A case for preconceptual education programs for women: Integrative review

Abstract

Exposure to environmental factors before conception or in the very early stage of the embryonic period, can cause permanent changes in an individual life that can result in the development of chronic illness later in life or be transferred to progeny and hence future generations. Diverse effects of poor diet, alcohol, tobacco consumption, infectious diseases, obesity, anxiety, and depression in pregnancy and fetal origin of adult diseases all are well documented and known. Many of these are preventable or can be modified or treated. The general provision of prepregnancy interventions, however, are neglected by current health system policy. According to the World Health Organization (WHO), 50% of pregnancies worldwide are unintentional. The consequences of this is that embryo exposure to the teratogens can occur weeks before the pregnancy has been detected. Most women modify their risky behavior, such as smoking cessation, reducing alcohol consumption and even alter their lifestyle to a healthier one, such as consuming folic acid and multivitamins, when they learn about their pregnancy, typically around 8-10 weeks of gestational age. By this time, however, women have missed the opportunity of providing a healthy uterine environment for their fetus through the critical stage of the embryonic period. Preconception care is a relatively new concept and provides a unique opportunity to improve maternal health and pregnancy outcomes before pregnancy, through pregnancy, and after birth. Despite the general acknowledgment of the potential valuable impact of preconception care, there are various impediments to implementation of preconception care as part of routine practice in the health system.

Keywords

Pre-conceptual / Pre-conceptual care / Preconception counseling / Barriers for preconception / Healthy pregnancy behaviors

References

[1] Adamo KB, Ferraro ZM, Brett KE. Can we mofify the interuterine environment to halt the intergenerational cycle of obesity? International Journal of Environmental Research and Public Health. 2012; 9(4): 1263-1307. PMid:22690193. https://doi.org/10.3390/ijerph9041263

[2] Boekelheide K, Blumberg B, Chaplin RE, et al. Predicting later life outcomes of early life exposures. Environmental Health Perspectives. 2012; 120(10): 1353-1361. PMid:22672778. https://doi.org/10.1289/ehp.1204934

[3] Del Giudice M. Early stress and human behavioural development:emerging perspectives. Journal of Developmental Origins of Health and Disease. 2014; 5(4): 270-280. PMid:24965133. https://doi.org/10.1017/S2040174414000257

[4] Gluckman PD, Hanson MAD, Cooper CMD, et al. Mechanisms of disease : effect of inutero and early life conditions on adult health and disease. New England Journal of Medicine. 2008; 359(1): 61-73.PMid:18596274. https://doi.org/10.1056/NEJMra0708473

[5] Lewis A, Galbally M, Gannon T, et al. Early life programming as a target for prevention of child and adolescent mental disorders. BMC Medicine. 2014; 12(1): 1-15. PMid:24559477. https://doi.org/10.1186/1741-7015-12-33

[6] Burton T, Metclfe NB. Can environmental conditionsexperienced in early life influence future generations? Proc Biol Sci. 2014; 281(1785): 201-212. PMid:24807254. https://doi.org/10.1098/rspb.2014.0311

[7] Patterson PH. Maternal infection and autism. Brain Behavioural Immun. 2012; 26(3): 393-02. PMid:22001185. https://doi.org/10.1016/j.bbi.2011.09.008

[8] Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005; 8(1): 19-32. https://doi.org/10.1080/1364557032000119616

[9] Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implementation Science. 2010; 5(1): 69. PMid:20854677. https://doi.org/10.1186/1748-5908-5-69

[10] Rogers LM. Tobacco and pregnancy. Reproductive Toxicology. 2009; 28(2): 152-160. PMid:19450949. https://doi.org/10.1016/j.reprotox.2009.03.012

[11] Jauniaux E, Burton GJ. Morphological and biologica effects of maternal exposure to tobacco smoke on the feto-placental unit. Early Human Development. 2007; 83(11): 699-706. PMid:17900829.https://doi.org/10.1016/j.earlhumdev.2007.07.016

[12] Machaalani R, Ghazavi E, Hinton T, et al. Cigarette smoking during pregnancy regulates the expression of specific nicotinic acetylcholine receptor subunits in the human placenta. Toxicol Appl Pharmacol. 2014; 276(3): 204-212. PMid:24607864. https://doi.org/10.1016/j.taap.2014.02.015

[13] Milne E, Greenop KL, Scott RJ, et al. Parental smoking and risk of childhood brain tumors. International Journal of Cancer. 2013; 133(1): 253-259. PMid:23280760. https://doi.org/10.1002/ijc.28004

[14] Berlin I, Grange G, Jacob N, et al. Nicotine patches in pregnant smokers: randomised placebo controlled multicentre trial of efficacy. BMJ. 2014; 348: 1622. PMid:24627552. https://doi.org/10.1136/bmj.g1622

[15] Reid N, Gamble J, Creedy DK, et al. Benefits of caseload midwifery to prevent fetal alcohol spectrum disorder: a discussion paper. Women and Birth. 2019; 32( 2019): 3-5. PMid:29602689.https://doi.org/10.1016/j.wombi.2018.03.002

[16] May PA, Baete A, Russo J, et al. Prevalence and characteristics of fetal alcohol spectrum disorder. Pediatrics. 2014; 134(6): 855-866.PMid:25349310. https://doi.org/10.1542/peds.2013-3319

[17] Moos MK, Dunlop AL, Jack BW, et al. Healthier women, healthier reproductive outcomes: recommendations for the routine care of all women of reproductive age. American Journal of Obstetrics and Gynaecology. 2008; 199(6Suppl 2): S280-289. PMid:19081422.https://doi.org/10.1016/j.ajog.2008.08.060

[18] Roberts SC, Wilsnack SC, Foster DG, et al. Alcohol use before and during unwanted pregnancy. Alcoholism: Clinical and Experimental Research. 2014; 38(11): 2844-2852. PMid:25336245.https://doi.org/10.1111/acer.12544

[19] Van de Wulp NY, Hoving C, de Vries H. A qualitative investigation of alcohol use advice during prenancy: expereinces of Dutch midiwves,pregnanct women and their partners. Midwifery. 2013; 29(11):e89-98. PMid:23434309. https://doi.org/10.1016/j.midw.2012.11.014

[20] Carmichael Sl, Yang W, Feldkamp ML, et al. Reduced risks of neural tube defeacts and orofacial clefts with highger diet quaity. Arch Pediatr Adolesc Med. 2012; 166(2): 121-126. PMid:21969361.https://doi.org/10.1001/archpediatrics.2011.185

[21] Correa A, Gilboa SM, Botto LD, et al. Lack of periconceptual vitamins or supplements that contain folic acid and diabetes mellitus associated birth defects. American Journal of Obstetrics and Gynaecology. 2012; 206(3): 211-1213. PMid:22284962. https://doi.org/10.1016/j.ajog.2011.12.018

[22] Hammiche F, Vujkovic M, Wijburg W, et al. Increased preconception omega-3 polyunsaturated fatty acid intake imporves embryo morphology. Fertility abd Sterility. 2011; 95(5): 1820-1823. PMid:21130435.https://doi.org/10.1016/j.fertnstert.2010.11.021

[23] Skouteris H, Huang T, Millar L, et al. A systems approach to reducing maternal obesity: The Health Preconception, Pregnancy ad Postbirth (HIPPP) Collaborative. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2015; 55: 397-400. PMid:26121995.https://doi.org/10.1111/ajo.12341

[24] Godfrey KM, Sheppard A, Gluckman PD, et al. Epigenetic gene promotor methylation at birth is associated with child’s later adiposity. Diabetes. 2011; 60(5): 1528-1534. PMid:21471513. https://doi.org/10.2337/db10-0979

[25] Fisher SC, Kim SY, Sharma AJ, et al. Is obesity still increasing among pregnant women? Prepregnancy obesity trends in 20 states, 2003-2009. Prev Med. 2013; 56(6): 372-378. PMid:23454595.https://doi.org/10.1016/j.ypmed.2013.02.015

[26] Tracy SK, Cowan J. Chapter 22. Screening and assessment.In PairmanS, PincombeJ, ThorogoodC & Tracy SK.3rd edit. Midwifery Preparaton for Practice. Elsevier.

[27] Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nibe pregnant wome: a retrospecive review of medical records. The Lancet. 2020; 395: 809-815. https://doi.org/10.1016/S0140-6736(20)30360-3

[28] Di Mascio DD, Khalil A, Saccone G, et al. Outcome of coronavirus spectrum infections during pregnancy: a systematic review and meta-analysis. American Journal of Obstetrics and Gynaecology. MFM. 2020; 2(2, Suppl): 100107. PMid:32292902. https://doi.org/10.1016/j.ajogmf.2020.100107

[29] Yan J, Guo J, Fan C, et al. Coronovirus disease 2019 in pregnant women: a report based on 116 cases. American Journal of Obstetrics and Gynaecology. 2020; 223(1): 111. PMid:32335053.https://doi.org/10.1016/j.ajog.2020.04.014

[30] Pan WL, Gau ML, Lee TY, et al. Midfulness-based programme on the psychologucal health of pregnant women. Women and Birth. 2019; 32( 2019): e102-109. PMid:29752225. https://doi.org/10.1016/j.wombi.2018.04.018

[31] Van Ravestyn LM, van den Berg MPL, Hoogendijk JG, et al. Interventions to treat mental disorders during pregnancy: a systematic review and multiple treatment analysis. PLoS One. 2017; 12(3): e0173397. PMid:28358808. https://doi.org/10.1371/journal.pone.0173397

[32] Dunlop AL, Logue KM, Thorne C, et al. Change in women’s knowledge of general and personal preconception health risks following targeted brief counseling in publicaly funded primary care setting. American Journal Health Promotion. 2013; 27(3): S50-S57. PMid:23286664. https://doi.org/10.4278/ajhp.120116-QUAN-39

[33] Schwarz EB, Parisi SM, Handler SM, et al. Clinical decision support to promote safe prescribing in women of reproductive age: a cluster randomised trail. J Gen Intern Med. 2012; 27: 831-838. PMid:22297687. https://doi.org/10.1007/s11606-012-1991-y

[34] Bayrami R, Ebrahimipour H, Ebrahimi M, et al. Health care provide’s knowledge, attitude and practice regarding pre-conceptual care. Journal of Research and Health. 2013; 3(4): 519-526.

[35] Weisman CS, Hillemeier MM, et al. Improving womens preconceptual health: long term effects of the Strong HealthyWomen behavious change intervention in the Central Pennsylvannia Women’s Health Study. Womens Health Issues. 2011; 21: 265-271. PMid:21536455.https://doi.org/10.1016/j.whi.2011.03.007

[36] Mutsaerts MA, Groen H, Buuiter-van de Meer A, et al. Effects of paternal and maternallifestyle factors on pregnancy complications and perinatal outcome of pregnancy. A population Based birth cohort study. Hum Reprod. 2014; 29(4): 824-834. PMid:24510962.https://doi.org/10.1093/humrep/deu006

[37] Mazza D, Chapman A, Michie S. Improviing the uptake of preconception care guidelines as perceived by general practitioners:a qualitative study. BMC Health Services Research. 2013; 13:36. PMid:23368720. https://doi.org/10.1186/1472-6963-13-36

[38] Lumm KJ, Sundaram R, Buck Louis GM. Women’s lifestyle behaviours while tryng to become pregnant: evidence supporting preconception guidance. American Journal of Obstetrics and Gynaecology. 205(203): e1-203, e7. PMid:21658667. https://doi.org/10.1016/j.ajog.2011.04.030

[39] Waggoner MR. Motherhood preconceived: the emeergence of the preconception health and health care initiative. Journal of Health Politics and Law. 2013; 38(2): 345-371. PMid:23262764. https://doi.org/10.1215/03616878-1966333