Designing & Evaluating General Individual Preconception Care

Preconception Care (PCC) entails risk assessment, health promotion, counselling, and intervention. The Dutch Health Council categorized PCC into general PCC targeted at couples planning a pregnancy within the general population, and specialist PCC for couples with a known or predefined risk for an adverse pregnancy outcome. In the Netherlands in 2007, the Health Council advised to integrate general PCC into the health care system. Although PCC is regarded as a promising preventive healthcare approach for prospective parents and the future child, it’s implementation in daily practice is scarce. Several barriers are given, e.g. the discussion of the components of PCC and the limited number of PCC programs which have been evaluated; these have been mainly in secondary and tertiary care. Therefore, the aim of this thesis was to gain more insight in the optimal design and implementation of a general PCC program

Knowledge on preconceptional folic acid supplementation and intention to seek for preconception care among men and women in an urban city: A population-based cross-sectional study

Background: To study the knowledge of a large city population on preconception folic acid supplementation and intention to seek for preconception care within an urban perinatal health program. Methods: Cross-sectional surveys run in Rotterdam, the Netherlands, in 2007 and annually from 2009 to 2014. A random sample of residents aged between 16 and 85 years was taken each year from the municipal population register. Bivariate analysis, interaction analysis, trend analysis and logistic regression were performed. Results: Knowledge on preconceptional folic acid supplementation significantly improved (+20 %) between 2007 and 2009, and the intention to consult a GP or midwife in the preconception period significantly increased (+53 %) from 2007 to 2012. Logistic regression analyses showed that low socio-economic status was significantly associated with low preconceptional folic acid knowledge, but with higher intention to seek out preconception care. An interaction effect was found between educational level and ethnicity, showing that the higher the educational level the lower the gap of level of knowledge between the different ethnic groups. Conclusion: Despite campaigns about folic acid supplementation knowledge on this supplement remains low. The intention amongst men and women to seek out preconception care is still insufficient. Structural interventions to increase and maintain awareness on folic acid supplementation, especially among high-risk groups, are needed