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Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2017 Jul 1;108(4):388–397. doi: 10.17269/CJPH.108.6029

Preconception health interventions delivered in public health and community settings: A systematic review

Hilary K Brown 19,29,39, Melissa Mueller 49,59, Sarah Edwards 29,49, Catriona Mill 59,69, Joanne Enders 69,79, Lisa Graves 89, Deanna Telner 99, Cindy-Lee Dennis 39,109,119,129
PMCID: PMC6972093  PMID: 29120310

Abstract

OBJECTIVES: The objective of this systematic review was to assess the effects of preconception health interventions, delivered to individuals of reproductive age in public health and community settings, on reproductive, maternal, and child health outcomes.

METHODS: A search of Ovid MEDLINE, CINAHL, EMBASE, PsychINFO, Scopus, Gender Studies Database, and SocINDEX from July 1999 through July 2016 was performed. We included studies that reported original data, used an interventional study design, included reproductive-aged women or men, were written in English, and were published in peer-reviewed journals. Two reviewers independently used standardized instruments for data extraction and quality assessment. A narrative synthesis was performed.

SYNTHESIS: Twelve studies met the inclusion criteria. These studies included randomized controlled trials and quasi-experimental, pre-post, and time- series designs. Most studies were conducted in the United States; all but one study included only women. Interventions were mainly educational initiatives focused on nutrition, immunization, and lifestyle behaviours and were delivered in a single contact. The studies reported positive effects on health knowledge (n = 9), behaviour change (n = 4), and health outcomes (n = 1). Study quality was weak (n = 11) or moderate (n = 1), with limitations related to selection bias, blinding, data collection methods, and participant attrition.

CONCLUSION: To develop a comprehensive, standardized approach to preconception health promotion and care in Canada, there is a clear need for high- quality research evaluating the effectiveness of preconception health interventions. Studies should use a health equity lens that includes all individuals of reproductive age and addresses the broad determinants of preconception health.

Key words: Health promotion, preconception care, public health

Mots Clés: Promotion de la santé, prise en charge préconceptionnelle, santé publique

Footnotes

Conflicts of Interest: None to declare.

Acknowledgements: The authors thank Jorden Smith-Habib for performing the database searches and Natalie Bourdages, Shelley Charbonneau, Josée Dion-St. Pierre and Kimberley Marshall for reviewing previous versions of the manuscript.

References

  • 1.World Health Organization. Pre-Conception Care: Maximizing the Gains for Maternal and Child Health. Geneva, Switzerland: World Health Organization; 2013. [Google Scholar]
  • 2.Alberta Perinatal Health Program. 2014 Preconception Health Framework. Edmonton, AB: Alberta Perinatal Health Program; 2007. [Google Scholar]
  • 3.World Health Organization. Meeting to Develop a Global Consensus on Preconception Care to Reduce Maternal and Childhood Mortality and Morbidity. Geneva, Switzerland: World Health Organization; 2012. [Google Scholar]
  • 4.Atrash HK, Johnson K, Adams MM, Cordero JF, Howse J. Preconception care for improving perinatal outcomes: The time to act. Matern Child Health J. 2006;10:S3–11. doi: 10.1007/s10995-006-0100-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Centers for Disease ControlPrevention. Preconception Health and Health Care: Information for Health Professionals. Washington, DC: Centers for Disease Control; 2012. [Google Scholar]
  • 6.Chandranipapongse W, Koren G. Preconception counseling for preventable risks. Can Fam Physician. 2013;59:737–39. [PMC free article] [PubMed] [Google Scholar]
  • 7.Grosse SD, Sotnikov SV, Leatherman S, Curtis M. The business case for preconception care: Methods and issues. Matern Child Health J. 2006;10:S93–99. doi: 10.1007/s10995-006-0101-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Allen VM, Armson BA, Wilson RD, Johnson JA, Blight C, Gagnon A, et al. Teratogenicity associated with pre-existing and gestational diabetes. J Obstet Gynaecol Can. 2007;29:927–44. doi: 10.1016/S1701-2163(16)32653-6. [DOI] [PubMed] [Google Scholar]
  • 9.Yi Y, Lindemann M, Colligs A, Snowball C. Economic burden of neural tube defects and impact of prevention with folic acid: A literature review. Eur J Pediatr. 2011;170:1391–400. doi: 10.1007/s00431-011-1492-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Herman WH, Janz NK, Becker MP, Charron-Prochownik D. Diabetes and pregnancy: Preconception care, pregnancy outcomes, resource utilization and costs. Obstet Gynecol Surv. 1999;54:489–91. [PubMed] [Google Scholar]
  • 11.Dubois L, Girard M, Tatone-Tokuda F. Determinants of high birth weight by geographic region in Canada. Chronic Dis Can. 2007;28:63–70. [PubMed] [Google Scholar]
  • 12.Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:980–1004. doi: 10.1016/S0140-6736(14)60696-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Finer LB, Zolna MR. Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception. 2011;84:478–85. doi: 10.1016/j.contraception.2011.07.013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Moos MK, Dunlop AL, Jack BW, Nelson L, Coonrod DV, Long R, et al. Healthier women, healthier reproductive outcomes: Recommendations for the routine care of all women of reproductive age. Am J Obstet Gynecol. 2008;199:S280–89. doi: 10.1016/j.ajog.2008.08.060. [DOI] [PubMed] [Google Scholar]
  • 15.Wise PH. Transforming preconceptional, prenatal, and interconceptional care into a comprehensive commitment to women’s health. Womens Health Issues. 2008;18:S13–18. doi: 10.1016/j.whi.2008.07.014. [DOI] [PubMed] [Google Scholar]
  • 16.Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE. Continuum of care for maternal, newborn, and child health: From slogan to service delivery. Lancet. 2007;370:1358–69. doi: 10.1016/S0140-6736(07)61578-5. [DOI] [PubMed] [Google Scholar]
  • 17.Ontario Ministry of HealthLong-Term Care Healthy Kids Panel. No Time to Wait: The Healthy Kids Strategy. Toronto, ON: Queen’s Printer for Ontario; 2013. [Google Scholar]
  • 18.Ontario Public Health Association. SHIFT: Enhancing the Health of Ontarians: A Call to Action for Preconception Health Promotion & Care. Toronto, ON: Ontario Public Health Association; 2014. [Google Scholar]
  • 19.Ontario Ministry of HealthLong-Term Care. Ontario Public Health Standards 2008. Toronto, ON: Ontario Ministry of Health and Long-Term Care; 2008. [Google Scholar]
  • 20.Hussein N, Kai J, Qureshi N. The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review. Eur J Gen Pract. 2016;22:42–52. doi: 10.3109/13814788.2015.1099039. [DOI] [PubMed] [Google Scholar]
  • 21.Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Korenbrot CC, Steinberg A, Bender C, Newberry S. Preconception care: A systematic review. Matern Child Health J. 2002;6(2):75–88. doi: 10.1023/a:1015460106832. [DOI] [PubMed] [Google Scholar]
  • 23.Armijo-Olivo S, Stiles CR, Hagen NA, Biondo PD, Cummings GG. Assessment of study quality for systematic reviews: A comparison of the cochrane collaboration risk of bias tool and the effective public health practice project quality assessment tool: Methodological research. J Eval Clin Pract. 2012;18(1):12–18. doi: 10.1111/j.1365-2753.2010.01516.x. [DOI] [PubMed] [Google Scholar]
  • 24.BMC Med Inform Decis Mak. 2014. [DOI] [PMC free article] [PubMed]
  • 25.Bimla S E, Sobota M, Gonzales R, Gerbert B. Computerized counseling for folate knowledge and use: A randomized controlled trial. Am J Prev Med. 2008;35(6):568–71. doi: 10.1016/j.amepre.2008.06.034. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, et al. “Folate before pregnancy”: The impact on women and health professionals of a population-based health promotion campaign in South Australia. Med J Aust. 2001;174(12):631–36. doi: 10.5694/j.1326-5377.2001.tb143471.x. [DOI] [PubMed] [Google Scholar]
  • 27.DeJoy SB. Pilot test of a preconception and midwifery care promotion program for college women. J Midwifery Womens Health. 2014;59(5):523–27. doi: 10.1111/jmwh.12106. [DOI] [PubMed] [Google Scholar]
  • 28.Hillemeier MM, Downs DS, Feinberg ME, Weisman CS, Chuang CH, Parrott R, et al. Improving women’s preconceptional health: Findings from a randomized trial of the strong healthy women intervention in the Central Pennsylvania women’s health study. Womens Health Issues. 2008;18(Suppl6):S87–96. doi: 10.1016/j.whi.2008.07.008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Hussaini KS, Hamm E, Means T. Using community-based participatory mixed methods research to understand preconception health in African American communities of Arizona. Matern Child Health J. 2013;17(10):1862–71. doi: 10.1007/s10995-012-1206-5. [DOI] [PubMed] [Google Scholar]
  • 30.King KW, Freimuth V, Lee M, Johnson-Turbes CA. The effectiveness of bundled health messages on recall. Am J Health Promot. 2013;27(Suppl3):S28–35. doi: 10.4278/ajhp.120113-QUAN-27. [DOI] [PubMed] [Google Scholar]
  • 31.Mackert M, Kim E, Guadagmo M, Donovan-Kicken E. Using Twitter for prenatal health promotion: Encouraging a multivitamin habit among college-aged females. Stud Health Technol Inform. 2012;182:93–103. [PubMed] [Google Scholar]
  • 32.Milan JE, White AA. Impact of a stage-tailored, web-based intervention on folic acid-containing multivitamin use by college women. Am J Health Promot. 2010;24(6):388–95. doi: 10.4278/ajhp.071231143. [DOI] [PubMed] [Google Scholar]
  • 33.Wade GH, Herrman J, McBeth-Snyder L. A preconception care program for women in a college setting. MCN Am J Matern Child Nurs. 2012;37(3):164–70. doi: 10.1097/NMC.0b013e31824b59c7. [DOI] [PubMed] [Google Scholar]
  • 34.Watson M, Watson L, Bell R, Halliday J. The increasing knowledge of the role of periconceptional folate in Victorian women of child-bearing age: Follow-up of a randomized community intervention trial. AustN Z J Public Health. 2001;25(5):389–95. [PubMed] [Google Scholar]
  • 35.Williams P, McHenery J, McMahon A, Anderson H. Impact evaluation of a folate education campaign with and without the use of a health claim. Aust N Z J Public Health. 2001;25(5):396–404. [PubMed] [Google Scholar]
  • 36.Alter DA, Naylor CD, Austin PA, Tu JV. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med. 1999;341:1359–67. doi: 10.1056/NEJM199910283411806. [DOI] [PubMed] [Google Scholar]
  • 37.McKeary M, Newbold B. Barriers to care: The challenges for Canadian refugees and their health care providers. J Refug Stud. 2010;23(4):523–45. [Google Scholar]
  • 38.Cochrane Database Syst Rev. 2009. [DOI] [PMC free article] [PubMed]
  • 39.Thiese MS. Observational and interventional study design types: An overview. Biochem Med (Zagreb) 2014;24(2):199–210. doi: 10.11613/BM.2014.022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS, et al. Recommendations to improve preconception health and health care — United States. MMWRRecomm Rep. 2006;55(6):1–23. [PubMed] [Google Scholar]
  • 41.Best Start Resource Centre. Preconception Health: Awareness and Behaviours in Ontario. Toronto, ON: Best Start Resource Centre; 2009. [Google Scholar]
  • 42.World Health Organization. The World Health Report 2001: MentalHealth: New Understanding, New Hope. Geneva, Switzerland: World Health Organization; 2001. [Google Scholar]
  • 43.Goodman JH. Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. JAN. 2004;45(1):26–35. doi: 10.1046/j.1365-2648.2003.02857.x. [DOI] [PubMed] [Google Scholar]
  • 44.Public Health Agency of Canada. Congenital Anomalies in Canada 2013. Ottawa, ON: Public Health Agency of Canada; 2013. [Google Scholar]
  • 45.Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA. Socioeconomic disparities in adverse birth outcomes: A systematic review. Am J Prev Med. 2010;39(3):263–72. doi: 10.1016/j.amepre.2010.05.012. [DOI] [PubMed] [Google Scholar]
  • 46.Can J Public Health. 2016.

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