women seeking fertility care at the Massachusetts General Hospital (2004-2019). During preconception, women provided information on their psychological stress using the short version of the validated Perceived Stress Scale 4 (PSS-4). We used regression models to evaluate the associations of stress with live birth (N = 768 attempting to conceive) and perinatal outcomes (N = 413 live births) while adjusting for confounders. Stratified analyses by mode of conception [natural, intrauterine insemination (IUI), and IVF (in vitro fertilization)] and selected socioeconomic factors (race, education, and income) were also conducted. Higher psychological stress was negatively associated with the overall probability of live birth (adjusted RR = 0.95, 95% CI: 0.92, 0.98), particularly among women conceiving using IVF. However, we found no association between women's psychological stress and gestational age and birth weight in the overall analyses and also stratified by mode of conception. Similarly, we observed no differences in women's psychological stress with any of the measured outcomes by socioeconomic factors. These results highlight the importance of considering the preconception window and mode of conception when evaluating the relationship between women's preconception stress and live birth.

The Influence of Knowledge about Anemia, Dates, and Iron Tablets on Hemoglobin Levels in Prospective Pregnant Women at South Klaten Community Health Center

<p><strong>Background</strong>: Anemia, commonly known as a deficiency in blood, influences individual behavior. Higher knowledge about anemia before conception correlates with a greater awareness of nutritional needs. Preventing anemia in preconception women involves iron tablet consumption, while dates serve as an alternative means to prevent anemia. This study aims to ascertain the influence of anemia knowledge, date consumption, and iron tablet intake on hemoglobin levels among prospective pregnant women at the Klaten Selatan Community Health Center. This research heald on January to September 2023 in the operational area of the Klaten Selatan Community Health Center.</p><p><strong>Methods</strong>: This research adopts a pre-experimental design employing a one- group pretest-posttest study. Purposive Random Sampling method is used, encompassing 40 research subjects. The dependent variable is hemoglobin levels, while the independent variables are knowledge about anemia, date consumption, and iron tablets. Data collection involves primary data through questionnaire responses and observation sheets. Research analysis includes univariate analysis, bivariate analysis utilizing the Spearman Rho test for knowledge variables and the Friedman test for date and iron tablet consumption variables. <strong>Results</strong>: There is a significant impact of knowledge about anemia (p = 0.000), date consumption (p = 0.0094), and iron tablet intake (p = 0.0073) on hemoglobin levels among prospective pregnant women.</p><p><strong>Conclusion</strong>: Knowledge about anemia influences hemoglobin levels, and there is an increase in hemoglobin levels after consuming dates and iron tablets among prospective pregnant women at the Klaten Selatan Community Health Center.</p><p> </p><p><strong>Keywords</strong>: <em>Knowledge, Dates, Iron Tablets, Hemoglobin Levels</em></p><p><strong> </strong></p>

Optimising Preconception Care

Women with PCOS are at an increased risk of infertility and a range of pregnancy complications. It is therefore important to understand how to optimise preconception care to reduce these risks. A reproductive life plan and age-appropriate education on optimising reproductive health is recommended in adolescents and women with PCOS. This should occur across the domains of appropriate nutritional intake (dietary and supplement sources), optimising physical activity, considering the effects of excess weight on fertility and being aware of the effects of substances on fertility. Dietary intake should be consistent with population guidelines for healthy eating with appropriate intake of core food groups and limited intake of discretionary foods high in added sugar, sodium, trans and saturated fats. Recommendations exist for preconception micronutrient supplementation including folic acid and iodine (in the Australian context) with others (e.g., vitamin D, iron, calcium and B12) as per deficiencies or other country specific guidelines. Recommendations for physical activity should also be consistent with general population guidelines comprising moderate intensity physical activity of >150 minutes/week or vigorous intensity physical activity of 75 minutes/week or a combination of both, engaging in muscle strengthening activities [Formula: see text]2 days/week and minimising the amount of time spent in prolonged sitting. The association of excess weight on reduced fertility are recognised from epidemiological literature and current guidelines highlight strategies of modest weight loss at higher BMIs. This is an important and emerging field of literature where future research can elucidate efficacy in randomised controlled trials across different interventions and populations. When working with all women preconception, and in particular women with PCOS, it is important to consider weight stigma, disordered eating and eating disorders when discussing the relationship of infertility and weight and potential modification of weight. Substance use can be considered across limiting high intake of caffeine and avoiding alcohol and illicit substance intake and smoking.

Enablers and Barriers Related to Preconception Physical Activity: Insights from Women of Reproductive Age Using Mixed Methods

Engaging in regular preconception physical activity (PA) is associated with benefits, including improved cardiovascular health and mental well-being. However, most women do not meet PA recommendations in the preconception period. This study aimed to investigate enablers and barriers related to PA in preconception women using a sequential mixed method design. An online survey was followed by Zoom interviews with women of reproductive age (aged 18–45 years). A weaving approach and the Capability Opportunity Motivation Behaviour (COM-B) model were used to integrate and present the data. Seven hundred and eighty-eight non-pregnant women from Australia, India, and the US completed the quantitative survey, and 13 Australian-based women participated in a qualitative interview. Physical activity levels were associated with having social support, a desire to improve body image, and becoming a healthier person. Women encountered barriers such as misconceptions about PA, competing priorities, financial constraints, and a lack of accessibility. Enablers for participation in PA included knowledge of its importance, a desire to be healthier, weight loss, social support, and having goals. The multifaceted and intricate nature of enablers and barriers for preconception PA lays the groundwork for developing tailored interventions and policies aimed at promoting preconception PA among women.

The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care.

Weight stigma is a well-recognised public health issue affecting many members of society including women during the preconception period. The impacts of preconception weight stigma on women are significant and may result in decreased access to and uptake of healthcare, and mental health concerns. The consequences of this weight stigma may translate to negative maternal outcomes and even intergenerational effects on the child. Eliminating weight stigma is therefore imperative. The aim of this paper is to report recommendations to reduce weight stigma for preconception women produced at a workshop with clinical and academic experts on preconception health and weight stigma at the 5th European Conference on Preconception Health and Care. The recommendations are related to two key areas: general societal recommendations prompting all people to acknowledge and adjust our attitudes towards larger-bodied people; and healthcare-specific recommendations imploring clinicians to upskill themselves to reduce weight stigma in practice. We therefore call for urgent approaches to address societal weight-stigmatising attitudes and norms related to both the general population and preconception women, while providing professional development opportunities for healthcare professionals relating to weight stigma. Eliminating weight stigma for preconception women may have positive impacts on the outcomes for mothers and children during pregnancy and beyond.

The Effect of Education through Digital Media WhatsApp Auto Responding (WAR) on Knowledge about Anemia in Pregnant Women

Anemia in pregnant women is still a problem in Parung Panjang village, Parung Panjang sub-district, Bogor district. The main cause is a lack of knowledge about the importance of iron for pregnant women. To address this problem, a quasi-experimental pre-posttest one group design study was conducted with a sample of 18 pregnant women and preconception women. The knowledge measurement tool used was a questionnaire. The measuring instrument used was a questionnaire on knowledge about anemia in pregnant women. The results showed a significant increase (p <0.05) in the knowledge of pregnant women and preconception women about anemia after the education and counseling activities were carried out, and they were enthusiastic and active in the discussion. The conclusion of this study is that the WhatsApp Auto Responding (WAR) media can be effectively used as one of the efforts to improve knowledge and prevent anemia in pregnant women in Parung Panjang village. The recommendation is to make education and counseling activities related to anemia using WAR a routine activity in Parung Panjang Village.Keywords: Anemia, auto responding, online education, pregnant women, WAR.

Preconception and Pregnancy Nutrition Support for Women with a History of Bariatric Surgery: A Mixed-Methods Survey of Healthcare Professionals in the UK.

Preconception bariatric surgery improves obesity-related maternal pregnancy complications but may reduce the absorption of nutrients required for healthy fetal growth and development. Women who receive preconception nutritional support after bariatric surgery are less likely to have adverse pregnancy outcomes. This study aimed to investigate the provision of preconception and pregnancy-specific nutritional support for women having bariatric surgery in the UK. A mixed-methods survey was distributed to healthcare professionals working in obesity or maternity services between December 2018 and October 2019. We collected both quantitative and qualitative data which were analysed using a mixed-methods approach. We received 135 responses from online (n = 99) and postal (n = 36) questionnaires. Only 45% of participants reported being 'very familiar' with the preconception/pregnancy nutritional needs of this population. Barriers to providing nutritional support included: a lack of resources and time; poor communication both across services and with women; not having contact with women preconception; and a lack of information and guidance. Respondents felt that dietitians have the expertise in nutrition necessary to provide support; however, GPs and midwives have the most frequent patient access post-surgery, both before and during pregnancy. Optimal preconception and pregnancy-related nutritional support requires multidisciplinary care pre- and post-surgery, and healthcare professionals require training and guidance to inform practice.

Systemic anti-inflammatory treatment of atopic dermatitis during conception, pregnancy and breastfeeding: Interdisciplinary expert consensus in Northern Europe.

Treating atopic dermatitis (AD) in pregnant or breastfeeding women, and in women and men with AD aspiring to be parents is difficult and characterized by uncertainty, as evidence to inform decision-making on systemic anti-inflammatory treatment is limited. This project mapped consensus across dermatologists, obstetricians and patients in Northwestern Europe to build practical advice for managing AD with systemic anti-inflammatory treatment in men and women of reproductive age. Twenty-one individuals (sixteen dermatologists, two obstetricians and three patients) participated in a two-round Delphi process. Full consensus was reached on 32 statements, partial consensus on four statements and no consensus on four statements. Cyclosporine A was the first-choice long-term systemic AD treatment for women preconception, during pregnancy and when breastfeeding, with short-course prednisolone for flare management. No consensus was reached on second-choice systemics preconception or during pregnancy, although during breastfeeding dupilumab and azathioprine were deemed suitable. It may be appropriate to discuss continuing an existing systemic AD medication with a woman if it provides good disease control and its benefits in pregnancy outweigh its risks. Janus kinase (JAK) inhibitors, methotrexate and mycophenolate mofetil should be avoided by women during preconception, pregnancy and breastfeeding, with medication-specific washout periods advised. For men preconception: cyclosporine A, azathioprine, dupilumab and corticosteroids are appropriate; a 3-month washout prior to conception is desirable for methotrexate and mycophenolate mofetil; there was no consensus on JAK inhibitors. Patient and clinician education on appropriate (and inappropriate) AD treatments for use in pregnancy is vital. A shared-care framework for interdisciplinary management of AD patients is advocated and outlined. This consensus provides interdisciplinary clinical guidance to clinicians who care for patients with AD before, during and after pregnancy. While systemic AD medications are used uncommonly in this patient group, considerations in this article may help patients with severe refractory AD.

Awareness of Nutrition and Supplements Among Pregnant and Preconception Women: A Real-World Study in Vietnam.

Few studies have addressed relationships between health literacy (HL) and nutritional awareness in preconception/pregnancy populations, especially within Asia. We explored the rationale for nutrition-related education and/or HL interventions to improve nutritional intake among preconception/pregnant women. A cross-sectional questionnaire-based real-world study was conducted among 100 preconception and 200 pregnant women in Vietnam in January/February 2022. The questionnaire included a validated screening tool for HL (Newest Vital Sign [NVS]), and questions on preconception/pregnancy-related nutritional knowledge and behavior, prenatal supplementation, sources of nutritional advice. Most respondents (62%) had limited HL and only 5% had adequate HL. Respondents with limited HL (NVS 0-1) showed less awareness of benefits of healthy eating before/during pregnancy, such as reduction in risk of birth defects. Most (94%) considered prenatal supplements beneficial, yet 64% were not convinced of supplement safety. The limited HL group reported the lowest use of supplements, including multivitamins, iron, and folic acid/folate. The prevalence of limited HL and the low awareness of preconception/pregnancy-related nutrition suggest an urgent need to invest in nutrition-specific education and improving HL in maternal populations. This will help support adequate maternal nutrition and appropriate micronutrient supplementation before conception and throughout the "first 1000 days" of life.

Knowledge and practices of preconception care among rural Japanese women: findings from a mixed methods investigation

BackgroundPreconception care is not widespread in Japan and there is a pressing need to improve the practice. The present study assessed the knowledge and behavior of preconception care among women to seek effective intervention. Our research questions were: 1) How much do women know about preconception care? 2) How much are they practicing preconception care and what are the information sources of their behavior? 3) Do the women's preconception care behavior associated with accurate knowledge?MethodsThe research was conducted in a rural town in central Japan. Using an exploratory sequential mixed methods design, we undertook interviews, developed a survey based on the qualitative results, and then conducted a survey. The interviews explored how preconception care was perceived and practiced in women of childbearing age. The survey was designed to investigate the knowledge of preconception care among women with and without pregnancy experience, their practice behavior of preconception care, and whether the behavior is associated with knowledge.ResultsThe participants were 13 for the interview and 232 for the survey. They had limited access to preconception care recommendations and advice for specific actions was given by obstetricians and gynecologists after pregnancy. There was a large gap in knowledge about preconception care between parous and nulliparous women, especially about the need for folic acid supplementation. Practices that were manageable in their daily lives, such as cessation of smoking and alcohol, diet, and weight management, were considered common sense. In contrast, recommended practices that require medical attention, such as screening for sexually transmitted diseases and cervical cancer, tended to be less accurately known and practiced. Participants' sources of information about preconception care were the Internet, family and friends and mass media.ConclusionIn rural Japan, women of childbearing age lack knowledge about preconception care, especially before their first pregnancy. Primary care providers should try outreach to schools and women’s groups in the community, promote information sharing among family and close friends, and utilize information technology to enhance the knowledge and practice of preconception care.

Recommendation and intake of dietary supplements periconceptional and during pregnancy: results of a nationwide survey of gynaecologists

BackgroundMicronutrient supplementation during pregnancy is a controversial issue. For some micronutrients, for example folic acid or iodine, the evidence regarding supplementation is clear, whereas for others, such as zinc or vitamin E, it is not. Studies show that a large number of pregnant women have deficient levels of folic acid and iodine. However, especially with folic acid, starting supplementation during the preconception period is crucial. It is, therefore, important that gynaecologists explain this to their pregnant or preconceptional patients. Our goal was to find out how gynaecologists make their recommendations on this topic, how they assess the compliance of their patients and which micronutrients they consider to be important before/during pregnancy and during breastfeeding.Method and ResultsWe sent about 12,000 questionnaires to all registered resident gynaecologists in Germany, with a response rate of 12.2%. Regarding which micronutrients gynaecologists consider to be particularly important during pregnancy, there was a broad agreement for both folic acid and iodine (> 88% answered yes). According to the questionnaire, doctors rate other micronutrients, such as vitamin D and omega-3 fatty acids, as less essential. The controversial evidence level for many micronutrients certainly plays a role here. Overall, the intake rate, especially for preconceptional women, is classified as rather low (< 60%). The most widely valued reason is the high price of dietary supplements. It was also noticeable that doctors consider certain micronutrients to be particularly important but then do not include them in the products they recommend.ConclusionOverall, there seems to be uncertainty about micronutrients in pregnancy and their supplementation. The study situation is often ambiguous and there are no official guidelines, leading to ambiguous recommendations from doctors and therefore low intake rates for pregnant or preconceptional women.

Increasing Knowledge, Self-Efficacy and Hemoglobin Levels in Pre-Conception Women through Nutrition Assistance Program

Anemia, which is associated with various complications during pregnancy and childbirth can be prevented, especially in pre-conception or pre-pregnancy women, by fulfilling nutrition needs. One way to achieve this is by implementing nutrition assistance programs specifically designed for pregnant women or those planning to conceive. Therefore, this study aims to examine the impact of a dietary support program on the knowledge, self-efficacy, and hemoglobin level of pre-conception women. The design used was a non-randomized controlled trial with a pretest-posttest approach, while the sample consisted of married women preparing to get pregnant, with a total of 67 people meeting the inclusion criteria. Data obtained were analyzed using the Wilcoxon Signed Ranks Test and Independent sample T-test. The results demonstrated a significant difference in knowledge levels (p=0.000), self-efficacy (p=0.000), and hemoglobin levels (p=0.000) between the intervention and control groups. Therefore, it is essential to address the readiness of pre-conception women, particularly regarding their nutrition status, to prevent potential complications that may arise during pregnancy and childbirth.&#x0D;

Maternal preconception BMI and gestational weight gain are associated with weight retention and maternal and child body fat at 6-7 years postpartum in the PRECONCEPT cohort.

There is limited evidence from prospective cohorts in low-resource settings on the long-term impact of pre-pregnancy body mass index (PPBMI) and gestational weight gain (GWG) on postpartum weight retention (PPWR) and maternal and child body composition. We examined the associations between PPBMI and timing of GWG on PPWR at 1, 2, and 6-7 years and maternal and child percent body fat at 6-7 years. We used data from the PRECONCEPT study (NCT01665378) that included prospectively collected data on 864 mother-child pairs from preconception through 6-7 years postpartum. The key outcomes were PPWR at 1, 2, and 6-7 years, and maternal and child percent body fat at 6-7 years that was measured using bioelectric impedance. Maternal conditional GWG (CGWG) was defined as window-specific weight gains (< 20wk, 21-29wk, and ≥ 30wk), uncorrelated with PPBMI and all prior body weights. PPBMI and CGWG were calculated as standardized z-scores to allow for relative comparisons of a 1 standard deviation (SD) increase in weight gain for each window. We used multivariable linear regressions to examine the associations, adjusting for baseline demographic characteristics, intervention, breastfeeding practices, diet and physical activity. Mean (SD) PPBMI and GWG were 19.7 (2.1) kg/m2 and 10.2 (4.0) kg, respectively. Average PPWR at 1, 2, and 6-7 years was 1.1, 1.5 and 4.3 kg, respectively. A one SD increase in PPBMI was associated with a decrease in PPWR at 1 year (β [95% CI]: -0.21 [-0.37, -0.04]) and 2 years (-0.20 [-0.39, -0.01]); while a one SD in total CGWG was associated with an increase in PPWR at 1 year (1.01 [0.85,1.18]), 2 years (0.95 [0.76, 1.15]) and 6-7 years (1.05 [0.76, 1.34]). Early CGWG (< 20 weeks) had the greatest association with PPWR at each time point as well as with maternal (0.67 [0.07, 0.87]) and child (0.42 [0.15, 0.69]) percent body fat at 6-7 years. Maternal nutrition before and during pregnancy may have long-term implications for PPWR and body composition. Interventions should consider targeting women preconception and early in pregnancy to optimize maternal and child health outcomes.

Exposure to ambient air pollution from the preconceptional period and risk of gestational hypertension

Although accumulative studies have revealed the associations between air pollutants and elevated risk of gestational hypertension (GH), evidence from developing countries with relatively higher levels of air pollutants remains limited. In this retrospective study, a total of 45,439 birth records were collected in Beijing, China from 2013 to 2018. For PM2.5, SO2, NO2, and O3, exposure windows from the 3rd month of preconception to the 6th month of conception and the averages of 3 months of preconception, trimester 1 and trimester 2 periods were all calculated for assessment of GH risks. The correlations between air pollutants and the risk of GH were analyzed by logistic regression model. Our results showed that exposure to PM2.5 and SO2 in the preconceptional and early pregnancy periods was related to the elevated risk of GH. Furthermore, 3 months preconceptional exposure to PM2.5 (PCPM2.5: OR = 1.134 (1.114, 1.155)) and SO2 (PCSO2: OR = 1.158 (1.135, 1.181)) showed a higher risk of GH than the results of the trimester 1 (T1PM2.5: OR = 1.131 (1.104, 1.159); T1SO2: OR = 1.164 (1.141, 1.187)) and the trimester 2 (T2PM2.5: OR = 1.154 (1.126, 1.182); T2SO2: OR = 1.121 (1.098, 1.144)). The study also found significant and higher OR values for PCPM2.5, and PCSO2 from 2013 to 2016 when air pollution was serious in Beijing compared with 2017 to 2018 when the air pollution was obviously improved. Subgroup analysis also found that during 3 months of preconception women with higher age and who exposure to higher temperatures showed higher GH risk from PM2.5 and SO2 than that of the younger group and who exposure to lower temperature, respectively. Collectively, our findings suggest that air pollution exposure was adversely associated with GH in pregnant women and the preconceptional period is a critical air pollution exposure window for GH. Improving air quality can benefit public health, especially for sensitive populations like pregnant women.

Women's preconception health in England: a report card based on cross-sectional analysis of national maternity services data from 2018/2019.

To present the first national-level report card on the state of women's preconception health in England. Cross-sectional population-based study. Maternity services, England. All pregnant women in England with a first antenatal (booking) appointment recorded in the national Maternity Services Dataset (MSDS) from April 2018 to March 2019 (n= 652 880). We analysed the prevalence of 32 preconception indicator measures in the overall population and across socio-demographic subgroups. Ten of these indicators were prioritised for ongoing surveillance based on modifiability, prevalence, data quality and ranking by multidisciplinary UK experts. The three most prevalent indicators were the proportion of the 22.9% of women who smoked 1year before pregnancy who did not quit smoking before pregnancy (85.0%), those who had not taken folic acid supplementation before pregnancy (72.7%) and previous pregnancy loss (38.9%). Inequalities were observed by age, ethnicity and area-based deprivation level. The ten indicators prioritised were not taking folic acid supplementation before pregnancy, obesity, complex social factors, living in the most deprived areas, smoking around the time of conception, overweight, pre-existing mental health condition, pre-existing physical health condition, previous pregnancy loss and previous obstetric complication. Our findings suggest important opportunities to improve the state of preconception health and reduce socio-demographic inequalities for women in England. In addition to MSDS data, other national data sources that record further and possibly better quality indicators could be explored and linked to build a comprehensive surveillance infrastructure.

Experiencing Trauma During or Before Pregnancy: Qualitative Secondary Analysis After Two Disasters.

Despite the existing knowledge about stress, trauma and pregnancy and maternal stress during natural disasters, little is known about what types of trauma pregnant or preconception women experience during these disasters. In May 2016, the worst natural disaster in modern Canadian history required the evacuation of nearly 90,000 residents of the Fort McMurray Wood Buffalo (FMWB) area of northern Alberta. Among the thousands of evacuees were an estimated 1850 women who were pregnant or soon to conceive. In August 2017, Hurricane Harvey devastated areas of the United States including Texas, with 30,000 people forced to flee their homes due to the intense flooding. To explore immediate and past traumatic experiences of pregnant or preconception women who experienced one of two natural disasters (a wildfire and a hurricane) as captured in their expressive writing. Research questions were: (1) What trauma did pregnant or preconception women experience during the fire and the hurricane? (2) What past traumatic experiences, apart from the disasters, did the women discuss in their expressive writing? A qualitative secondary analysis of expressive writing using thematic content analysis was conducted on the expressive writing of 50 pregnant or preconception women who experienced the 2016 Fort McMurray Wood Buffalo Wildfire (n = 25) and the 2017 Houston Hurricane Harvey (n = 25) Narrative data in the form of expressive writing entries from participants of two primary studies were thematically analyzed. One of the expressive writing questions was used in this analysis: "What is the most traumatic, upsetting experience of your entire life, especially that you have never discussed in great detail with others?" NVivo 12 supported thematic content analysis. For some women, the disasters elicited immense fear and anxiety that surpassed previous traumatic life events. Others, however, disclosed significant past traumas that continue to impact them, including betrayal by a loved one, abuse, maternal health complications, and illness. We recommend a strengths-based and trauma-informed care approach in both maternal health and post-disaster relief care.