Preconception Care: Concepts and Perceptions: An ethical perspective

General individual preconception care is a new strategy to improve the health of future children and their mothers –and to a lesser extent the prospective fathers’ health- through primary intervention. Improving their health through preconception care comprises two component actions. The first is to impart relevant information to prospective parents, thereby improving knowledge. The second is to modify individual behaviour based on the knowledge gained. General individual preconception care anticipates on both these components and entails risk assessment, health promotion, counselling, and interventions. Risk assessment is the systematic identification and evaluation of risk factors for so-called adverse ‘pregnancy outcomes’. Risk factors vary widely and include not taking folic acid supplements, using medication that can cause malformations or functional damage to an embryo, overweight, smoking, diabetes or having an inheritable disease. Health promotion means informing and educating couples on how to improve their health in order to improve the future child’s health, including avoiding alcohol and tobacco, and the importance of proper nutrition and exercise. Prospective parents are counselled about additional screening, diagnostic tests, and specialist consultations that may be necessary if risks are identified. Intervention refers to efforts to modify or eliminate risk factors

Preconception care: An essential preventive strategy to improve children's and women's health

Reproductive health has improved little in the last few decades. The Netherlands, particularly in large cities, has relatively high perinatal death rates compared with other European countries. Lack of improvement in reproductive outcomes despite improved quality of and better access to prenatal care strongly suggests that prenatal care alone is insufficient. We discuss how preconception care offers new strategies for improving reproductive health, how it usefully connects the life course of the affected individual and many health-care disciplines, and the benefits of combining a top-down policy structure and bottom-up organisation around caregivers. Given the likely benefits and cost savings calculated for the Netherlands, we conclude that failing to facilitate preconception care would reflect a breakdown of both professional and governmental responsibilities. Journal of Public Health Policy (2011) 32, 367-379. doi:10.1057/jphp.2011.13;published online 10 March 201

Informing on prenatal screening for Down syndrome prior to conception. An empirical and ethical perspective

In most Western countries, information on prenatal screening for Down syndrome is provided in the first-trimester of pregnancy. The purpose of this study was to examine whether this information should additionally be provided before pregnancy to improve the informed decision-making process. In an empirical study, we obtained data from pregnant women with respect to their preferences regarding information on prenatal screening preconceptionally. Questionnaire data (n?=?510) showed that 55.7% of responding women considered participating in prenatal screening for Down syndrome before pregnancy. 28.0% of women possessed information on prenatal screening preconceptionally. 84.6% preferred not to receive information preconceptionally in retrospect. In an ethical analysis, we elaborated on these preferences by weighing pros and cons. We considered two arguments against the provision of information on prenatal screening preconceptionally: women's preference to receive information in a step-by-step manner, and the risk of providing a directive message. We identified three reasons supporting its provision preconceptionally: the likelihood of making an informed decision could, firstly, be increased by unchaining the initial information from possible subsequent decisions, and, secondly, by providing women sufficient time to deliberate. Thirdly, the probability of equal access to prenatal screening may increase. To conclude with, we propose to incorporate an information offer on prenatal screening for Down syndrome in preconception care consultations. By offering information, instead of providing information, prospective parents are enabled to either accept or decline the information, which respects both their right to know and their right not-to-know. (c) 2012 Wiley Periodicals, In