Preconception care comprises counselling and the provision of biomedical, behavioural and social health interventions to optimise the health of women and their partners prior to pregnancy and improves health related outcomes for themselves and their children.
Most doctors are convinced of the value of preconception care, but there are logistical issues such as time constraints in healthcare appointments, preconception counselling being largely directed towards women, and the insurmountable fact that for preconception care, you need a planned conception – which in reality doesn’t always happen. Despite the challenges on the ground, exactly what value can it bring to patients – both male and female?
Researchers were interested in whether preconception care in a primary setting (rather than in hospital or community settings) improved pregnancy outcomes, such as birth weight, prematurity or foetal abnormalities. They were also looking at whether preconception care affected preconception risk factors among both men and women, like smoking or drinking alcohol.
They conducted a systematic review of almost 30 articles, most of them randomised control trials, looking at specific interventions under the umbrella of preconception care– single and multiple education sessions, dietary changes, and the use of supplements such as folic acid. They also considered who was providing the interventions, to see if having healthcare professionals (like GPs, nurses and midwives) yielded different results to other providers (such as trained facilitators).
The research found that both single and multiple education sessions improved knowledge about health and pregnancy, and reduced preconception risk factors among women. It also found that interventions provided by trained facilitators improved health knowledge and reduced risk factors. Of all the studies only one included men, but it did show that preconception education improved health knowledge in this group. Only a handful of the studies looked at pregnancy outcomes after these interventions, so there wasn’t enough evidence for the researchers to evaluate whether preconception care in primary settings improved pregnancy outcomes.
Preconception care can empower patients to approach conception with increased health knowledge and reduced risk factors. This research shows that even brief education sessions can have an effect, and that preconception care provided by trained facilitators as well as healthcare professionals can be effective, which may increase its feasibility in areas with less consistent access to healthcare.