Correspondence (letter to the editor): Preconception Interventions Should Not Be Overlooked

Despite some positive results, this interesting review provides a sobering look at the limited possibilities of influencing preterm birth during pregnancy (1). Only three of the risk factors mentioned (short cervix in the second trimester, abstinence from nicotine, and avoidance of heavy physical work) provide evidence for the effectiveness of suitable interventions. However, many of the other risk factors listed are the result of missed preconception interventions, with reduced chances of a normal course of pregnancy right from the start. This also affects the risk of preterm pregnancy termination for medical reasons, which now accounts for about a third of all preterm births. Common indications for iatrogenic preterm birth are hypertension and diabetic complications of pregnancy, which in turn are associated with pregravid maternal overweight and obesity (2). The chance of a spontaneous conception within a year is already reduced with a body mass index (BMI)>25kg/m². It also is reduced with increasing age. The average age at first birth is now 30 years. The need for reproductive medicine measures increases with age, while success rates decrease (3). At the same time, there is an increase in the incidence of multiple pregnancies, which are associated with a high risk (relative risk [RR]: 7.7) of preterm birth. The preconception state of health is a key determinant for fertility and the course of pregnancy. As this state is affected by modifiable factors of influence that arise over relatively long periods of time, each woman should have sufficient competence in issues of sexual and reproductive health, and this should be promoted through preconception counseling (3, 4).