Preconception health refers to the health of women and men during their reproductive years, which are the years they can have a child. It focuses on taking steps now to protect the health of a baby they might have sometime in the future.
However, all women and men can benefit from preconception health, whether or not they plan to have a baby one day. This is because part of preconception health is about people getting and staying healthy overall, throughout their lives. In addition, no one expects an unplanned pregnancy.
Preconception care is an opportunity for the couple to improve the health before they start trying for a baby. A healthcare professional can help them to assess their health, fitness and lifestyle, to identify areas that they may want to improve. Preconception care can make a useful contribution to reducing maternal and childhood mortality and morbidity, and to improving maternal and child health in both high- and low-income countries.
In high-income countries, in addition to optimizing general preconception health and risk awareness of the population as a whole, preconception care can address the relatively higher levels of maternal and childhood mortality and morbidity that exist in some pockets of socially marginalized and economically deprived families and communities. In low-income countries, similar but larger effects may be achieved. Preconception care can contribute to improving maternal and child health outcomes in large segments of the population.
Problems Addressed
The following health problems are addressed in Preconception Care –
- Nutritional deficiencies and disorders
- Vaccine-preventable infections
- Tobacco use
- Environmental risks
- Genetic disorders
- Early pregnancies, unwanted pregnancies, and pregnancies in rapid succession
- Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV)
- Infertility and subfertility
- Female genital mutilation
- Mental health disorders, including epilepsy
- Psychoactive substance use
- Intimate partner and sexual violence
Benefits of Preconception Care
- Reduce maternal and child mortality
- Prevent unintended pregnancies
- Prevent complications during pregnancy and delivery
- Prevent stillbirths, preterm birth and low birth weight
- Prevent birth defects
- Prevent neonatal infections
- Prevent underweight and stunting
- Prevent vertical transmission of HIV/STIs
- Lower the risk of some forms of childhood cancers
- Lower the risk of type 2 diabetes and cardiovascular disease later in life
What does Preconception Care include?
Genetic Condition
- Taking a thorough family history to identify risk factors for genetic conditions
- Family planning
- Genetic counselling
- Carrier screening and testing
- Appropriate treatment of genetic conditions
- Community-wide or national screening among populations at high risk
Nutritional Condition
- Screening for anaemia and diabetes
- Supplementing iron and folic acid
- Information, education and counselling
- Monitoring nutritional status
- Supplementing energy- and nutrient-dense food
- Management of diabetes, including counselling people with diabetes mellitus
- Promoting exercise
- Iodization of salt
Lifestyle Condition
- Screening of women and girls for tobacco use (smoking and smokeless tobacco) at all clinical visits using “5 As” (ask, advise, assess, assist, arrange)
- Providing brief tobacco cessation advice, pharmacotherapy (including nicotine replacement therapy, if available) and intensive behavioural counselling services
- Screening of all non-smokers (men and women) and advising about harm of second-hand smoke and harmful effects on pregnant women and unborn children
Education
- Creating awareness and understanding of fertility and infertility and their preventable and unpreventable causes
- Defusing stigmatization of infertility and assumption of fate
- Screening and diagnosis of couples following 6–12 months of attempting pregnancy, and management of underlying causes of infertility/sub-fertility, including past STIs
- Counseling for individuals/couples diagnosed with unpreventable causes of infertility/sub-fertility
- Keeping girls in school
- Influencing cultural norms that support early marriage and coerced sex
- Providing age-appropriate comprehensive sexuality education
- Providing contraceptives and building community support for preventing early pregnancy and contraceptive provision to adolescents
- Empowering girls to resist coerced sex
- Engaging men and boys to critically assess norms and practices regarding gender-based violence and coerced sex
- Educating women and couples about the dangers to the baby and mother of short birth intervals
Environmental Condition
- Providing guidance and information on environmental hazards and prevention
- Protecting from unnecessary radiation exposure in occupational, environmental and medical settings
- Avoiding unnecessary pesticide use/providing alternatives to pesticides
- Protecting from lead exposure
- Informing women of childbearing age about levels of methyl mercury in fish
- Promoting use of improved stoves and cleaner liquid/gaseous fuels
Behavioral Aspect
- Health promotion to prevent dating violence
- Providing age-appropriate comprehensive sexuality education that addresses gender equality, human rights, and sexual relations
- Combining and linking economic empowerment, gender equality and community mobilization activities
- Recognizing signs of violence against women
- Providing health care services (including post-rape care), referral and psychosocial support to victims of violence
- Changing individual and social norms regarding drinking, screening and counseling of people who are problem drinkers, and treating people who have alcohol use disorders
STDs and HIV Care
- Providing age-appropriate comprehensive sexuality education and services
- Promoting safe sex practices through individual, group and community-level behavioural interventions
- Promoting condom use for dual protection against STIs and unwanted pregnancies
- Ensuring increased access to condoms
- Screening for STIs
- Increasing access to treatment and other relevant health services
- Family planning
- Promoting safe sex practices and dual method for birth control (with condoms) and STI control
- Provider-initiated HIV counselling and testing, including male partner testing
- Providing antiretroviral therapy for prevention and pre-exposure prophylaxis
- Providing male circumcision
- Providing antiretroviral prophylaxis for women not eligible for, or not on, antiretroviral therapy to prevent mother-to-child transmission
- Determining eligibility for lifelong antiretroviral therapy
Vaccination
- Vaccination against rubella
- Vaccination against tetanus and diphtheria
- Vaccination against Hepatitis B
Reference
http://www.acog.org/Patients/FAQs/Good-Health-Before-Pregnancy-Preconception-Care
http://www.cdc.gov/preconception/overview.html
http://phpa.dhmh.maryland.gov/mch/Documents/prams_preconception_care.pdf
https://www.nlm.nih.gov/medlineplus/preconceptioncare.html
http://www.aafp.org/afp/2007/0801/p397.html
http://www.nhs.uk/chq/Pages/2594.aspx?CategoryID=54&SubCategoryID=127
http://www.who.int/maternal_child_adolescent/documents/preconception_care_policy_brief.pdf