We used critical appraisal and review techniques, and both quantitative and qualitative methods for empirical data collection and analysis. We reviewed over 4000 papers and 100 guidelines, analysed data from two large cohort studies, surveyed over 1000 antenatal women and over 500 of their partners, including a robust measure of pregnancy planning and conducted 40 interviews with health professionals and women.
The overall aim of the study was to provide evidence about pre-pregnancy health and care for women and men in England in order to inform future policy and practice.
The broad objectives were to:
1) Examine literature and analyse datasets to establish the quality of evidence and guidelines on preconception health and care
2) Assess knowledge, attitudes and behaviours of women and men of childbearing age regarding pregnancy planning and preconception care
3) Synthesise the evidence obtained to inform policy and guide strategy to improve pre-pregnancy health and care in England
There is good, albeit incomplete, research evidence of the benefits of intervention to support a stronger policy of preconception care for women in England. Two thirds of pregnancies leading to births are planned; interventions including folate supplementation, preconception care for women with diabetes and smoking cessation are known to be cost-effective; and there is evidence that health professionals can influence positive behaviour change among women before pregnancy.
However, awareness of preconception health and care among the public and health professionals is generally low – particularly in men and even among women attending an assisted conception service. There are very few studies about how best to deliver effective preconception interventions in clinical practice.
Engagement between women and health professionals about preconception health and care is often lacking, responsibility for providing preconception care is confused and delivery patchy, leading to multiple missed opportunities to improve maternal and child health.
This may support the current WHO proposals for a life course approach to the prevention of non-communicable disease, starting in the pre-conception period. Awareness of preconception health issues, pregnancy planning and uptake of interventions before pregnancy care are related but are distinct issues. Improvement in all three is required for a step change in preconception health and pregnancy outcomes.
Evidence based guidance and health economic evaluation are necessary but not sufficient to change practice. A more comprehensive strategy directed at health professionals and the public is needed.
Department of Health, Policy Research Programme.
For more information please contact: firstname.lastname@example.org
How Do Women Prepare for Pregnancy? Preconception Experiences of Women Attending Antenatal Services and Views of Health Professionals
Judith Stephenson, Dilisha Patel, Geraldine Barrett, Beth Howden, Andrew Copas, Obiamaka Ojukwu, Pranav Pandya, Jill Shawe
Published: July 24, 2014 DOI: 10.1371/journal.pone.0103085
How do women plan for pregnancy?
Preconception care for men