Provision Of Preconception Care Research Articles

How, when and who should ask about pregnancy intentions in primary care? A qualitative study of primary health care professionals' preferences.

Knowing people's pregnancy intentions would help health care professionals (HCPs) to take a holistic approach to reproductive health, and particularly to providing preconception care. To assess the feasibility of implementation of questions about pregnancy preferences in a range of primary care settings in Great Britain, including digital implementation. Qualitative study using online semi-structured interviews with primary care professionals across Great Britain in 2022. Twelve online interviews were conducted with GPs (n=3), practice nurses (n=3), sexual and reproductive health professionals (n=4) and health visitors (n=2). Framework analysis was conducted in Nvivo, adapting a coding frame from complementary interviews with women. HCPs perceived asking about pregnancy preferences as valuable in meeting patients' reproductive health needs and most suited to women's health consultations, medication and disease reviews, baby checks, or as an addition to lifestyle questions leading to health promotion advice. An introductory, non-discriminatory signposting sentence was well-liked, and the preferred question in a face-to-face clinical encounter was asking how the person would feel about a pregnancy in the next year, in line with women's preference. Guidance and training would give clinicians confidence in knowing how to ask about pregnancy preferences and advise their patients accordingly. Asking about pregnancy intentions is acceptable to women and HCPs and feasible in primary care, but implementation needs to be adapted to the patient and context. Digital options that enable patients to self-manage can reduce the need for HCP input and avoid medicalising a normal process.

Training in preconception care focused on primary health care providers: Effects on preconception care knowledge and provision

ObjectiveTo assess the effect of a rapid training intervention on the knowledge of health providers and the provision of preconception care in primary health care services. MethodsRandomized community trial in eight primary health care facilities (four were randomly allocated to the intervention group and four to the control group) in 2020 in Brazil. The intervention consisted of rapid training in preconception health for all health providers in the intervention group. Health providers who had medicine and nursing backgrounds answered structured questionnaires about their knowledge and practices of preconception health-related topics, and reproductive-age women attending the services completed a questionnaire about their experience with preconception care in pre- and postintervention (three months after the intervention) periods. FindingsThe level of knowledge among health providers increased after the intervention, but providing information about preconception care and prescribing folic acid showed no significant change, with the exception of screening for future pregnancy intention. Key conclusions and implications for practiceAlthough the knowledge of health providers on preconception care is a fundamental requirement for its provision in primary health care settings, rapid training focused on preconception health topics was not sufficient to change their practices, with the exception of pregnancy intention screening, which experienced a slight increase after the training. It appears that additional elements, such as the reorganization of primary health care services to prioritize non-pregnant women, the development and implementation of specific guidelines, along with strategies for the dissemination of preconception care awareness, may also play crucial roles for full preconception care implementation in addition to health providers’ knowledge of such issues.

Provision of Preconception Care by Midwives, Nurses and Doctors at Ndola Teaching Hospital in Ndola District, Zambia

Provision of Preconception Care by Midwives, Nurses and Doctors at Ndola Teaching Hospital in Ndola District, Zambia

Hospital-based case-control study of risk factors for early neonatal mortality in the Gaza Strip.

Early neonatal death is an essential epidemiological indicator of maternal and child health. To identify risk factors for early neonatal deaths in the Gaza Strip. This hospital-based case-control study included 132 women who experienced neonatal deaths from January to September 2018. The control group comprised 264 women who were selected using systematic random sampling and gave birth to live newborns at the time of data collection. The controls who had no history of neonatal death or stillbirth were less likely to have an early neonatal death than women who had such history. The controls who did not have meconium aspiration syndrome or amniotic fluid complications were less likely to have an early neonatal death than women who experienced these complications during delivery. The controls who had a singleton birth outcome were less likely to have an early neonatal death than women who had multiple births. Interventions are needed to provide preconception care, improve the quality of intrapartum and postnatal care, provide high-quality health education, and improve the quality of care provided by neonatal intensive care units in the Gaza Strip.

Hospital-based case–control study of risk factors of early neonatal mortality in the Gaza Strip

Background: Early neonatal death is an essential epidemiological indicator of maternal and child health. Aims: To identify risk factors for early neonatal deaths in the Gaza Strip. Methods: This was a hospital-based case–control study. We included 132 women with neonatal deaths recorded from January to September 2018. The control group comprised 264 women who were selected using systematic random sampling and gave birth to live newborns at the time of the data collection. Results: The controls who had no history of neonatal death or still birth were less likely to have an early neonatal death compared with women who did have such a history. The controls who did not have meconium aspiration syndrome or amniotic fluid complications were less likely to have an early neonatal death compared with women who did experience these complications during delivery. The controls who had a singleton birth outcome were less likely to have an early neonatal death compared with women who had multiple births. Conclusion: It is important to establish intervention programmes to provide preconception care, improve the quality of intrapartum and postnatal care, provide high-quality health education, and improve the quality of care provided within neonatal intensive care units.

Does preconception care make a difference to pregnancy outcomes? A quasi-experimental, mixed-methods study

BackgroundPreconception care comprises a set of prevention and management interventions that aim to identify and modify risks to a woman's health or pregnancy outcome by emphasising factors that must be acted on before or early in pregnancy. This study aimed to ascertain the effect of the preconception care programme offered at UN Relief and Works Agency primary health-care centres in Gaza, Relief and Works Agency, on pregnancy outcomes. MethodsA quasi-experimental, mixed-methods study was done between Aug 16, 2018, and April 30, 2019. A stratified sampling process resulted in the selection of five of 22 UN Relief and Works Agency primary health-care clinics in Gaza, from which a sample of women was selected by the convenience method. A purposive sample of 11 key informants were interviewed. 60 beneficiaries and non-beneficiaries of preconception care also participated in focus group discussions. A structured interview questionnaire and records review were used for the quantitative study, and a semi-structured protocol was used for the qualitative study. Quantitative data were analysed with SPSS version 21.0 and an open coding thematic technique was used to analyse the qualitative data. The protocol of this study was approved by the Gaza Field Office and headquarters of the UN Relief and Works Agency and by the Al Quds University and was given ethical permission by the Palestinian Helsinki committee. All participants provided written informed consent. Findings800 women (400 who received preconception care and 400 controls) were included in the analysis. 188 (47%) of recipients first learned about the service through midwives. 176 (44%) of recipients registered for the service because they were planning to get pregnant. Regarding preconception care activities, 288 (72%) of recipients indicated that they received health advice, 396 (99%) were screened for hypertension, diabetes, and dental and breast problems and given folic acid, and more than 328 (82%) of recipients were counselled about its importance. 368 (92%) of recipients of preconception care took folic acid before conception, compared with 60 (15%) of non-recipients. 232 (58%) of recipients of preconception care and 268 (67%) of non-recipients had complications during their latest pregnancy, including genitourinary tract infection and anaemia. The percentage of women who delivered via caesarean section was 100 (25%) of recipients and 72 (18%) of non-recipients. 92 (23%) of recipients of preconception care and 128 (32%) of non-recipients had complications during their last delivery, especially bleeding. 72 (64%) of recipients and 268 (67%) of non-recipients had a full-term pregnancy. The mean birthweight of babies was 3274·5 g among recipients and 3225·4 g among non-recipients (p=0·2). InterpretationOur study showed that providing preconception care promotes positive maternal outcomes, yet further enhancement is needed. Targeting recipients of service, improving staff communication, informing and counselling prospective mothers, and ensuring compliance with technical instructions are areas that require further attention, as is strengthening monitoring and supervision. FundingNone.

Current state of preconception care in sub-Saharan Africa: A systematic scoping review.

BackgroundPreconception care (PCC) utilisation is essential to extend and complete the health continuum. However, these services are not yet incorporated into many low-income countries’ existing maternal health services.AimThis study aims to review the current literature on the knowledge, utilisation and provision of PCC.SettingThis included women and healthcare workers (HCWs) in Sub-Saharan African (SSA) countries.MethodsArksey and O’Malley’s scoping review methodology framework is used in this study. The following databases, Google Scholar, Science Direct, PubMed, Scopus and Dissertation via ProQuest, were searched. Articles that met the eligibility criteria were included in this study.ResultsOut of the 451 retrieved articles, 39 were relevant. In most studies, women’s utilisation and HCW’s provision of PCC were considered limited. Their knowledge, however, varies between studies, and there were a few studies conducted among women with chronic conditions. Several factors influenced women and HCWs’ knowledge, utilisation and provision of PCC, including age, level of education, employment, practice area, resources and knowledge. Preconception care interventions most commonly identified, utilised and provided were HIV testing, counselling and family planning, while preconception folic acid supplementation was the least.ConclusionThe estimates of knowledge and utilisation were suboptimal among women, while provision was the worst affected among HCWs. Gaps exist between the HCW knowledge and practice of PCC. There is a need to promote, prioritise, integrate and optimise the opportunistic provision of PCC in SSA. There is also a need for more studies on PCC provision and utilisation among women with chronic medical conditions.

How to improve preconception care in a local setting? Views from Dutch multidisciplinary healthcare providers

ObjectiveTo explore healthcare providers’ views on improving preconception care in their region. DesignMixed-methods study. SettingWorking conferences aimed to educate healthcare providers on preconceptional risk factors and conduct a region-specific analysis of barriers and facilitators for implementing preconception care, were organised in ten municipalities in the Netherlands. Participants250 healthcare providers of various disciplines attended a working conference and participated in the study. Measurements and findingsParticipants were asked to both fill out a questionnaire concerning statements and experiences with preconception care and to participate in a workshop, to identify barriers and facilitators for the implementation of a local preconception care program. Almost all healthcare providers suggested that the responsibility for providing preconception care consultations lies within primary care (general practitioners (n = 239; 95.6%) and midwives (n = 236; 94.4%)). Professionals other than midwives found it significantly more difficult to start a conversation about a wish to conceive compared to midwives (26.8% versus 20.2%, p-value = 0.006) and felt less competent to provide preconceptional information (32.3% versus 15.1%, p-value = <0.001). Innovative facilitators were mentioned to improve reaching the target population with preconceptional information, i.e. the use of social media and local ambassadors. Key conclusionWhile the responsibility for providing preconception care consultations is best suited with primary care, many other healthcare providers involved may act as referrers towards preconception care. Still, approximately 1 in 7 midwives (strongly) disagree with the statement that it is part of their job to provide preconceptional information to couples with a wish to conceive. Implications for practiceThere is a need for integrating preconception care in many curricula and postgraduate courses, especially for non-midwives, to improve the delivery of preconception care. Insights in the suggested barriers and facilitators can improve the implementation of (local) preconception care programs.

Retrospective evaluation of preconception care opportunities in a chain community pharmacy setting

ObjectivesCertain prescription medications should be avoided during pregnancy to reduce the risk of fetal harm. Identification of these medications to minimize exposure may be achieved through the integration of preconception care recommendations into medication therapy management (MTM) services. The primary objective of this study was to identify missed opportunities for pharmacists to provide preconception care support related to medications associated with adverse pregnancy outcomes for reproductive-aged women who received MTM consultations at a regional supermarket pharmacy chain. Secondary objectives examined the concurrent use of prenatal vitamins, folic acid, or hormonal contraception in patients receiving medications associated with adverse pregnancy outcomes. MethodsThe study examined all MTM and prescription drug claims submitted by a regional chain of supermarket pharmacies from January 1, 2018 to June 30, 2019, to identify female patients aged 15-45 years who received MTM services. Prescription claims were cross-referenced to determine which of these patients also received medications associated with adverse pregnancy outcomes. To identify patients with long-term use of opioids and nonsteroidal anti-inflammatory drugs, a restriction based on days supplied was then applied. ResultsOf the 2020 female patients who received MTM services and filled at least 1 prescription during the study period, 731 (36.2%) were found to have received at least 1 medication associated with adverse pregnancy outcomes for the minimal days’ threshold. Of these, 509 (69.6%) lacked evidence of concurrent prescription contraception, and 74 (10.1%) had a concurrent prescription for folic acid or prenatal vitamins. ConclusionThe use of medications associated with adverse pregnancy outcomes was widespread in this sample of reproductive-aged women. The findings of this study indicate the need for additional research to investigate the implementation of targeted MTM interventions to build standard workflow processes and facilitate pharmacists’ management of this critical clinical issue.

Knowledge of preconception care and associated factors among maternal health care providers working in urban public health institutions of Eastern Ethiopia.

Background:Provision of preconception care is significantly affected by the health care provider’s knowledge of preconception care. In Ethiopia, preconception care is rare, if even available, as part of maternal health care services. Thus, this study aimed to determine the level of knowledge of preconception care and associated factors among health care providers working in public health facilities in Eastern Ethiopia.Methods:A multicenter cross-sectional study was conducted from 1 March to 1 April 2020. A simple random sampling technique was used to select a total of 415 maternal health care providers. We utilized a structured, pretested, and self-administered questionnaire to collect data. Data were entered into EpiData (version 3.1) and exported to STATA (version 16) for analysis. Descriptive statistics and bivariate and multivariate logistic regression analyses were performed. All covariates with a p value ⩽0.20 in bivariate logistic regression were entered into a multivariate logistic regression analysis to control the confounding variables; variables with a p value <0.05 were considered statistically significant.Results:Out of 410 respondents, 247 (60.2%; 95% confidence interval: 55.4–65.1) had good knowledge of preconception care. Having an educational level of Bachelor of Science degree and above (adjusted odds ratio: 6.97, 95% confidence interval: 3.85–12.60), 5 or more years work experience (adjusted odds ratio: 2.60, 95% confidence interval: 1.52–4.49), working in a hospital (adjusted odds ratio: 2.50, 95% confidence interval: 1.25–4.99), reading preconception care guidelines (adjusted odds ratio: 3.06, 95% confidence interval: 1.40–6.68), and training on preconception (adjusted odds ratio: 2.90, 95% confidence interval: 1.37–6.15) were significantly associated with good knowledge of preconception care.Conclusions and Recommendations:Three out of five maternal health care providers in this study had good knowledge of preconception care. Facilitating continuous refreshment training and continuous professional development for health workers, preparing comprehensive preconception care guidelines for health institutions, and reading preconception care guidelines were highly recommended.

Preconception care to improve pregnancy outcomes: clinical practice guidelines

Introduction: There is scientific evidence that the health of women before pregnancy contributes to the maternal and infant outcomes of pregnancy. There is also scientific evidence that the health of women of reproductive age may be improved through the provision of Preconception Care (PCC). Preconception care includes interventions to assess, identify, address, and modify a woman’s health conditions and risks to ensure that these health conditions and risks do not negatively affect the outcome of her pregnancy. Many of the medical conditions, environmental exposures, personal behaviors, and psychosocial risks associated with negative pregnancy outcomes have been identified and there are recommendations for including these conditions in PCC services. Objective: Our purpose is to present a tool for clinical care providers involved in delivering PCC services. We try to answer the following questions: what do providers actually do when a woman of reproductive age arrives at their offices? What questions to ask? What examinations to conduct? What laboratory tests to perform? And, what education and counselling to offer? Methods: We reviewed published and un-published literature related to the scientific evidence for the effectiveness of PCC in improving pregnancy outcomes. We searched PubMed for published articles, and we searched the internet for unpublished reports prepared by international organizations such as the World Health Organization and reports from governmental agencies. We summarized the information and presented a comprehensive overview of actions that providers should take to address various risk behaviors, exposures and health conditions. Results: Several scientists, countries, and international organizations have proposed answers to the above questions. However, there has been no consistency and there is not a single publication that includes a comprehensive compilation of the proposed actions. We summarized the recommended actions that clinical care providers should take in addressing various health conditions, risk behaviors, and exposures. Conclusion: It is recommended that all providers screen all women for their intentions to become pregnant and to provide them with appropriate services. Women should be referred to specialized care when risk behaviors and medical conditions that go beyond the skills and abilities of the primary care provider are identified.

Practice nurses and providing preconception care to women in Australia: a qualitative study.

The aims of this study were to explore women's and health professionals' perspectives of preconception care and whether expanding the role of practice nurses (PNs) to provide preconception care is acceptable. In a descriptive qualitative approach, 23 semistructured interviews and three focus groups were conducted with women (n=14), PNs (n=8), GPs (n=10) and practice managers (n=2) in the state of Victoria, Australia, between September and December 2019. An inductive process of thematic analysis identified five themes and 12 subthemes. Women and health professionals viewed preconception to be when a woman is planning a pregnancy. Women wanted personalised preconception care, and receiving this from a PN was considered to be acceptable. If the role of PNs is expanded, PNs would require training and professional recognition of their role to provide preconception care. Funding barriers were discussed by PNs, GPs and practice managers, along with potential solutions, such as Medicare item numbers and checklists to streamline consultations. Other resources in the wider community, such as schools, were identified as important aspects of a coordinated approach. Overall, expanding the role of PNs to provide preconception care was acceptable to women and health professionals to increase women's awareness and uptake of preconception care.

Assessing the potential of a Virtual Patient Advocate to provide preconception care and health advice to women living in Australia.

A preconception Virtual Patient Advocate (VPA) called "Gabby" supported African-American women to decrease their preconception health risks and may be a scalable resource to increase women's access to preconception care. Aims were to assess the acceptability of a preconception VPA in women living in Australia and document the changes required to adapt Gabby to suit an Australian context. Taking a descriptive qualitative approach, nonpregnant female participants (n = 31), aged 18-45 years, living in metropolitan and regional Victoria, Australia interacted with Gabby. Focus groups (n = 7) that gathered participants' perspectives of their experience with Gabby ran in July-August 2019 before being transcribed verbatim and thematically analyzed. Six interrelated themes and 12 subthemes were identified. Participants found VPAs to be an acceptable provider of health information with potential to increase women's access preconception health advice. Gabby was considered to be trustworthy and was able to develop rapport with participants in a relatively short time. Context-specific, relevant, tailored and trustworthy information and advice were considered more important that Gabby's physical appearance. Participants had strong opinions about potential technological advancements (e.g., reminders and rewards) and addressing navigation issues to increase Gabby's acceptability. Participants envisaged that they would use Gabby for readily available and evidence-based information before seeking advice from a health professional if required. Overall, the concept VPAs to provide preconception advice and Gabby were acceptable to participants. Future development of VPAs, Gabby, and other online technology-based resources should consider women's high expectations of the online health information they choose to interact with.

Study design of a stepped wedge cluster randomized controlled trial to evaluate the effect of a locally tailored approach for preconception care \u2013 the APROPOS-II study

BackgroundIn a previous feasibility study (APROPOS) in a single municipality of the Netherlands, we showed that a locally tailored preconception care (PCC) approach has the potential to positively affect preconceptional lifestyle behaviours. Therefore, we designed a second study (APROPOS-II) to obtain a more robust body of evidence: a larger group of respondents, more municipalities, randomization, and a more comprehensive set of (clinical) outcomes. The aim of this study is to assess the effectiveness and the implementation process of a local PCC-approach on preconceptional lifestyle behaviours, health outcomes and the reach of PCC among prospective parents and healthcare providers.MethodsThis study is an effectiveness-implementation hybrid type 2 trial. This involves a stepped-wedge cluster randomized controlled trial design aiming to include over 2000 future parents from six municipalities in the Netherlands. The intervention has a dual-track approach, focusing on both the uptake of PCC among future parents and the provision of PCC by healthcare providers. The PCC-approach consists of 1) a social marketing strategy directed towards prospective parent(s) and 2) a local care pathway to improve interdisciplinary collaboration. Data will be collected before and after the introduction of the intervention through questionnaires and medical records in each of the participating municipalities. The primary outcome of this study is change in lifestyle behaviours (e.g. folic acid use, smoking and alcohol use). Secondary outcomes are pregnancy outcomes (e.g. miscarriage, preterm birth, gestational diabetes) and the uptake of PCC. Moreover, a process evaluation will be performed, providing information on the efficacy, feasibility, barriers and facilitators regarding the implementation of the intervention.DiscussionThe APROPOS-II study introduces a locally tailored PCC-approach in six municipalities in the Netherlands that will contribute to the body of evidence regarding the effectiveness of PCC and its implementation. If this intervention has a positive effect on lifestyle behaviour changes, leading to improved pregnancy outcomes and the future health of prospective parents and their offspring, it could subsequently be upscaled to (inter)national implementation.Trial registrationDutch Trial register: NL7784 (Registered June 6th, 2019).

Primary health care nursing students' knowledge of and attitude towards the provision of preconception care in KwaZulu-Natal.

BackgroundSub-Saharan African countries have been the worst affected by the high incidence of maternal and child mortality rates and HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) pandemic. Preventive care is the area that requires serious attention as a lot of maternal and child morbidity and mortality can be averted through rendering comprehensive care to women of child-bearing age. Preconception care (PCC) is recognised as an important factor in improving pregnancy outcome; yet, most primary health care (PHC) nurses lack the necessary resources to render PCC.AimTo describe the PHC nursing student’s knowledge of and attitude towards the provision of PCC.SettingHigher Education Institution that offers PHC programme at six different sites to nurses working in the PHC clinics in the province.MethodsA quantitative, non-experimental, descriptive study design was used. The total population from three sites selected, based on their geographical location were all invited to participate in the study. Questionnaire was used to collect data which was subsequently analysed using the Statistical Package for Social Sciences (SPSS) version 24.ResultsThe response rate was approximately 85% (n = 138). The respondents have practised in the PHC clinic for more than 1 year. Study centre, age and area of employment were found to be predictors of knowledge, but no direct association was found between the demographic factor and attitude. Furthermore, a significant difference was found between knowledge and age, and between the area of employment and attitude.ConclusionPHC nursing students were knowledgeable and had a favourable attitude towards PCC, but the absence of PCC resources in many practices has hindered them to a greater extent. It is recommended that for proper implementation of PCC to occur, health care workers should be provided with the necessary resources.

A Healthy Mother and Baby through Optimal Timing and Spacing of Pregnancy

One of the strategies that can assist to improve maternal and newborn outcomes in Malawi is the provision of preconception care. Most of the problems that affect the neonates and their mothers occur before pregnancy and during organogenesis. Men and women of childbearing age need appropriate advice and healthcare to assist them to have healthy maternal and newborn outcomes. Persistent use of family planning and healthy timing and spacing of pregnancy could assist in reducing some of the causes of the maternal and infant mortality rate. Preconception health should be promoted through the use of family planning methods at a recommended time to have a healthy pregnancy. A quantitative descriptive non-experimental design was used to examine the use of preconception interventions at health centres in the urban areas of Blantyre, Malawi. Information was collected from 300 men and women of childbearing age between 18 and 35 years that had a pregnancy and intended to get pregnant in five years. The major findings indicated that information on optimal timing and spacing of pregnancy should be provided to men and women of childbearing age and that there should be adequate use of family planning methods. There were mixed messages on healthy timing and spacing of pregnancy as 32.8 per cent of the participants indicated that pregnancy should be spaced in 1 to 2 years and 23.5 per cent indicated that pregnancy should be spaced more than 5 years. About n = 196 (64.9%) had one to two children. Healthcare providers should provide guidelines on healthy timing and spacing of pregnancy through preconception care that would enable men and women of childbearing age to access information and care to improve pregnancy outcomes.

Preconception care and contraception services: Opportunities for community pharmacists

AbstractThere are multiple opportunities for community pharmacists to take on greater roles in the delivery of preconception care and contraceptive services, and pharmacists have indicated interest in developing and expanding such services. Therefore, the objective of this review is to summarize published literature related to community pharmacists' provision of preconception care and contraceptive interventions to help guide related service development and raise awareness about potential opportunities to further expand and integrate such services into practice. Two searches were performed on February 5, 2019 of Medline, Academic Search Complete, and the International Pharmaceutical Abstracts databases from database inception to December 31, 2018. The first search utilized the terms [([contraception or birth control or family planning or contraceptive] OR contraception education OR contraceptives OR contraceptive access) AND ([pharmacists or pharmacist] OR pharmacy OR community pharmacy OR community pharmacist)]; the second search utilized the terms [(preconception OR preconception care OR preconception counseling OR preconception health OR [“preconception care” or “pre‐pregnancy care” or “prepregnancy care”]) AND ([pharmacists or pharmacist] OR pharmacy OR community pharmacy OR community pharmacist)]. Inclusion criteria for the review were articles written in English describing a community pharmacist‐delivered service in the United States. Six articles detailed community pharmacists' roles in contraception, including prescribing hormonal and emergency contraception and administration of injectable contraception. Each study found high rates of patient uptake and satisfaction with these services. One article detailed community pharmacists' provision of preconception care services; again, there was rapid uptake of the service. These articles together highlighted the logistical ease, economic viability, and patient acceptance of such services. Opportunities to expand and integrate these services exist. Published data show that community pharmacists have demonstrated provision of contraceptive and preconception care services in the US, and opportunities exist to grow these programs.

Understanding and provision of preconception care by general practitioners.

Preconception care (PCC) defines health interventions prior to conception aimed at improving pregnancy and infant outcomes. To explore the understanding and provision of PCC by general practitioners (GPs) within the Sydney Local Health District. A questionnaire developed with GPs assessed structure and content of PCC provided, attitudes toward PCC and perceived barriers and facilitators. One hundred and ten GPs completed the survey: 84% reported that GPs should be the main providers of PCC; however, only 53% were aware of PCC guidelines. Seventy-five percent of responders initiated PCC discussion with women of reproductive age, 56% provided PCC to women at higher risk of adverse outcomes and 16% waited for the discussion to be initiated by the patient. Smoking, vaccination, alcohol and supplements/medication use were the most discussed PCC components, while serology, full blood count and blood pressure were the most performed assessments. Most respondents stated that PCC is essential for women with pre-existing diabetes, previous pregnancy complications or chronic illness. However, only 45% stated PCC was essential for women >35years and 39% for women who were overweight. Importantly, weight and mental health were among the least discussed PCC components. General practitioners are key providers of PCC; however, only half are aware of PCC guidelines and most do not recognise overweight to be a significant preconception issue. The most common barriers to PCC delivery were time constraints, lack of knowledge and lack of resources for patients. Improved resources and education are required to support adequate PCC provision.

Preconception lifestyle intervention in obese infertile women is more effective for those with a history of childhood adversity

Federal recommendations for providing quality family planning services were published in 2014 and included preconception care (PCC). This paper aims to describe the prevalence of PCC delivery among publicly funded clinics, prior to the recommendations.Prevalence of providing occasional or frequent PCC in the last 3 months and having written protocols for recommended PCC screenings were estimated in 2015 using survey data collected from a nationally representative sample of publicly funded clinic administrators (2013–2014, N=1,615). Analyses included examination of differential distributions of outcomes by clinic characteristics (p<0.05) and multivariable regression.Prevalence of occasional or frequent PCC delivery was 81% for women and 38% for men. The percentage of clinics with written protocols for specific PCC screenings ranged from 74% to 88% (women) and 66% to 83% (men). Prevalence of having written protocols for all PCC screenings was 29% for women and 22% for men. Characteristics negatively associated with having written protocols for all PCC screenings for women and men (respectively) were as follows: not receiving Title X funding (adjusted prevalence ratio [APR]=0.6, 95% CI=0.50, 0.76; APR=0.6, 95% CI=0.47, 0.77) and being a community health center (APR=0.5, 95% CI=0.37, 0.72; APR=0.5, 95% CI=0.30, 0.67); health department (APR=0.7, 95% CI=0.61, 0.87; APR=0.6, 95% CI=0.49, 0.76); or hospital/other (APR=0.6, 95% CI=0.50, 0.79; APR=0.6, 95% CI=0.43, 0.75) (versus Planned Parenthood).Provision of PCC appears to differ by clinic characteristics and by interpretation of the phrase “preconception care,” suggesting opportunities for education and improvement.

Contraceptive Use Among Women with Prediabetes and Diabetes in a US National Sample.

Although elevated blood glucose is associated with adverse maternal and fetal health outcomes, evidence suggests that women with diabetes may not be receiving comprehensive reproductive health care, including family planning and preconception care. Using a population-based sample, we evaluated the relationship between contraceptive use and biomarker-identified diabetes. This cross-sectional study used data from 5548 women in the nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health) from 2007 to 2009. Women were aged 24 to 32 years, sexually active with men, and not pregnant. Hemoglobin A1C identified prediabetes and diabetes from blood specimens. The primary outcome was most effective contraception used in the past year: more effective (sterilization, intrauterine device, implant, combined hormonal methods, or injectable), less effective (condoms, diaphragms, spermicides, natural family planning, or withdrawal), or none. Multinomial regression models were adjusted for race and ethnicity, education, insurance, health care access, and body mass index. Of the women with diabetes, 37.6% used more effective contraception, 33.6% less effective contraception, and 28.8% none. Women with diabetes had higher odds of using no contraception, rather than more effective contraception, than women with normoglycemia (adjusted odds ratio [aOR], 1.90; 95% CI, 1.25-2.87). Women with diabetes who were undiagnosed had greater odds of using less effective contraception, rather than more effective contraception, compared with those who were diagnosed (aOR 3.39; 95% CI, 1.44-7.96). Contraceptive use did not differ between women with prediabetes and normoglycemia. Less effective contraceptive methods were commonly used by women with diabetes. Midwives and other women's health care providers can support women with diabetes to reach their pregnancy goals by providing preconception care and family planning.