Pilot Randomized Controlled Trial of an Interconception Intervention Provided by Public Health Nurses.

OBJECTIVES: Preconception health impacts perinatal outcomes, but the difficulty in engaging reproductive-aged individuals in health promotion activities is a barrier to effective implementation of preconception interventions. Since most women have more than one pregnancy and many risk factors repeat across pregnancies, the time between pregnancies-the interconception period-may be an opportune time to improve health. Our objective was to examine the feasibility and acceptability of an interconception intervention delivered by public health nurses. METHODS: We conducted a pilot randomized controlled trial in three small urban and rural public health units in Ontario, Canada, in 2017-2018 among women who were ≥ 18 years of age and between 2 and 12 months postpartum after a first birth. Women randomly allocated to the intervention group received a preconception risk assessment, tailored health education, and referral for clinical follow-up as needed, while those in the control group received standard care. Primary outcomes were intervention feasibility, adherence, and acceptability. RESULTS: Of 66 eligible women, 61% agreed to participate and were randomized to the intervention (n = 16) or control (n = 24) groups. The follow-up rate was 78% at 1 month and 71% at 3 months. Most women (83%) were satisfied with the intervention, including the number and length of sessions and content of recommendations. CONCLUSIONS FOR PRACTICE: Results demonstrate the potential feasibility and acceptability of an interconception intervention delivered in a public health setting. The short- and long-term impacts of the intervention on knowledge, behavior, and health should be tested in a larger sample.

Measurement of Preconception Health Knowledge: A Systematic Review.

OBJECTIVE: Preconception health is an important determinant of maternal, paternal, and infant outcomes. Knowledge is commonly used to evaluate the effectiveness of interventions to promote preconception health. Our objective was to examine how preconception health knowledge has been measured in the existing literature and to identify measurement gaps, biases, and logistical challenges. DATA SOURCE: MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Database of Systematic Reviews, and gray literature were searched from database inception to January 2018. STUDY INCLUSION AND EXCLUSION CRITERIA: Studies were included if they measured preconception or interconception health knowledge and included reproductive-aged women and/or men. DATA EXTRACTION: Two independent reviewers completed data extraction and quality appraisal using standardized instruments. DATA SYNTHESIS: Due to measurement heterogeneity, a narrative synthesis was performed. RESULTS: The review included 34 studies from 14 countries with data collected in 2000 to 2017. Most studies used cross-sectional (n = 24) or prepost designs (n = 7). Studies primarily sampled women (n = 25), and methodological quality was rated largely as weak (n = 18) or moderate (n = 14). Preconception health knowledge tools focused on fertility, folic acid, and alcohol, with few questions pertaining to men's health, mental health, or the interconception period. Only 19 (56%) studies reported psychometric properties of their knowledge tools. CONCLUSIONS: This systematic review revealed the need for a valid and reliable knowledge tool that reflects a holistic conceptualization of preconception health.