Uptake Of Preconception Care Research Articles

Current preconception care practice in the Netherlands — An evaluation study among birth care professionals

ObjectiveTo evaluate the current practice of preconception care in the Netherlands and the perceptions of birth care professionals concerning preconception care. MethodsWe have developed a digital questionnaire and conducted a cross-sectional study by distributing the questionnaire among 102 organisations: 90 primary care midwifery practices and obstetric departments of 12 hospitals in the Southwest region of the Netherlands between December 2020 and March 2021. One birth care professional per organization was asked to complete the questionnaire. Descriptive statistics were used to present the results. FindingsRespondents of eighty-three organisations (81.4 %) filled in the questionnaire, of whom 74 respondents were independent primary care midwives and 9 respondents were obstetricians. Preconception care mostly consisted of an individual consultation in which personalized health and lifestyle advice was given. Among the respondents, 44.4 % reported that the organization had a preconception care protocol. The way in which the consultation was carried out, as well as the health and lifestyle related questions asked, differed between respondents. More than 85 % of the respondents inquire about the following possible risk factors for complications: maternal illnesses, obstetric history, folic acid supplement intake, alcohol intake, smoking, substance abuse, hereditary disease, prescription medication, dietary habits, overweight, and birth defects in the family. The respondents acknowledged that preconception care should be offered to all couples who wish to become pregnant, as opposed to offering preconception care only to those with an increased risk of complications. Still, respondents do not receive many questions regarding the preconception period or requests for preconception care consultations. Key conclusionBirth care professionals acknowledge the need for preconception care for all couples. In the Netherlands, preconception care consists mostly of an individual consultation with recommendations for health and lifestyle advice. However, the identification of risk factors varies between birth care professionals and less than half of the respondents indicate that they have a protocol available in their practice. Furthermore, the demand of parents-to-be for preconception care is low. More research, that includes more obstetricians, is necessary to investigate if there is a difference between the care provided by primary care midwives and obstetricians. Implications for practice: To increase the awareness and uptake of preconception care, it would be prudent to emphasize its importance to parents-to-be and professionals, and actively promote the use of widespread, standardized protocols for birth care professionals.

The effect of a locally tailored intervention on the uptake of preconception care in the Netherlands: a stepped-wedge cluster randomized trial (APROPOS-II study)

BackgroundThe preconception period provides a window of opportunity for interventions aiming to reduce unhealthy lifestyle behaviours and their negative effect on pregnancy outcomes. This study aimed to assess the effectiveness of a locally tailored preconception care (PCC) intervention in a hybrid-II effectiveness implementation design.MethodsA stepped-wedge cluster randomized controlled trial was performed in four Dutch municipalities. The intervention contained a social marketing strategy aiming to improve the uptake (prospective parents) and the provision (healthcare providers) of PCC. Prospective parents participated by administering a questionnaire in early pregnancy recalling their preconceptional behaviours. Experiences of healthcare providers were also evaluated through questionnaires. The composite primary outcome was adherence to at least three out of four preconceptional lifestyle recommendations (early initiation of folic acid supplements, healthy nutrition, no smoking or alcohol use). Secondary outcomes were preconceptional lifestyle behaviour change, (online) reach of the intervention and improved knowledge among healthcare providers.ResultsA total of 850 women and 154 men participated in the control phase and 213 women and 39 men in the intervention phase. The composite primary outcome significantly improved among women participating in the municipality where the reach of the intervention was highest (Relative Risk (RR) 1.57 (95% Confidence Interval (CI) 1.11–2.22). Among women, vegetable intake had significantly improved in the intervention phase (RR 1.82 (95%CI 1.14–2.91)). The aimed online reach- and engagement rate of the intervention was achieved most of the time. Also, after the intervention, more healthcare providers were aware of PCC-risk factors (54.5% vs. 47.7%; p = 0.040) and more healthcare providers considered it easier to start a conversation about PCC (75.0% vs. 47.9%; p = 0.030).ConclusionThe intervention showed some tentative positive effects on lifestyle behaviours among prospective parents. Primarily on vegetable intake and the knowledge and competence of healthcare providers. The results of this study contribute to the evidence regarding successfully implementing PCC-interventions to optimize the health of prospective parents and future generations.Trial registrationDutch Trial Register: NL7784 (Registered 06/06/2019).

Knowledge, Attitude, and Practice among Palestinian Mothers Attending the Governmental Primary Health Care Centers Regarding Preconception Care Services

Background: Preconception care considers the backbone for safe pregnancy and childbirth outcomes. Therefore, early preconception care provided by healthcare professionals before pregnancy is crucial in reducing childbirth morbidity and mortality rates. This study aims to assess mothers' knowledge, attitude, and practice (KAP) about preconception care at governmental primary health care clinics in the Gaza Strip. Methods: A descriptive cross-sectional study was conducted in seven primary health care centers and data was collected using a self-administered questionnaire (including 3-point Likert Scale). A convenience sample of 372 mothers aged from 16 to 49 years, and who visit governmental clinics as a routine followup were selected. Results: the overall level of practices regarding preconception care was (75%) was reported about the importance of eating a wellshowed a high attitude level in terms of the importance of Conclusion: In Gaza Strip, mothers have fair knowledge and attitude levels but low level of practice regarding preconception care which shows that there is an opportunity in existing circumstances for the implementation of interventions targeting predictors for increased knowledge and uptake of preconception care.

Exploring male perceptions regarding the need to engage in preconception care – a mixed-method study amongst Dutch (prospective) fathers

Purpose While most preconception care (PCC) interventions are aimed at women, men are also in need of PCC to reduce risk factors affecting the spermatozoa quality. The objective of this study is to explore male perceptions regarding the need to engage in PCC. Materials and methods In a mixed-method cross-sectional study, 229 men participated with a questionnaire and 14 individual semi-structured interviews were conducted. Questionnaires data were analysed using multiple regression analyses. The interviews were analysed using thematic analyses. Results Most men did not retrieve preconceptional information (n = 135; 59.0%) nor visited a preconceptional consult (n = 182; 79.5%). Men who categorised their preconceptional lifestyle as unhealthy (score ≤6 out of 10) less often retrieved information (adjusted OR 0.36 [95% CI 0.14–0.93]) than men with a healthy preconceptional lifestyle. While several men expressed their fear for infertility, this did not lead to an increased uptake of PCC as men felt they were healthy enough already. Conclusion Despite high awareness of the positive influence of a healthy lifestyle, the perceived need for preparing for pregnancy among men remains low. Tailoring preconceptional information towards male needs provides a window of opportunity to improve men’s reproductive health and possibly the health of future generations.

Knowledge and perceptions of preconception care among health workers and women of reproductive age in Mzuzu City, Malawi: a cross-sectional study

BackgroundPreconception care is one of the preventive strategies in maternal and new-born health as recommended by WHO. However, in sub-Saharan Africa there is poor preconception care practices. This study examined knowledge and perceptions of preconception care among health workers and women of reproductive age group in Mzuzu City, Malawi.MethodsA descriptive cross-sectional study was conducted using a mixed methods approach. Selection of respondents was done through a multistage and purposive sampling techniques respectively. A total of 253 women of reproductive age from nine townships of Mzuzu City responded to the questionnaire and 20 health workers were interviewed.ResultsA total of 136 (54%) respondents had heard of preconception care. About 57.7% (n = 146) demonstrated a good level of knowledge of preconception care while 42.3% (n = 107) had poor knowledge. About 72% (n = 105) of those with good of knowledge of preconception care, lacked awareness on possibilities of talking to a health care provider on intentions of getting pregnant. About 74.7% (n = 189) of women had a positive perception towards preconception care. Knowledge of preconception care was a good predictor of positive perception (AOR = 2.5; 95% CI 1.2–5.0), however its predictability was influenced by the academic level attained. Those with secondary (AOR = 10.2; 95% CI 3.2–26.2) and tertiary (AOR = 2.3; 95% CI 1.1–4.9) were more likely to have good knowledge of preconception care than those with primary school education level. About 95% (n = 19) of health workers lacked details about preconception care but they admitted their role in preconception care.ConclusionPreconception care practice among health workers and women of reproductive age in Mzuzu City was low. However there was positive perception towards preconception care in both parties. There is an opportunity in existing platforms for implementation of interventions targeting identified predictors for increased knowledge and uptake of preconception care.

Predictors of preconception care behaviour among women of reproductive age using a behaviour-change model

Purpose: Although preconception care (PCC) has been integrated into women’s care programmes in the country for more than a decade, it has not yet been welcomed by Iranian women, and the rate of PCC uptake is very low. Therefore, this study aims to determine predictors of uptake of PCC based on the Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF) model among women of reproductive age referred to health centres in Urmia, Northwest Iran, in 2019. Methods: This cross-sectional study was carried out on 230 women of childbearing age at Urmia health centres during 2019. Subjects were selected using a multistage sampling method. A valid reliable researcher-made questionnaire, including demographic information, items related to the BASNEF model constructs regarding PCC and items related to PCC behaviour, was used to collect data. Data were analysed using descriptive and inferential statistics (frequencies, means and standard deviations, independent t-test, chi-square test, logistic and linear regression). Results: The findings showed that the rate of receiving PCC was 19.6%. Overall, the BASNEF model predicted 42% of the intention to receive health care. Among the model constructs, enabling factors (β=0.32, p<0.001) and attitude (β=0.41, p<0.001) significantly explained women’s behavioural intention towards receiving PCC. In the logistic regression model, intention (β=0.15, p<0.001) and enabling factors (β=0.12, p=0.034) had a significant role in predicting PCC. Conclusion: The low uptake of PCC by women of childbearing age in Urmia suggests the need to design and implement interventions based on women’s attitudes, intentions and enabling factors in order to stimulate and maintain women’s health-promoting behaviours during childbearing age.

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.

Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya.

Introduction A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Despite the role of preconception care for HIV discordant couples, there is little data on fertility desire and preconception care uptake. This study aimed at documenting fertility desire (desire to conceive), determining the uptake of preconception care, identifying HIV prevention strategies used during preconception care, and determining immediate conception outcomes among HIV discordant couples in Kenya. Methods We retrospectively extracted electronic medical record data on discordant couples at an HIV care discordant couples' clinic. We included data on couples who expressed a desire to conceive and were offered preconception care and followed up for 29 months. We collected data on sociodemographic characteristics, preconception prevention methods, and associated outcomes. Results Among couples, with male HIV-positive partners, there was a twofold likelihood of accepting preconception services (OR = 2.3, CI 95% (1, 1, 5.0)). A shorter discordant union was independently associated with the uptake of preconception services (OR = 0.92, CI 95% (0.86, 0.98)). The most used prevention intervention (38.5%) among discordant couples was a combination of pre-exposure prophylaxis (PrEP) by the uninfected partner, alongside HAART by the partner living with HIV. Pregnancy rates did not significantly (p = 0.06) differ among those who took up preconception care versus those who did not. HIV-negative partners of couples who declined preconception care had a significantly (p = 0.04) higher attrition from clinic follow-up. One confirmed seroconversion occurred; an HIV incidence rate of 0.19 per 100 person-years.Conclusion The study demonstrates the feasibility of implementing safe and effective preconception servicesas part of routine HIV care for discordant couples living in low resource settings. The provision and the utilisation of safer conception services may be hindered by the poor retention to follow-up and care of HIV-negative partners. This challenge may impede the expected benefits of preconception care as an HIV prevention intervention.

Knowledge, uptake of preconception care and associated factors among reproductive age group women in West Shewa zone, Ethiopia, 2018

BackgroundPreconception care is a set of interventions that are to be provided before pregnancy, to promrote the health and well-being of womwen and couples .MethodsA community-based cross-sectional study was employed among a sample of 680 reproductive-aged women in the West Shewa zone, Oromia regional state, from November 2017 until the end of January 2018. The data were collected using a pre-tested and structured questionnaire. The collected data were coded and entered into Epi data version 3.1 and exported to SPSS 22 for analysis. Bivariate and multivariate logistic regression models were utilized to determine factors associated with the outcome variable. The association was presented in odds ratio with 95% confidence interval and significance determined at a P-value less than 0.05.ResultA total of 669 participants had participated with a response rate of 98.3%. Among the respondants, only 179 (26.8%) had a good knowledge of PCC and 97 (14.5%) of them had utilized PCC. Factors that show significant association with good knowledge of PCC are history of institutional delivery (AOR = 1.43 (95%CI (1.31–7.33), PNC service utilization, (AOR = 5.02 (95%CI (3.22–7.84), history of using modern contraceptive, (AOR = 1.44 (95%CI (1.37–6.98) higher educational status (AOR = 4.12 (95%CI (1.22–6.52) and being regularly employed (AOR = 1.8 (95%CI (1.01–3.22). Factors like better family monthly income (AOR = 4.1 (95%CI (1.57–9.35), history of PNC (AOR = 6.33 (95%CI (3.94–10.17) and good knowledge of PCC (AOR = 4.3 (95%CI (2.67–6.98) had shown positive association towards the uptake of PCC.Conclusion and recommendationThis study found that only one-quarter of the women in the study has good knowledge of PCC and low uptake of PCC. History of institutional delivery, PNC service utilization, history of using a modern contraceptive, educational status and being regularly employed were factors that affect knowledge of PCC and family income, having good knowledge about PCC and history of PNC were affect the uptake of PCC.Therefore, PCC needs serious attention from the government and other stakeholders.

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).

Utilisation of preconception care services and determinants of poor uptake among a cohort of women in Abakaliki Southeast Nigeria

Preconception care (PCC) is a preventive strategy for maternal and perinatal morbidity and mortality. This study aimed to assess the level of awareness and utilisation of PCC services. A descriptive cross-sectional survey was conducted at a teaching hospital. Interviewer-administered questionnaires were used to extract information. A total of 450 participants responded; 44.2% (190/450) were aware, 31.7% (143/450) had good knowledge, while only 10.3% (46/450) received PCC. Health care providers were the main source of information (77.9%). There was statistically significant correlation between awareness and participants’ level of education (p < .001) and residence (p < .001), as well as between utilisation and education (p < .001), and information from doctors (p < .001). There was a low level of awareness and poor utilisation of PCC, underpinning the need to scale up health education, establishment of functional PCC clinics and formulation of evidence-based guidelines to improve uptake and pregnancy outcome.Impact statementWhat is already known on the subject of the paper? PCC has been known in high-income countries as a prevention-based strategy, which aims at improving obstetric outcomes. However, the level of utilisation in low-income countries like Nigeria is either unknown or far too low.What do this study add? This work has provided local data on PCC; clearly indicating that the awareness and utilisation of PCC services in Abakaliki, Nigeria is very low when compared with other regions of the world, and this was influenced by the socio-demographic factors – particularly education and place of residence (for awareness), and level of education and information from health care providers (for utilisation), thus suggesting that enlightenment and improvement in social infrastructures could improve awareness, access and utilisation of PCC.What are the implications for clinical practice and/or further research? The implications of these findings in low resource settings like ours will include introducing interventions to scaling up health education, universal establishment of functional PCC units and formulation of evidence-based guidelines aimed at improving the uptake of PCC and pregnancy outcome. Further research will also be needed in future to assess the impact of such interventions and how to sustain potential benefits.

Correlates of Preconception Care among Mothers Prone to Hypertensive Disorders in Nairobi City County

Improved uptake of preconception care has been associated with reduced rates of maternal mortality yet the awareness and uptake of preconception care services among pregnant women, and healthcare teams remain low. This study assessed the awareness of preconception care among pregnant mothers with hypertensive disorders, to examine the influence of male partners in seeking of preconception care and to determine the perceived effects of lack of pre-conception care among pregnant mothers with hypertensive disorders. This was a cross-sectional study in which a sample of 325 mothers seeking ante-natal care was selected from Mbagathi District Hospital, Pumwani Maternity Hospital and Langata Health Centre respectively. A stratified proportionate sampling was used to select the 325 mothers from the three health facilities. Structured questionnaires were used in data collection. Descriptive statistics (mean, median, frequency) were used in analyzing characteristics of the sample. Inferential statistics (Chi-square) was used to test for the relationship between the study variables and seeking of pre-conception care. A p-value of 0.05 was considered significant at a 95% confidence level. A majority of respondents n=232 indicated that preconception care consists of advice prior to conception, medical care during pregnancy and receiving ante-natal care. Health workers at 63% (n=174) were the main source of information on pre-conception care. 72.5% of the respondents had discussed a joint pre-conception care with their male partner. About 27.5% of the respondents had not discussed a pre-conception care plan with their male partners with the leading reason being that partners did not see the reason to accompany their wives for pre-conception care. Marital status at p=0.000 (c 2 = 25.365, df=4), education at p=0.048(c 2 = 18.465, df=10), discussing and making joint plans with partner on pre-conception care at p=0.008 (c 2 = 9.782, df=2) significantly influenced decision to attend pre-conception care. 44.67 % (n=130) of respondents indicated that lack of pre-conception care increases the risk of hypertension disorder causing miscarriage. Twenty-eight percent (n=80) of the respondents indicated that lack of pre-conception care exposes a mother to birth complications that develop due pre-eclampsia. This study identified views of mothers on the uptake of pre-conception care. Perceived lack of time and lack of interest among men were the main barriers that hindered male partners from accompanying their female partners for pre-conception care. Factors that promoted uptake of pre-conception care included, being married, discussing a joint plan with a male partner and having a higher level of education. This study highlights the need for health promotion activities to encourage the need of preparing for pregnancy in the general population. In this regard, health care workers should incorporate health messages on preconception care during ante-natal, immunization and post-natal care sessions to increase awareness on the importance of preconception care.

Opportunities of mHealth in Preconception Care: Preferences and Experiences of Patients and Health Care Providers and Other Involved Professionals.

BackgroundThe importance of the preconception period and preconception care (PCC) are broadly acknowledged and the potential benefits regarding health promotion have been studied extensively. PCC provides the opportunity to identify, prevent, and treat modifiable and nonmodifiable risk factors to optimize the health of couples trying to become pregnant. The prevalence of modifiable and nonmodifiable risk factors in these couples is high, but the uptake of PCC remains low.ObjectiveThe aim of this study is to identify the preferences and experiences of women and men (patients) trying to become pregnant and of health care providers and other involved professionals regarding mobile health (mHealth), in particular the coaching platform Smarter Pregnancy, and its potential role in PCC.MethodsPatients who participated in the Smarter Pregnancy randomized controlled trial (RCT) and health care providers and professionals also involved in PCC were invited to participate in a qualitative study. The barriers, benefits, and opportunities of big data collection by mHealth were discussed in focus group sessions, prompted with statements regarding PCC.ResultsWe composed five focus groups, consisting of 27 patients in total (23 women and 4 men), who participated in the RCT, and nine health care providers and other professionals. Of the patients, 67% (18/27) were familiar with the concept of PCC, but only 15% (4/27) received any form of PCC. A majority of 56% (combined percentages of statements 1 [n=18], 2 [n=11], and 3 [n=16]) of the patients believed in the benefit of receiving PCC, and all agreed that men should be involved in PCC as well. Patients did not have a problem using anonymized data obtained from mHealth tools for scientific purposes. Patients and health care providers and other professionals both acknowledged the lack of awareness regarding the importance of PCC and stated that mHealth provides several opportunities to support clinical PCC.ConclusionsOur findings substantiate previous studies addressing the low uptake of PCC due to unawareness or lack of perception of its relevance by couples who are trying to become pregnant. The positive judgment and experiences with mHealth, in particular Smarter Pregnancy, will stimulate future research and further development of effective and cost-effective personalized mHealth apps for patients, health care providers, and other professionals as an add-on to clinical PCC.

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.

Barriers in the Uptake and Delivery of Preconception Care: Exploring the Views of Care Providers

Objectives To examine health care professionals’ views of their role and responsibilities in providing preconception care and identify barriers that affect the delivery and uptake of preconception care. Methods Twenty health care professionals who provide preconception care on a regular basis were interviewed using semi-structured interviews. Results We interviewed twelve community midwives, three General Practitioners, three obstetricians, one cardiologist specialized in congenital heart diseases and one gastroenterologist.We identified four barriers affecting the uptake and delivery of preconception care (PCC): (1) lack of a comprehensive preconception care program; (2) limited awareness of most future parents about the benefits of preconception care, hesitance of GP’s about the necessity and effectiveness of PCC; (3) poor coordination and organization of preconception care; (4) conflicting views of health care professionals on pregnancy, reproductive autonomy of patients and professional responsibility. Conclusion We have identified four barriers in the uptake and delivery of preconception care. Our findings support the timely implementation of a comprehensive program of PCC (already advocated by the Health Council of the Netherlands) and increasing awareness and knowledge of PCC from care providers and future parents. We emphasize the need for further research on how organizational barriers lead to suboptimal PCC and how interdisciplinary collaboration and referral can lead to optimally tailored intervention approaches.

How do women prepare for pregnancy? Preconception experiences of women attending antenatal services and views of health professionals.

Main objectiveTo determine the extent to which women plan and prepare for pregnancy.MethodsCross-sectional questionnaire survey of pregnant women attending three maternity services in London about knowledge and uptake of preconception care; including a robust measure of pregnancy planning, and phone interviews with a range of health care professionals.Main resultsWe recruited 1173/1288 (90%) women, median age of 32 years. 73% had clearly planned their pregnancy, 24% were ambivalent and only 3% of pregnancies were unplanned. 51% of all women and 63% of those with a planned pregnancy took folic acid before pregnancy. 21% of all women reported smoking and 61% reported drinking alcohol in the 3 months before pregnancy; 48% of smokers and 41% of drinkers reduced or stopped before pregnancy. The 51% of all women who reported advice from a health professional before becoming pregnant were more likely to adopt healthier behaviours before pregnancy [adjusted odds ratios for greatest health professional input compared with none were 2.34 (95% confidence interval 1.54–3.54) for taking folic acid and 2.18 (95% CI 1.42–3.36) for adopting a healthier diet before pregnancy]. Interviews with 20 health professionals indicated low awareness of preconception health issues, missed opportunities and confusion about responsibility for delivery of preconception care.Significance of the findingsDespite a high level of pregnancy planning, awareness of preconception health among women and health professionals is low, and responsibility for providing preconception care is unclear. However, many women are motivated to adopt healthier behaviours in the preconception period, as indicated by halving of reported smoking rates in this study. The link between health professional input and healthy behaviour change before pregnancy is a new finding that should invigorate strategies to improve awareness and uptake of pre-pregnancy health care, and bring wider benefits for public health.

Preconception care: Practice and beliefs of primary care workers

A number of lifestyle modifications and medical interventions can be of benefit to maternal and neonatal health, when applied prior to conception. These include smoking cessation, supplementation with folic acid, cessation or moderation of alcohol intake and improvement of diabetic control. However, preconception care (PCC) is not widely practised in the UK, despite being apparently acceptable to health professionals and to women of childbearing age. The aims of the study were to describe the current practice of PCC in Barnsley and to assess the beliefs and attitudes of primary health care practitioners. This information would help direct appropriate educational and clinical governance intervention to this service in the locality in the light of other evidence about the effectiveness of PCC. A questionnaire was devised to explore the beliefs about, and practice in providing, PCC in primary care in the Barnsley Health Authority area and sent to all known GPs, practice nurses (PNs), health visitors (HVs) and midwives (MWs) in practices in the area in July 2000. A total of 163 completed questionnaires were received (one reminder, response rate 60.1%). Few practices had a written policy on PCC. Most respondents were providing it mainly on an opportunistic basis and had done so less than five times in the previous 3 months; GPs and PNs were most commonly involved. They agreed that advice about smoking, drug use, folic acid, genetic counselling, chronic disease, alcohol, and maternity care and screening for rubella, genital infections, hepatitis, human immunodeficiency virus and cervical cytology were important. They felt that advice about diet, exercise, supplements, food safety, occupational hazards and State benefits, and screening for nutritional status were less important. Although respondents felt that PCC was effective, and important to women of childbearing age, it was not a high priority in their workload. They indicated that this care was best provided in general practice and that they had the appropriate skills. Barriers to providing PCC included lack of resources and lack of contact with women planning to conceive. Few had received any training on PCC since qualifying in their discipline. The practitioners who responded to this survey agreed to a large extent about the importance of the subject, and about the content and effectiveness of PCC. Factors hindering the delivery of this service include resource constraints, lack of training and practice policies and procedures, and difficulty in targeting couples planning conception. Further research is needed into ways to increase the provision and uptake of PCC.