Preconception counseling impact in pregnancy outcomes in patients with spondyloarthritis.

INTRODUCTION: Spondyloarthritis (SpA) is a group of chronic inflammatory diseases, often affecting women in reproductive age. These diseases can have a significant impact on the reproductive health of women. Preconception counseling and medication adjustments have shown to reduce flares and improve pregnancy outcomes in women with rheumatoid arthritis. However, in women with SpA data of the impact of preconception counselling on pregnancy outcomes is scarce. The aim of this study is to evaluate that. METHODS: In this retrospective multicentric study, data was collected from medical records of women who gave birth from 2020 to 2022. The study included 45 pregnancies, which were divided into two categories whether they received preconception consultation or not. Data was collected on patient characteristics, disease duration, medications used, and preconception counselling. Outcomes were divided into two groups: maternal and fetal outcomes. RESULTS: 30 out of 45 pregnancies (66.67%) had received preconception counselling, having a significantly lower percentage of flares occurring postpartum compared to the non-counselling group (36.6% vs 6.4%, p=0.031) and lower percentage of contraindicated medication during pregnancy (20.0 vs 0.0%, p=0.011). CONCLUSION: Preconception counselling in women with SpA can increase the likelihood of medication adjustments before pregnancy and decrease the occurrence of flares postpartum. These findings suggest that preconception counselling should be implemented in the management of pregnant women with SpA to improve pregnancy outcomes. Further studies are needed to confirm the effectiveness of preconception counselling and to determine the optimal approach.

Preconception and contraceptive care for women living with HIV/AIDS attending antiretroviral treatment clinics in Lagos State, Nigeria.

Background: Women living with HIV/AIDS possess fertility desires similar to their uninfected counterparts, and with advances in health therapies, these women can realistically have and raise uninfected children. Preconception care (PC) is a specialized form of intervention aimed at the prevention, identification, treatment, and management of biomedical, behavioural, and social conditions that militate against safe motherhood and the delivery of healthy offspring. Objective: The study aimed to assess preconception and contraceptive care among women living with HIV and attending Antiretroviral Therapy Clinics in Alimosho, Lagos State, Nigeria. Methods: This was a descriptive facility-based cross-sectional study of 383 women of reproductive age living with HIV/AIDS and attending ART clinics in the study area. Probability sampling methods were used in the selection procedures. Data were analyzed using descriptive statistics, Chi-square test, and univariate logistic regression at a 5% level of significance. Stratified and simple random sampling were used in the selection process. Results: Only 37.4% of respondents received optimal PC services. Being 20-29 years old [OR =1.716 (95% CI: 1.664, 1.769), p = 0.020], being 30-39 years [OR =1.514 (95% CI: 0.598, 3.831), p = 0.005], tertiary education [OR =8.43. (95% CI: 1.41, 18.5), p = 0.020], and being single [OR =2.00 (95% CI: 1.928-2.072), p = 0.002] were significantly related to the utilization of contraceptives. Conclusion: There is a need to provide structure and guidelines for optimal streamlined PC and contraceptive services for women living with HIV/AIDS.

Preconception health and care policies, strategies and guidelines in the UK and Ireland: a scoping review.

BACKGROUND: Preconception health has the potential to improve parental, pregnancy and infant outcomes. This scoping review aims to (1) provide an overview of the strategies, policies, guidelines, frameworks, and recommendations available in the UK and Ireland that address preconception health and care, identifying common approaches and health-influencing factors that are targeted; and (2) conduct an audit to explore the awareness and use of resources found in the scoping review amongst healthcare professionals, to validate and contextualise findings relevant to Northern Ireland. METHODS: Grey literature resources were identified through Google Advanced Search, NICE, OpenAire, ProQuest and relevant public health and government websites. Resources were included if published, reviewed, or updated between January 2011 and May 2022. Data were extracted into Excel and coded using NVivo. The review design included the involvement of the "Healthy Reproductive Years" Patient and Public Involvement and Engagement advisory panel. RESULTS: The searches identified 273 resources, and a subsequent audit with healthcare professionals in Northern Ireland revealed five additional preconception health-related resources. A wide range of resource types were identified, and preconception health was often not the only focus of the resources reviewed. Resources proposed approaches to improve preconception health and care, such as the need for improved awareness and access to care, preconceptual counselling, multidisciplinary collaborations, and the adoption of a life-course approach. Many behavioural (e.g., folic acid intake, smoking), biomedical (e.g., mental and physical health conditions), and environmental and social (e.g., deprivation) factors were identified and addressed in the resources reviewed. In particular, pre-existing physical health conditions were frequently mentioned, with fewer resources addressing psychological factors and mental health. Overall, there was a greater focus on women's, rather than men's, behaviours. CONCLUSIONS: This scoping review synthesised existing resources available in the UK and Ireland to identify a wide range of common approaches and factors that influence preconception health and care. Efforts are needed to implement the identified resources (e.g., strategies, guidelines) to support people of childbearing age to access preconception care and optimise their preconception health.

The cost of inaction on preconception health in Nigeria: An economic impact analysis.

A growing body of evidence has shown the effects of poor preconception health on adverse pregnancy outcomes and, subsequently, maternal and child morbidity and mortality. However, the cost of poor preconception health remains relatively unexplored. Using the case of Nigeria, this study provides the first estimate of the disease and economic burden of poor preconception health at a country level. Using data from international databases and the scientific literature, the study used a cost-of-illness approach to quantify the foregone productivity and direct healthcare costs resulting from six preconception risk factors (adolescent pregnancy, short birth interval, overweight and obesity, intimate partner violence, female genital mutilation, folate deficiency). The results indicate that 6.7% of maternal deaths, 10.9% of perinatal deaths, and 10.5% of late neonatal deaths were attributable to the selected preconception risk factors in 2020. The economic burden of poor preconception health in Nigeria was estimated at US$ 3.3 billion in 2020, of which over 90% was generated by premature mortality. If prevalence rates remain constant, total economic losses could amount to US$ 46.2 billion by 2035. This analysis paves the way for further studies investigating the economic costs and benefits of preconception interventions and policies in low and middle-income countries.

Investigating the relationship between health literacy and preconceptual care components during the first 14 weeks of pregnancy: a cross-sectional study.

BACKGROUND AND AIM: Preconceptual care aiming to improve health is influenced by various factors including health literacy. Considering the importance and necessity of high quality preconceptual care, this study aimed to determine the relationship between health literacy and receiving components of preconceptual care prior to pregnancy. METHODS: This cross-sectional study included 693 participants with pregnancies of less than 14 weeks gestation referred to health centers and gynecologists in Shiraz city, Iran. Multi-stage sampling was done from May 2021 to February 2022 in 18 comprehensive urban health centers and 20 gynecology offices via proportional allocation method. The data collection tool comprised a questionnaire consisting of 3 parts: (1) individual and fertility characteristics, (2) information related to the components of preconceptual care and (3) health literacy for Iranian adults. This was completed by individual participants via the self-reporting method. RESULTS: The majority of participants were between 30 and 34 years old. They also identified as women with a university education and were predominantly unemployed. The mean health literacy of participants was 76.81%. Health literacy obtained the highest mean score in the dimension of 'understanding' and the lowest mean score in the dimension of 'access'. The frequency of preconceptual counseling, folic acid supplement consumption, exercise, blood testing, dental visits, genetic counseling, Pap smear testing and rubella, diphtheria, and hepatitis vaccinations prior to pregnancy was 66.8%, 53.8%, 45.6%, 71.86%, 44.44%, 12%, 53.4%, 10.83%, respectively. Many (> 64%) received preconceptual care at specialist gynecology offices. Results demonstrated that health literacy had a statistically significant relationship with preconceptual care, folic acid consumption, exercise and dental care, (p < 0.001), along with blood testing and Pap smear testing (p < 0.05). CONCLUSION: Overall, our results demonstrate that despite health literacy being optimal, uptakes of some components of preconceptual care are low. As such, it will be important to further raise awareness of the importance of preconceptual care for people prior to pregnancy as a priority in health promotion and education.

Assessment of the effect of pre-conception care on preventing mother-to-child transmission of HIV in Nyeri County.

Introduction: the provision of essential preconception care services for HIV-positive pregnant women is crucial to prevent HIV transmission to infants. This includes pregnancy intention screening services, adequate viral load monitoring and suppression before conception, and necessary nutritional support. In Nyeri County, the prevalence of Mother-to-Child Transmission (MTCT) of HIV is 5.3%, which is higher than the global threshold of 5%. This study aims to evaluate the impact of pre-conception care services in preventing HIV transmission to infants in Nyeri County. The study objectives are to assess the utilization of pre-conception care services among HIV-positive women, specifically focusing on pregnancy intention screening, viral load monitoring and suppression, and access to nutritional assessment services before pregnancy. Additionally, the study aims to investigate the relationship between the provision of pre-conception care services and infant HIV outcomes. Methods: this cross-sectional retrospective descriptive study employed stratified sampling to select eight level 4 and level 5 hospitals in Nyeri County. The target population consisted of HIV-infected women seeking postnatal care in these facilities, with a sample size of 252 women who had HIV-exposed infants under two years old and were receiving post-natal care at the respective hospitals. Sociodemographic characteristics, including age, marital status, and education level, were collected. Data analysis involved both descriptive and inferential statistics. Results: our findings revealed that only 34.2% of HIV-positive women seeking postnatal care had received information or services related to pregnancy intention screening, a crucial aspect of pre-conception care. Almost half (46.4%) of the women who participated in the study had undergone viral load measurements before pregnancy, which is another critical component of preconception care. Additionally, 85.6% of these women had received nutritional services during pregnancy from their healthcare providers. Interestingly, all women who received any pre-conception care services reported that their infants were alive and tested HIV-negative. Conclusion: preconception care is crucial in preventing mother-to-child transmission of HIV. Efforts should be made to ensure that all HIV-infected women planning to conceive have access to preconception care services.

Holistic preconception care: Providing real-time guidance via a mobile app to optimise maternal and child health.

Introduction: Preconception is a critical period to optimise gamete function and early placental development, essential for successful conception and long-term maternal-child health. However, there is a lack of preconception services and consequently, global fertility rates continue to fall and mothers embark on their pregnancy journey in poor health. There is an urgent need to implement a holistic community-level preconception care programme to optimise risk factors for poor fecundability and improve long-term maternal-child health. Method: We reviewed current evidence on fecundability lifestyle risk factors, the efficacy of existing preconception interventions and the use of digital platforms for health optimisation, to create a new digital-based preconception intervention model that will be implemented via an app. We present the theory, content and mode of delivery of this holistic model targeting couples planning for pregnancy. Results: We propose a new model featuring a user-friendly mobile app, which enables couples to self-assess fecundability risks through a personalised risk score that drives a tailored management plan. This tiered management provides anticipatory guidance supported by evidence-based recommen-dations, and promotes ongoing engagement for behavioural optimisation and specialist referrals as required. Based on the health belief model, this new model delivered with a mobile app seeks to shift couples' perceptions about their susceptibility and severity of subfertility, benefits of making a change and barriers to change. Conclusion: Our proposed digital-based intervention model via a mobile app stands to enhance preconcep-tion care by providing personalised risk assessments, real-time feedback and tiered management to optimise preconception reproductive health of couples. This model forms a reference content framework for future preconception care intervention delivery.

Laboratory testing for preconception/prenatal carrier screening: A technical standard of the American College of Medical Genetics and Genomics (ACMG).

Carrier screening has historically assessed a relatively small number of autosomal recessive and X-linked conditions selected based on frequency in a specific subpopulation and association with severe morbidity or mortality. Advances in genomic technologies enable simultaneous screening of individuals for several conditions. The American College of Medical Genetics and Genomics recently published a clinical practice resource that presents a framework when offering screening for autosomal recessive and X-linked conditions during pregnancy and preconception and recommends a tier-based approach when considering the number of conditions to screen for and their frequency within the US population in general. This laboratory technical standard aims to complement the practice resource and to put forth considerations for clinical laboratories and clinicians who offer preconception/prenatal carrier screening.

Preconception Care Interventions for Adolescents and Young Adults to Prevent Adverse Maternal and Child Health Outcomes: Protocol for an Evidence Gap Map.

BACKGROUND: Preconception is the period before a young woman or woman conceives, which draws attention to understanding how her health condition and certain risk factors affect her and her baby's health once she becomes pregnant. Adolescence and youth represent a life-course continuum between childhood and adulthood, in which the prepregnancy phase lacks sufficient research. OBJECTIVE: The aim of the study is to identify, map, and describe existing empirical evidence on preconception interventions that enhance health outcomes for adolescents, young adults, and their offspring. METHODS: We will conduct an evidence gap map (EGM) activity following the Campbell guidelines by populating searches identified from electronic databases such as MEDLINE, Embase, CINAHL, and Cochrane Library. We will include interventional studies and reviews of interventional studies that report the impact of preconception interventions for adolescents and young adults (aged 10 to 25 years) on adverse maternal, perinatal, and child health outcomes. All studies will undergo title or abstract and full-text screening on Covidence software (Veritas Health Innovation). All included studies will be coded using the Evidence for Policy and Practice Information (EPPI) Reviewer software (EPPI Centre, UCL Social Research Institute, University College London). Cochrane Risk of Bias tool 2.0 and Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2) tool will be used to assess the quality of the included trials and reviews. A 2D graphical EGM will be developed using the EPPI Mapper software (version 2.2.4; EPPI Centre, UCL Social Research Institute, University College London). RESULTS: This EGM exercise began in July 2023. Through electronic search, 131,031 publications were identified after deduplication, and after the full-text screening, 18 studies (124 papers) were included in the review. We plan to submit the paper to a peer-reviewed journal once it is finalized, with an expected completion date in May 2024. CONCLUSIONS: This study will facilitate the prioritization of future research and allocation of funding while also suggesting interventions that may improve maternal, perinatal, and child health outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56052.

[Type 2 diabetes and pregnancy: management from preconception to the postpartum]. / Diabète de type 2 et grossesse : prise en charge de la préconception au postpartum.

With the increasing prevalence of diabetes, we are more frequently confronted to treat pregnant women with pre-existing type 2 diabetes. Thereby, we need to take several factors into account such as glycemic control before and during pregnancy, comorbidities such as overweight/obesity and hypertension, as well as existing complications and the need for changes in diabetes treatment. Pregnancy leads to increased insulin requirements, particularly from the second trimester onwards. In this context, a healthy lifestyle and control of weight gain are also necessary. This article provides an overview of the interdisciplinary management of type 2 diabetes before and during pregnancy and in the postpartum period.

En raison de l'augmentation de la prévalence du diabète, nous sommes de plus en plus confrontés à des femmes enceintes avec un diabète de type 2 préexistant. Les défis sont le contrôle glycémique avant et durant la grossesse, les comorbidités telles que le surpoids/l'obésité et l'hypertension artérielle ainsi que les complications existantes et le besoin de changement de traitement du diabète. La grossesse entraîne une forte augmentation des besoins en insuline, en particulier à partir du deuxième trimestre. Dans ce contexte, une bonne hygiène de vie et le contrôle de la prise de poids sont également nécessaires. Cet article offre une vue d'ensemble de la prise en charge interdisciplinaire du diabète de type 2 pendant la grossesse, y compris les soins prénataux et la phase péripartum.

Association between preconception care and family planning and previous adverse birth outcomes in Ethiopia: systematic review and meta-analysis.

OBJECTIVES: Inconsistent findings on the associations of preconception care with the utilisation of family planning and previous adverse birth outcomes have not been systematically reviewed in Ethiopia. Thus, this review aims to estimate the pooled association of preconception care with the utilisation of family planning and previous adverse birth outcomes in Ethiopia. DESIGN: Systematic review and meta-analysis of observational studies. DATA SOURCES: MEDLINE Complete, CINAHL Complete, Scopus and Global Health were searched from inception to 28 July 2023. ELIGIBILITY CRITERIA: Observational studies that reported preconception care as an outcome variable and the use of family planning before pregnancy or previous adverse birth outcomes as exposure variables were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently conducted study screening, data extraction and quality assessment. A fixed-effects model was used to determine the pooled association of preconception care with the utilisation of family planning and previous adverse birth outcomes. RESULTS: Eight studies involving a total of 3829 participants were included in the review. The pooled meta-analysis found that women with a history of family planning use had a higher likelihood of using preconception care (OR 2.09, 95% CI 1.74 to 2.52) than those women who did not use family planning before their current pregnancy. Likewise, the pooled meta-analysis found that women with prior adverse birth outcomes had a higher chance of using preconception care (OR 3.38, 95% CI 1.06 to 10.74) than women with no history of prior adverse birth outcomes. CONCLUSION: This review indicated that utilisation of preconception care had a positive association with previous use of family planning and prior adverse birth outcomes. Thus, policymakers and other relevant stakeholders should strengthen the integration of preconception care with family planning and other maternal healthcare services. PROSPERO REGISTRATION NUMBER: CRD42023443855.

Influence of paternal preconception health on pregnancy, intrapartum, postpartum and early childhood outcomes: protocol for a parallel scoping review.

INTRODUCTION: Preconception care is the provision of behavioural, social or biomedical interventions to women and couples prior to conception. To date, preconception research has primarily focused on maternal health, despite the male partner's contribution before birth to both short-term and long-term child outcomes. The objectives of the reviews are: (1) to identify, consolidate and analyse the literature on paternal preconception health on pregnancy and intrapartum outcomes, and (2) to identify, consolidate and analyse the literature on paternal preconception health on postpartum and early childhood outcomes. METHODS AND ANALYSIS: A scoping review will be conducted following the Joanna Briggs Institute methodology. MEDLINE, PsycINFO, Embase, Scopus and CINAHL databases will be searched for articles published in English. Two independent reviewers will screen titles and abstracts and then full text using Covidence, with conflicts resolved by a third reviewer. Data extraction will be performed using Covidence. ETHICS AND DISSEMINATION: Ethics approval is not required for this scoping review. Results will be published in peer-reviewed journals as well as presented at relevant national and international conferences and meetings.

Zinc Supplementation Initiated Prior to or During Pregnancy Modestly Impacted Maternal Status and High Prevalence of Hypozincemia in Pregnancy and Lactation: The Women First Preconception Maternal Nutrition Trial.

BACKGROUND: Data regarding effects of small-quantity-lipid-based nutrient supplements (SQ-LNS) on maternal serum zinc concentrations (SZC) in pregnancy and lactation are limited. OBJECTIVES: The objectives of this study were to evaluate the effect of preconception compared with prenatal zinc supplementation (compared with control) on maternal SZC and hypozincemia during pregnancy and early lactation in women in low-resource settings, and assess associations with birth anthropometry. METHODS: From ∼100 women/arm at each of 3 sites (Guatemala, India, and Pakistan) of the Women First Preconception Maternal Nutrition trial, we compared SZC at 12- and 34-wk gestation (n = 651 and 838, respectively) and 3-mo postpartum (n = 742) in women randomly assigned to daily SQ-LNS containing 15 mg zinc from ≥3 mo before conception (preconception, arm 1), from ∼12 wk gestation through delivery (early pregnancy, arm 2) or not at all (control, arm 3). Birth anthropometry was examined for newborns with ultrasound-determined gestational age. Statistical analyses were performed separately for each time point. RESULTS: At 12-wk gestation and 3-mo postpartum, no statistical differences in mean SZC were observed among arms. At 34-wk, mean SZC for arms 1 and 2 were significantly higher than for arm 3 (50.3, 50.8, 47.8 µg/dL, respectively; P = 0.005). Results were not impacted by correction for inflammation or albumin concentrations. Prevalence of hypozincemia at 12-wk (<56 µg/dL) was 23% in Guatemala, 26% in India, and 65% in Pakistan; at 34 wk (<50 µg/dL), 36% in Guatemala, 48% in India, and 74% in Pakistan; and at 3-mo postpartum (<66 µg/dL) 79% in Guatemala, 91% in India, and 92% in Pakistan. Maternal hypozincemia at 34-wk was associated with lower birth length-for-age Z-scores (all sites P = 0.013, Pakistan P = 0.008) and weight-for-age Z-scores (all sites P = 0.017, Pakistan P = 0.022). CONCLUSIONS: Despite daily zinc supplementation for ≥7 mo, high rates of maternal hypozincemia were observed. The association of hypozincemia with impaired fetal growth suggests widespread zinc deficiency in these settings. This trial is registered at clinicaltrials.gov as #NCT01883193.

Skin disorders in women with poor obstetric history: MTHFR polymorphisms and importance of preconceptional counseling.

OBJECTIVES: This study focused on the link between skin disorders and Methylenetetrahydrofolate reductase (MTHFR) polymorphisms. METHODS: Study cases were taken from a pre-conceptional care program where patients with poor obstetric history were evaluated in terms of systemic disorders including skin diseases. This retrospective cohort (n = 472) consisted of 110 (23.3%) and 362 (76.7%) women with or without skin disorders, respectively. For ease of analysis, the history of skin diseases was classified into seven categories: (1) acne/rosacea/other acneiform disorders; (2) fungal disease; (3) pruritis/xerosis; (4) psoriasis vulgaris; (5) acrochordons and other benign skin growths; (6) urticaria/dermatitis; and (7) viral diseases. RESULTS: In this retrospective cohort of 472 women, we explored the impact of MTHFR A1298C and C677T polymorphisms on skin disorders. Despite similar allelic frequencies, our findings revealed a statistically significant association between the presence of MTHFR polymorphisms and skin disorders (p = .027). Subgroup analysis indicated significantly higher rates of MTHFR polymorphisms in patients with psoriasis vulgaris (p = .033) and acrochordons (p = .030), highlighting their potential relevance in specific skin disorder subtypes. CONCLUSIONS: The increased prevalence of psoriasis and acrochordons among women with MTHFR deficiency underscores the complex relationship between genetic factors and dermatological health. Our findings emphasized the critical role of MTHFR polymorphisms not only in poor obstetric history but also as significant contributors to skin disorders. This dual association highlights the importance of comprehensive preconception counseling, especially customized for women affected by skin disorders.

Feasibility and effectiveness of preconception check-ups at workplaces in Japan.

OBJECTIVES: Despite the recent increase in infertility and perinatal complications, preconception care is not commonly available in Japan. Working women are considered to have the greatest need for preconception care, as increasingly they marry and have children later in life. This study aimed to assess the feasibility and effectiveness of preconception check-ups in the workplace. METHODS: We provided 51 female employees aged 18-39 years with free preconception check-ups, including additional blood tests and an online medical questionnaire, during mandatory health check-ups at their workplace. A doctor provided online counseling based on the check-up results. We assessed fertility knowledge using the Cardiff Fertility Knowledge Scale (CFKS-J) and childbearing desire pre- and postintervention. RESULTS: Preconception check-ups revealed various potential risk factors for future pregnancies, including underweight (12%), obesity (20%), Chlamydia trachomatis IgG antibody positivity (22%), low rubella IgG antibody levels (47%), iron deficiency (12%), and 25-hydroxyvitamin D levels <30 ng/mL (98%). Postintervention, the participants reported high satisfaction with the check-ups and significantly advanced their reproductive plans (P = .008). Furthermore, 95% of the participants indicated an intention to seek medical attention or make lifestyle changes. The postintervention CFKS-J score (mean [SD]) was higher than the preintervention score (71.7 [19.3] vs 63.0 [22.0]; P = .006). CONCLUSIONS: We developed a preconception check-up package that can be integrated into workplace health examinations, complemented by tailored counseling. This novel check-up package is a feasible and effective approach for improving preconception health and fertility awareness.

Preconception health disparities among reproductive-aged women with and without disabilities in Canada.

OBJECTIVES: Preconception health (PCH), which describes the health status of reproductive-aged individuals, can influence reproductive, maternal, and fetal/neonatal outcomes. PCH disparities have been observed in certain populations, prompting the development of tailored resources. Our objective was to compare the PCH characteristics of women with and without disabilities. METHODS: We undertook a secondary analysis of the 2003-2014 cycles of the Canadian Community Health Survey (CCHS), which included n = 115,295 women aged 15-49 years. Among these, we also examined a sub-sample of n = 12,495 women with a subsequent obstetrical delivery identified in a linkage of the CCHS with the Discharge Abstract Database (DAD, 2003-2017). The outcomes were 8 PCH indicators. We used modified Poisson regression to estimate adjusted prevalence ratios (aPRs) for each PCH indicator, comparing women with and without disabilities, and multinomial logistic regression to calculate adjusted odds ratios for 1, 2, and ≥ 3 PCH indicators (vs. 0). Analyses were adjusted for baseline demographics. RESULTS: Reproductive-aged women with disabilities had significantly increased aPRs of smoking (1.42 [95% CI:1.37-1.48]), obesity (1.57 [1.48-1.65]), and self-reported fair/poor physical (5.56 [5.09-6.07]) and mental health (4.07 [3.71-4.47]), compared to those without disabilities. They were also more likely to have ≥ 3, 2, and 1 PCH indicators (vs. 0). Findings were similar in the sub-sample with a subsequent obstetrical delivery. CONCLUSION: Canadian reproductive-aged women with disabilities experience important PCH disparities. Further research is needed to inform tailored education and resources to support PCH in individuals with disabilities, in combination with policies to address structural barriers to PCH.

RéSUMé: OBJECTIFS: La santé préconceptionnelle (SPC), qui décrit l'état de santé des personnes en âge de procréer, peut influencer les résultats reproductifs, maternels et fœtaux/néonataux. Des disparités en matière de SPC ont été observées dans certaines populations, ce qui a conduit à la mise en place de ressources adaptées. Notre objectif était de comparer les caractéristiques de la SPC des femmes handicapées et non handicapées. MéTHODES: Nous avons entrepris une analyse secondaire des cycles 2003­2014 de l'Enquête sur la santé dans les collectivités canadiennes (ESCC), qui comprenait n = 115 295 femmes âgées de 15 à 49 ans. Parmi celles-ci, nous avons également examiné un sous-échantillon de n = 12 495 femmes ayant subi un accouchement obstétrique subséquent, identifiées dans le cadre d'un couplage de l'ESCC avec la Base de données sur les congés des patients (BDCP, 2003‒2017). Les résultats étaient 8 indicateurs de la SPC. Nous avons utilisé la régression de Poisson modifiée pour estimer les ratios de prévalence ajustés (aPR) pour chaque indicateur SPC, en comparant les femmes avec et sans handicap, et la régression logistique multinomiale pour calculer les rapports de cotes ajustés pour 1, 2 et ≥ 3 indicateurs SPC (par rapport à 0). Les analyses ont été ajustées en fonction des données démographiques de base. RéSULTATS: Les femmes handicapées en âge de procréer présentaient des aPR significativement plus élevés de tabagisme (1,42 [IC 95%: 1,37 à 1,48]), d'obésité (1,57 [1,48 à 1,65]) et de santé physique (5,56 [5,09 à 6,07]) et mentale (4,07 [3,71 à 4,47]) auto déclarée passable/mauvaise, par rapport à celles qui n'avaient pas de handicap. Elles étaient également plus susceptibles d'avoir ≥ 3, 2 et 1 indicateurs SPC (par rapport à 0). Les résultats étaient similaires dans le sous-échantillon avec un accouchement obstétrical ultérieur. CONCLUSION: Les femmes handicapées en âge de procréer au Canada connaissent d'importantes disparités en matière de SPC. D'autres recherches sont nécessaires pour fournir une éducation et des ressources adaptées afin de soutenir la SPC chez les personnes handicapées, en combinaison avec des politiques visant à éliminer les obstacles structurels à la SPC.

Pregnancy planning, prevention, and risk evaluation clinics: rethinking the traditional preconception consult.

The preconception consultation has traditionally centered pregnancy as desired and preordained. Separating preconception and contraceptive visits burdens patients and further fragments reproductive healthcare. We argue that the creation of a combined preconception and complex contraception clinic for individuals with significant medical and obstetrical comorbidities is one approach to promoting reproductive autonomy. Pregnancy planning, prevention, and risk evaluation clinics are designed to review pregnancy-related risks in the setting of patients' medical and obstetrical comorbidities, recommend strategies to reduce risks, and, if desired, provide contraceptive methods. Consultations for pregnancy risk evaluation and pregnancy prevention should not be considered mutually exclusive. Combining these visits is crucial for obstetrically and/or medically complex patients. Rethinking the traditional preconception consultation is a change in healthcare delivery that centers comprehensive reproductive healthcare.

Indian Academy of Pediatrics Consensus Guidelines on Preconception Care.

JUSTIFICATION: The preconception period is the earliest window of opportunity to ensure optimal human development.  Pregnancy and childbirth outcomes can be improved by interventions offered to support the health and well-being of women and couples prior to conception. Thus, preconception care is essential in preparing for the first thousand days of life. Adolescence, the stage of life that typically comes before the preconception stage, is characterized by various high-risk behaviors like substance abuse, sexual experimentation, injuries, obesity, and mental health issues which can adversely affect their health in adult life. Thus, a Consensus Guideline for pediatricians on providing preconception care to adolescents and young adults can go a long way in making the generations to come, healthier and more productive. OBJECTIVES: The purpose of these recommendations is to formulate an evidence-based Consensus Statement that can serve as a guidance for medical professionals to provide preconception care for young adults and adolescents. INTENDED USERS: All obstetric, pediatric, and adolescent health care providers. TARGET POPULATION: Adolescents and young adults. PROCESS: A large proportion of adolescents seek care from pediatricians and there is a lack of Consensus Guidelines on preconception care. Therefore, the Indian Academy of Pediatrics called an online National Consultative Meeting on April 03, 2023, under the chairmanship of Dr MKC Nair and the National Convenor Dr Himabindu Singh. A group of pediatricians with wide experience and expertise in adolescent health care were assigned the task of formulating evidence-based guidelines on preconception care. The group conducted a comprehensive review of existing evidence by searching resources including PubMed and Cochrane databases. Subsequently, a physical meeting was held at Amritsar on October 07, 2023 during which the consensus was reached through discussions and voting. The level of evidence (LoE) of each recommendation was graded as per the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011. RECOMMENDATIONS: Every woman planning a pregnancy needs to attain and maintain a eumetabolic state. Prospective couples need to be counselled on the importance of a healthy lifestyle including a nutritious diet, avoidance of substance abuse, and timely screening for genetic disorders. Screening for and management of sexually transmitted diseases in males and females, appropriate vaccination and addressing mental health concerns are also recommended.

Stimulating Preconception Care Uptake by Women With a Vulnerable Health Status Through a Mobile Health App (Pregnant Faster): Pilot Feasibility Study.

BACKGROUND: A low socioeconomic status is associated with a vulnerable health status (VHS) through the accumulation of health-related risk factors, such as poor lifestyle behaviors (eg, inadequate nutrition, chronic stress, and impaired health literacy). For pregnant women, a VHS translates into a high incidence of adverse pregnancy outcomes and therefore pregnancy-related inequity. We hypothesize that stimulating adequate pregnancy preparation, targeting lifestyle behaviors and preconception care (PCC) uptake, can reduce these inequities and improve the pregnancy outcomes of women with a VHS. A nudge is a behavioral intervention aimed at making healthy choices easier and more attractive and may therefore be a feasible way to stimulate engagement in pregnancy preparation and PCC uptake, especially in women with a VHS. To support adequate pregnancy preparation, we designed a mobile health (mHealth) app, Pregnant Faster, that fits the preferences of women with a VHS and uses nudging to encourage PCC consultation visits and engagement in education on healthy lifestyle behaviors. OBJECTIVE: This study aimed to test the feasibility of Pregnant Faster by determining usability and user satisfaction, the number of visited PCC consultations, and the course of practical study conduction. METHODS: Women aged 18-45 years, with low-to-intermediate educational attainment, who were trying to become pregnant within 12 months were included in this open cohort. Recruitment took place through social media, health care professionals, and distribution of flyers and posters from September 2021 until June 2022. Participants used Pregnant Faster daily for 4 weeks, earning coins by reading blogs on pregnancy preparation, filling out a daily questionnaire on healthy lifestyle choices, and registering for a PCC consultation with a midwife. Earned coins could be spent on rewards, such as fruit, mascara, and baby products. Evaluation took place through the mHealth App Usability Questionnaire (MAUQ), an additional interview or questionnaire, and assessment of overall study conduction. RESULTS: Due to limited inclusions, the inclusion criterion "living in a deprived neighborhood" was dropped. This resulted in the inclusion of 47 women, of whom 39 (83%) completed the intervention. In total, 16 (41%) of 39 participants visited a PCC consultation, with their main motivation being obtaining personalized information. The majority of participants agreed with 16 (88.9%) of 18 statements of the MAUQ, indicating high user satisfaction. The mean rating was 7.7 (SD 1.0) out of 10. Points of improvement included recruitment of the target group, simplification of the log-in system, and automation of manual tasks. CONCLUSIONS: Nudging women through Pregnant Faster to stimulate pregnancy preparation and PCC uptake has proven feasible, but the inclusion criteria must be revised. A substantial number of PCC consultations were conducted, and this study will therefore be continued with an open cohort of 400 women, aiming to establish the (cost-)effectiveness of an updated version, named Pregnant Faster 2. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/45293.

Factors associated with clinical nurses' preconception health behavior in Korea: a cross-sectional survey.

PURPOSE: Nurses have been reported to be at an increased risk for miscarriage and preterm labor. However, there is limited knowledge regarding nurses' preconception health behaviors. Therefore, this study aimed to identify factors influencing these behaviors. METHODS: One hundred sixty nurses, who were planning their first pregnancy within the upcoming year, participated in an online survey from August 11 to October 31, 2021. Data on preconception health behavior, perceived health status, pregnancy anxiety, nursing practice environment, and social support were analyzed using the t-test, Pearson correlation coefficients, and multiple regression analysis. RESULTS: Age (р=.024), educational level (р=.010), marital status (р=.003), work experience (р=.003), satisfaction with the work department (р<.001), smoking status (р=. 039), and previous health problems related to pregnancy outcomes (р=.004) were significantly associated with nurses' preconception health behaviors. Furthermore, perceived health status (р<.001), pregnancy anxiety (р=.011), nursing practice environment (р=.003), and social support (р<.001) showed significant correlations with preconception health behaviors. Social support (ß=. 28, р=.001), satisfaction with the work department (ß=.23, р=.032), marital status (ß=.22, р=.002), and perceived health status (ß=.23, р=.002) were confirmed as factors associated with preconception health behaviors. These factors explained 40.9% of the variance in preconception health behaviors (F=6.64, р<.001). CONCLUSION: Clinical nurses' preconception health behaviors were influenced by social support, perceived health status, satisfaction with the work department, and marital status. Interventions to improve clinical nurses' preconception health behaviors should target social support and perceived health status. A preconception health behavior education program considering clinical nurses' marital status and satisfaction with the workplace can also be implemented.