August 25th, 2011 by Hasham

Pre-Conception Health

New Recommendations on Preconception Health:

There have been important advances in medicine and prenatal care in recent years. Despite these advances, birth outcomes are worse in the United States than in other developed countries. Many babies are born prematurely or have low birthweight. In some groups of people, the problems are actually getting worse. Experts agree that women need to be healthier before becoming pregnant. While this is not a new idea, there has not been an organized effort to promote preconception health and health care until now. The recommendations shown here have been developed by local, state, and federal government agencies, with help from national medical organizations and groups such as the March of Dimes. They offer guidance to individuals and their families, health care providers, planners, and policy makers. The goal is to improve the health of women so that babies can be born healthier in the future.

Preconception Risk Factors:

The following selected preconception risk factors for adverse pregnancy outcomes and evidence for the effectiveness of preconception care have been used to develop clinical practice guidelines:

* Isotretinoins. Use of isotretinoins (e.g., Accutane) in pregnancy to treat acne can result in miscarriage and birth defects. Effective pregnancy prevention should be implemented to avoid unintended pregnancies among women with childbearing potential who use this medication.
* Alcohol misuse. No time during pregnancy is safe to drink alcohol, and harm can occur early, before a woman has realized that she is or might be pregnant. Fetal alcohol syndrome and other alcohol-related birth defects can be prevented if women cease intake of alcohol before conception.
* Anti-epileptic drugs. Certain anti-epileptic drugs are known teratogens (e.g., valproic acid). Recommendations suggest that before conception, women who are on a regimen of these drugs and who are contemplating pregnancy should be prescribed a lower dosage of these drugs.

Improving Preconception Health: Consumer Awareness:

Increase public awareness of the importance of preconception health behaviors and preconception care services by using information and tools appropriate across various ages; literacy, including health literacy; and cultural/linguistic contexts. Consumers should be more involved in improving preconception care services. Knowledge and attitudes and behaviors related to reproductive health are influenced by childhood experiences and prevailing social norms among adults. Certain U.S. adults are not aware of the factors that influence reproductive health and childbearing. The preconception guidelines from Canada state that preconception care is 1) physical preparation for pregnancy and parenting and 2) the social, psychological, and spiritual components of pregnancy. The factors that influence attitudes regarding preconception care include a person’s age and life stage, their childbearing history, and their life priorities.

Healthy Women Healthy Families:

There are many steps you can take before you become pregnant that will help prepare your body for a healthy pregnancy and baby. Preconception Health describes basic ways to keep a healthy lifestyle while you’re trying to conceive. Diet, exercise, weight, behavior and Folic Acid are discussed along with the importance of every woman having a pre-conception health check-up.

Improving Preconception Health: Interventions for Identified Risks

Timely preconception interventions for certain conditions can substantially improve maternal health and birth outcomes. Separating childbearing from the management of chronic health problems and infectious diseases places women, their future pregnancies, and their future children at unnecessary risk. Conditions and risk factors have been identified for which the following exist 1) evidence of potential harm to mother or baby, 2) high prevalence of adverse pregnancy outcome or effective interventions for reducing adverse pregnancy outcomes, and 3) one or more effective interventions that have been evaluated.

Certain women and men need additional counseling and interventions. For example, women who have conditions treated with medications that are known teratogens (e.g., anticonvulsant or anticoagulant medications and isotretinoins) might need to change prescriptions. Women with medical conditions associated with increased risks for morbidity and mortality to mother and fetus (e.g., diabetes, hypertension, heart disease, rubella sero-negativity, thrombophilias, dental disease, or obesity) need to control these conditions. Women with behaviors associated with increased health risks for the fetus (e.g., smoking and alcohol and illicit drug use) also need targeted interventions. Another group with specific counseling needs includes prospective parents with a family history of inherited (i.e., genetic) disorders.

The preparers of this report analyzed the National Ambulatory Medical Care Survey and demonstrated that diabetes affects approximately 1.85 million (21 per 1,000) women in the United States aged 18–44 years, and that preconceptional diabetes management has the potential to reduce the risk for pregnancy loss and congenital malformation for approximately 113,000 births per year. Anti-epileptic/antiseizure drugs are prescribed for approximately 1 million women (19 per 1,000), potentially affecting an estimated 75,000 pregnancies. Approximately 7 million (125 per 1,000) women of childbearing age are frequent drinkers, and without preconception interventions, alcohol misuse might affect approximately 577,000 births per year. Women with chronic medical conditions and their specialty providers should take advantage of every opportunity to discuss preconception health and risks. These conditions and risk factors affect substantial proportions of the approximately 4 million pregnancies that occur in the United States each year.

Studies of preconception care have indicated that providers do not routinely provide interventions for identified preconception risks. Dissemination of professional guidelines and evidence-based interventions are two vital ways to encourage changes in practice. However, quality improvement tools and techniques offer increased potential, particularly for specific interventions for women with identified conditions. Research has increasingly indicated that providers and health-care organizations are more likely to engage in evidence-based or best clinical practices, after participation in quality improvement projects (e.g., rapid improvement cycles using the plan/do/study/act approach, collaborative groups, or the model of improvement process that involves an aim/change/measure cycle). Incorporation of preconception care modules into the curricula of medical graduate, postgraduate, and continuing medical education might be another method of disseminating messages regarding the importance and content of preconception care for women .