Preconception Health and Care : A Window of Opportunity

Abstract: Women’s health and lifestyle before pregnancy can influence both the fertility and the health of mother and child. The overall aim of this thesis was to explore current preconception health and care and evaluate a new tool for preconception care.Study I was a qualitative descriptive analysis of preconception recommendations in six European countries. All six countries had guidelines for high-risk women, but guidelines for healthy women were fragmented and inconsistent. Guidelines regarding nutrition and lifestyle differed between countries. Preconception care was offered to high-risk women but otherwise on an opportunistic basis.Study II was a cross sectional study measuring pregnancy planning among 3390 pregnant women at antenatal clinics. Three out of four pregnancies were very or fairly planned and 12 % fairly or very unplanned. Women with planned pregnancies were more likely to have a higher socioeconomic status and to have longer relationships than women with unplanned pregnancies. The level of pregnancy planning was associated with planning behavior, such as information seeking and intake of folic acid, but without a reduction in alcohol consumption.Study III was a randomized controlled trial evaluating the Reproductive Life Plan (RLP) as a health promoting tool in contraceptive counselling. Women (n=299) at a student health center were randomized to standard care or standard care plus RLP. RLP-based counselling increased women’s knowledge of both reproduction and folic acid intake prior to pregnancy, affected the women’s RLP and was appreciated by the women.Study IV explored the adaption of RLP among midwives using mixed methods with focus group interviews and a questionnaire. Midwives generally adopted the RLP in contraceptive counselling, had predominantly positive experiences of the RLP and considered it a feasible tool for promoting reproductive health.In conclusion, preconception care is a public health issue. Pregnancy planning is associated with socioeconomic background, and preventive measures could have great health benefits both for women of reproductive age and their future children. There is a need for both national and European cohesive evidence-based preconception care guidelines. The RLP is a feasible tool for promoting preconception health and can potentially form the missing link between contraceptive counselling and antenatal care.