Validation of an internet questionnaire for risk assessment in preconception care.

AIM: Validation of a self-administered Internet questionnaire for preconception risk assessment. METHODS: Women with an appointment at the outpatient clinics for preconception care or fertility at the Erasmus Medical Center Rotterdam were requested to fill out the online questionnaire prior to attendance. Subsequently, the items of the questionnaire were verified by history taking during the first or next appointment. Agreement between the 2 screening methods (Internet vs. history taking) was calculated using Kappa statistic. RESULTS: Most lifestyle variables, including smoking, alcohol, and dietary items, showed a good to high level of agreement when compared to the interview. Most medical history and obstetric history items also showed a good to high level of agreement. The use of over-the-counter drugs revealed a poor level of agreement (Kappa = 0.21). The items pertaining to women's family history showed a reasonable level of agreement; however, the partner's family history was unreliable and should be checked at the interview. CONCLUSION: The online questionnaire www.zwangerwijzer.nl is a useful tool for the identification of a number of potential risk factors in the preconception care setting and was found to be a an efficient and clear screening instrument by the majority of women. However, additional history taking by trained professionals is necessary to verify several items and to further explore identified risk factors for an adverse pregnancy outcome.

[Preconception care: an essential part of the care for mother and child]. / Preconceptiezorg: een onlosmakelijk onderdeel van de zorg voor moeder en kind.

Despite the modernisation of antenatal care in the Western world, the incidence of a number of adverse pregnancy outcomes, such as birth defects, low birth weight and preterm birth, has not decreased over the past few decades. Since its inception at the beginning of the last century, the concept of antenatal care has not changed. The first antenatal visit typically starts at the end of the first trimester. By this stage of pregnancy organogenesis and early placentation have been completed making it almost impossible to reverse any unfavourable exposure on the foetus. Preconception care addresses risk factors that are present prior to pregnancy. By either eliminating or altering risk factors during this period, pregnancy outcome may improve. The goal of preconception care is to optimise the quality of foetal, newborn and infant life through primary prevention. With regard to genetic conditions the aims of preconception care are more nuanced. The principle components of preconception care include (a) risk assessment, (b) information and advice on health promotion, (c) specific counselling and (d) intervention. The effectiveness of preconception care has been demonstrated in women who are at increased risk of adverse pregnancy outcome. In women at low-risk, however, the usefulness of preconception care has yet to be established. The concept of preconception care is relatively simple, logical and promises much. For preconception care to be a success, it is crucial to make this form of preventive care available to all prospective parents. The Internet could play a major part in the dissemination of information that is relevant to a successful outcome of pregnancy.