Preconception care at the edges of the reproductive lifespan

A Call to Revisit the Prenatal Period as a Focus for Action Within the Reproductive and Perinatal Care Continuum

Objectives The broad maternal and child health community has witnessed increased attention to the entire continuum of reproductive and perinatal health concerns over the past few years. However, both recent discouraging trends in prenatal care access and utilization and a renewed understanding of prenatal care as a critical anchor of the reproductive/perinatal health continuum for women who do get pregnant demand a new effort to focus on the prenatal period as a gateway for maternal and infant health. Methods This commentary: describes the Medicaid expansions and the momentum for universal access to prenatal care of the 1980-1990s; examines the pivot away from this goal and its aftermath; provides a rationale for why renewed attention to prenatal care and the prenatal period is essential; and, explores the potential focus of an updated prenatal care agenda. Conclusion We conclude that increasing women's access to high quality prenatal care will require substantial effort at the clinical, community, policy, and system levels. Only when attention is paid to all phases of the reproductive/perinatal health continuum with an emphasis on continuity between all periods, and on the social determinants that affect health and well-being, will our nation be able to ensure the health of all women across the life course (whether or not they ever become mothers), while simultaneously fulfilling our nation's promise that all children-no matter their income or race/ethnicity-will have the opportunity to be born well.

Reproductive Life Planning: A Concept Analysis

BACKGROUND

In 2006, the U.S. Centers for Disease Control and Prevention issued 10 recommendations on preconception care, which included the statement that reproductive life planning should be considered an individual's responsibility across his or her life span.

PURPOSE

The purpose of this article is to provide a concept analysis of reproductive life planning using Walker and Avant's method as an organizing framework.

METHODS

Search engines were employed to review the existing knowledge base of the concept of reproductive life planning.

FINDINGS

The findings suggest that reproductive life planning is integral to preconception care and family planning. Attributes, antecedents, and consequences associated with reproductive life planning are discussed. Model, borderline, and contrary cases are also provided to illustrate the concept.

PRACTICE IMPLICATIONS

A reproductive life plan can serve as a framework for promoting reproductive health across the life span of both men and women. Healthcare providers must assess the individual's ability to understand and utilize educational resources to ensure full and effective participation in reproductive life planning.

Introducing reproductive life plan-based information in contraceptive counselling: an RCT

STUDY QUESTION

Can reproductive life plan (RLP)-based information in contraceptive counselling before pregnancy increase women's knowledge of reproduction, and of the importance of folic acid intake in particular?

SUMMARY ANSWER

The RLP-based information increased women's knowledge of reproduction including knowledge of folic acid intake.

WHAT IS KNOWN ALREADY

Many women have insufficient knowledge of reproduction, including a health-promoting lifestyle prior to conception, and highly educated women in particular postpone childbearing until an age when their fertile capacity has started to decrease.

STUDY DESIGN, SIZE, DURATION

The study was an randomized controlled trial with one intervention group (IG) and two control groups (CG1, CG2). A sample size calculation indicated that 82 women per group would be adequate. Recruitment took place during 3 months in 2012 and 299 women were included. The women were randomized in blocks of three. All groups received standard care (contraceptive counselling, Chlamydia testing, cervical screening). In addition, women in the IG were given oral and written RLP-based information about reproduction.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 299 out of 338 (88%) Swedish-speaking women visiting a Student Health Centre were included (mean age 23 years); response rate was 88%. Before the counselling, women in the IG and the CG1 completed a baseline questionnaire, including questions about lifestyle changes in connection to pregnancy planning, family planning intentions and knowledge of reproduction (e.g. the fecundity of an ovum). At follow-up 2 months after inclusion, a structured telephone interview was performed in all groups (n = 262, 88% participation rate).

MAIN RESULTS AND THE ROLE OF CHANCE

There was no difference between the groups regarding the mean knowledge score at baseline. The IG scored higher at follow-up than at baseline (P < 0.001); the mean increased from 6.4 to 9.0 out of a maximum 20 points. The women in the CG1 scored no differently at follow-up than at baseline. The difference in the knowledge score between the IG and the two CGs was significant (P < 0.001), whereas no difference was shown between the two CGs. There was no difference between the groups at baseline regarding how many women could mention folic acid intake among the things to do when planning to get pregnant. At follow-up, 22% in the IG, 3% in CG1 and 1% in CG2 mentioned folic acid intake (P < 0.001). At follow-up, more women in the IG also wished to have their last child earlier in life (P < 0.001) than at baseline, while there was no difference in the CG1.

LIMITATIONS, REASONS FOR CAUTION

As the study sample consisted of university students, it is possible that the effect of the intervention was connected to a high level of education and conclusions for all women of reproductive age should be drawn with caution.

WIDER IMPLICATIONS OF THE FINDINGS

The provision of RLP-based information seems to be a feasible tool for promoting reproductive health.

STUDY FUNDING/COMPETING INTEREST(S)

Study funding was received from the Faculty of Medicine, Uppsala University, Sweden. There are no conflicts of interest.

TRIAL REGISTRATION NUMBER

ClinicalTrial.gov Identifier NCT01739101.