Current practice of preconception care by primary caregivers in the Netherlands

Objectives: Over the past decade the value of preconception care (PCC) consultations has been acknowledged. Investments have been made to promote delivery and uptake of PCC consultations in the Dutch primary care setting. We assessed current activities, perceptions and prerequisites for delivery of PCC in primary care. Methods: A questionnaire was compiled and distributed by mail or e-mail among 1682 general practitioners (GPs) and 746 midwives in the Netherlands between 2013 and 2014. Results: The questionnaire was completed by 449 GPs and 250 midwives. While GPs and midwives were frequently asked about preconception risks, explicit requests by patients for a PCC consultation were less frequent. Although caregivers gave information on preconception risk factors, only a minority recommended PCC in the form of a dedicated consultation. Such consultations occurred infrequently. Risk factor assessment varied between GPs

Developing social marketed individual preconception care consultations: Which consumer preferences should it meet?

Aims: Preconception care (PCC) is care that aims to improve the health of offspring by addressing risk factors in the pre-pregnancy period. Consultations are recognized as a method to promote perinatal health. However, prospective parents underutilize PCC services. Uptake can improve if delivery approaches satisfy consumer preferences. Aim of this study was to identify preferences of women (consumers) as a first step to social marketed individual PCC consultations. Methods: In depth, semi-structured interviews were performed to identify women's views regarding the four components of the social marketing model: product (individual PCC consultation), place (setting), promotion (how women are made aware of the product) and price (costs). Participants were recruited from general practices and a midwife's practice. Content analysis was performed by systematic coding with NVIVO software. Results: The 39 participants reflected a multiethnic intermediately educated population. Product: Many participants had little knowledge of the need and the benefits of the product. Regarding the content of PCC, they wish to address fertility concerns and social aspects of parenthood. PCC was seen as an informing and coaching service with a predominant role for health-care professionals. Place: the general practitioner and midwife setting was the most mentioned setting. Promotion: A professional led promotion approach was preferred. Price: Introduction of a fee for PCC consultations will make people reconsider their need for a consultation and could exclude vulnerable patients from utilization. Conclusion: This study provides consumer orientated data to design a social marketed delivery approach for individual PCC consultations

Effectiveness of score card-based antenatal risk selection, care pathways, and multidisciplinary consultation in the Healthy Pregnancy 4 All study (HP4ALL): Study protocol for a cluster randomized controlled trial

Background: Promotion of healthy pregnancies has gained high priority in the Netherlands because of relatively unfavorable perinatal outcomes. In response, a nationwide study, 'Healthy Pregnancy 4 All' (HP4ALL), has been initiated. Part of this study involves systematic and broadened antenatal risk assessment (the Risk Assessment substudy). Risk selection in current clinical practice is mainly based on medical risk factors. Despite the increasing evidence for the influence of nonmedical risk factors (social status, lifestyle or ethnicity) on perinatal outcomes, these risk factors remain highly unexposed. Systematic risk selection, combined with customized care pathways to reduce or treat detected risks, and regular and structured consultation between community midwives, gynecologists and other care providers such as social workers, is part of this study. Methods/Design: Neighborhoods in 14 municipalities with adverse perinatal outcomes above national and municipal averages are selected for participation. The study concerns a cluster randomized controlled trial. Municipalities are randomly allocated to intervention (n = 3,500 pregnant women) and control groups (n = 3,500 pregnant women). The intervention consists of systematic risk selection with th

Change in Lifestyle Behaviors After Preconception Care: A Prospective Cohort Study

Purpose: To evaluate the effects of preconception care (PCC) consultations by change in lifestyle behaviors. Setting and Intervention: Women in deprived neighborhoods of 14 Dutch municipalities were encouraged to visit a general practitioner or midwife for PCC. Sample: The study included women aged 18 to 41 years who had a PCC consultation. Design: In this community-based prospective cohort study, we assessed initiation of folic acid supplementation, cessation of smoking, alcohol consumption, and illicit drug use. Measures: Self-reported and biomarker data on behavioral changes were obtained at baseline and 3 months later. Analysis: The changes in prevalence were assessed with the McNemar test. Results: Of the 259 included participants, paired analyses were available in 177 participants for self-reported outcomes and in 82 for biomarker outcomes. Baseline self-reported prevalence of no folic acid use was 36%, smoking 12%, weekly alcohol use 22%, and binge drinking 17%. Significant changes in prevalence toward better lifestyle during follow-up were seen for folic acid use (both self-reported, P <.001; and biomarker-confirmed, P =.008) and for self-reported binge drinking (P =.007). Conclusion: Our st

Design and outline of the healthy pregnancy 4 all study

Background: Promotion of healthy pregnancies has gained high priority in the Netherlands because of the relatively unfavourable perinatal health outcomes. In response a nationwide study Healthy Pregnancy 4 All was initiated. This study combines public health and epidemiologic research to evaluate the effectiveness of two obstetric interventions before and during pregnancy: (1) programmatic preconception care (PCC) and (2) systematic antenatal risk assessment (including both medical and non-medical risk factors) followed by patient-tailored multidisciplinary care pathways. In this paper we present an overview of the study setting and outlines. We describe the selection of geographical areas and introduce the design and outline of the preconception care and the antenatal risk assessment studies.Methods/design: A thorough analysis was performed to identify geographical areas in which adverse perinatal outcomes were high. These areas were regarded as eligible for either or both sub-studies as we hypothesised studies to have maximal effect there. This selection of municipalities was based on multiple criteria relevant to either the preconception care intervention or the antenatal risk assessment intervention, or to both. The preconception care intervention was designed as a prospective community-based cohort study. The antenatal risk assessment intervention was designed as a cluster randomised controlled trial - where municipalities are randomly allocated to intervention and control.Discussion: Optimal linkage is sought between curative and preventive care, public health, government, and social welfare organisations. To our knowledge, this is the first study in which these elements are combined

The Effect of Preconception Counselling on Lifestyle and Other Behaviour Before and During Pregnancy

Background: Recent studies suggest that the basis for adverse pregnancy outcomes is often established early in pregnancy, during organogenesis. It is therefore important to take preventive action as early as possible, preferably before pregnancy. Because most adverse pregnancy outcomes occur in women who are unaware of being at risk, we conducted a randomized controlled trial, "Parents to Be." With this study, we sought to assess the extent to which women who have participated in preconception counseling (PCC) increase their knowledge on pregnancy-related risk factors and preventive measures and change their behavior before and during pregnancy and to provide an overview of adverse pregnancy outcomes among such women. Methods: Knowledge: Women aged 18-40 who attended PCC and women who received standard care were matched on previous pregnancy, time since last pregnancy, age, country of birth, and educational achievement. They were sent a questionnaire on knowledge about pregnancy-related risk factors and preventive measures. Behavior: Data on pregnancies and outcomes were collected. Two months after pregnancy, a questionnaire was sent regarding behavior before and during pregnancy. Results: Knowledge of women who received PCC (81.5%; n = 211) exceeded that of women who did not (76.9%; n = 422). Levels of knowledge in women who were not yet pregnant after PCC were comparable to those in women who became pregnant after PCC, indicating that, even before pregnancy, PCC increased knowledge in women contemplating pregnancy. After PCC, significantly more women started using folic acid before pregnancy (adjusted odds ratio [OR], 4.93; 95% confidence interval [CI], 2.81-8.66) and reduced alcohol use during the first 3 months of pregnancy (adjusted OR, 1.79; 95% CI, 1.08-2.97). Among the group receiving standard care, about 20% of all pregnancies ended in an adverse outcome; in the group with PCC this was 16% (OR, 0.77; 95% CI, 0.48-1.22). Conclusion: After PCC, women have more knowledge about essential items. Importantly, they gained this greater knowledge before pregnancy and more women changed their behavior to reduce adverse pregnancy outcomes. © 2008 Jacobs Institute of Women's Health

The effect of a preconception care outreach strategy: the Healthy Pregnancy 4 All study

Background: Preconception care has been acknowledged as an intervention to reduce perinatal mortality and morbidity. However, utilization of preconception care is low because of low awareness of availability and benefits of the service. An outreach strategy was employed to promote uptake of preconception care consultations. Its effect on the uptake of preconception care consultations was evaluated within the Healthy Pregnancy 4 All study. Methods: We conducted a community-based intervention study. The outreach strategy for preconception care consultations included four approaches: (1) letters from municipal health services; (2) letters from general practitioners; (3) information leaflets by preventive child healthcare services and (4) encouragement by peer health educators. The target population was set as women aged 18 to 41 years in 14 Dutch municipalities with relatively high perinatal morbidity and mortality rates. We evaluated the effect of the outreach strategy by analyzing uptake of preconception care consultations between February 2013 and December 2014. Registration data of applications for preconception care as well as participant questionnaires were obtained for analysis. Results: The outreach strategy led to 587 applications for preconception care consultations. The majority of applications (n = 424; 72%) were prompted by the invitation letters (132,129) from the municipalities and general practitioners. The effect of the municipal letter seemed to fade out after 3 months. Conclusions: Outreach strategies amongst the general population promote uptake of preconception care consultations, although on a small scale and with a temporary effect

ラミナリアジャポニカに含まれるフコキサンチンとフコイダンの生活習慣病予防活性に関する研究

博士（学術）神戸大