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Akwaa Harrison O, Ifie I, Nkwonta C, Dzandu BA, Gattor AO, Adimado EE, Odoi KK, Aziavor B, Saalia FK, Steiner-Asiedu M. Knowledge, awareness, and use of folic acid among women of childbearing age living in a peri-urban community in Ghana: a cross-sectional survey. BMC Pregnancy Childbirth 2024; 24:241. [PMID: 38580949 PMCID: PMC10996122 DOI: 10.1186/s12884-024-06408-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/11/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Folic acid, a water-soluble B-complex vitamin, plays a crucial role in DNA synthesis and maintenance, making it particularly significant during reproduction. Its well-known ability to reduce the risk of congenital anomalies during the periconceptional period underscores its importance. The increased requirement for folate during pregnancy and lactation is essential to support the physiological changes of the mother and ensure optimal growth and development of the foetus and offspring. This study assessed the knowledge, awareness, and use of folic acid among pregnant and lactating women of reproductive age residing in Dodowa in the Shai Osu-Doku District, Accra, Ghana. METHODS The study was a cross-sectional design that involved 388 randomly selected participants (97 pregnant and 291 lactating women). Structured questionnaires were administered to gather information on the socioeconomic demographic characteristics, knowledge, awareness, and use of folic acid of the participants. Dietary intake was assessed using a food frequency questionnaire. The data were analysed using descriptive statistics and Pearson's chi-square analysis tests and are presented as frequencies and percentages, means, standard deviations, bar graphs, and pie charts. The significance of the results was determined at a 95% confidence interval. RESULTS The mean age of the participants was 31 ± 5.0 years. Among the study participants, 46.1% demonstrated knowledge of folic acid deficiency, while approximately 68.3% had a high awareness of folic acid supplementation. Approximately 75% of the participants indicated that they had not used folic acid supplements within the week, and 15.5% reported consuming folic acid-fortified food per week. CONCLUSIONS The women exhibited high awareness but poor knowledge regarding the usage of folic acid supplementation during pregnancy and lactation. Consequently, this lack of knowledge influenced the low use of folic acid supplements and low intake of folate-rich foods among pregnant and lactating mothers.
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Affiliation(s)
- Obed Akwaa Harrison
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana.
| | - Idolo Ifie
- Department of Food Science, University of Leeds, Leeds, England
| | - Chikere Nkwonta
- Department of Food Science, University of Leeds, Leeds, England
| | - Bennett Atta Dzandu
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Albert Owusu Gattor
- Faculty of Chemistry and Pharmacy, Medicinal Chemistry II, University of Regensburg, Regensburg, Germany
| | | | - Kofi Kafui Odoi
- Institutional Care Division, Ghana Health Services, Accra, Ghana
| | | | - Firibu Kwesi Saalia
- Department of Food Process Engineering, University of Ghana, Legon, Accra, Ghana
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Valen EN, Øverby NC, Hardy‐Johnson P, Vik FN, Salvesen L, Omholt ML, Barker ME, Hillesund ER. Lessons learned from talking with adults about nutrition: A qualitative study in the PREPARED project. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 2:e13540. [PMID: 37277971 PMCID: PMC10765357 DOI: 10.1111/mcn.13540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
Improving diet and dietary behaviour of men and women before pregnancy has the potential to benefit both their current and long-term health and the health of their children. Little is known, however, about adults' perception of diet's role in prepregnancy health. This study aimed to explore the state of knowledge and awareness of preconception nutritional health in adults within the fertile age range and what they perceived could motivate healthy eating using the self-determination theory as a theoretical framework. We analysed 33 short exploratory interviews with men (n = 18) and women (n = 15) aged 18-45 years. Participants were grab sampled from three different public locations in the southern part of Norway. Interviews were audio-recorded, transcribed verbatim in 2020 and analysed using a thematic analysis with a semantic approach in 2022. The findings suggest that adults within the fertile age range are not intrinsically motivated to eat healthily, but when they do, it is because eating healthily often aligns with other goals consistent with their values, that is, getting fit or looking good. They possess some basic knowledge of healthy behaviours during pregnancy but are generally unaware of the importance of preconception health and nutrition. There is a need to increase awareness of the impact of preconception health on the health of this and future generations. Improved nutritional education on the significance of diet before conception might facilitate optimal conditions for conceiving and for pregnancy in the adult population within fertile age range.
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Affiliation(s)
- Erlend N. Valen
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Nina Cecilie Øverby
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Polly Hardy‐Johnson
- Medical Research Council Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
| | - Frøydis N. Vik
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Lorentz Salvesen
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Mona L. Omholt
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
| | - Mary Elizabeth Barker
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
- Medical Research Council Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Elisabet R. Hillesund
- Department of Nutrition and Public HealthUniversity of AgderKristiansandVest‐AgderNorway
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Channon S, Coulman E, Cannings-John R, Henley J, Lau M, Lugg-Widger F, Strange H, Davies F, Sanders J, Scherf C, Couzens Z, Morantz L. Acceptability and feasibility of a planned preconception weight loss intervention in women with long-acting reversible contraception: the Plan-it mixed-methods study. Health Technol Assess 2023; 27:1-224. [PMID: 36688498 PMCID: PMC9885302 DOI: 10.3310/nkix8285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention. OBJECTIVES The objectives were to understand if routine NHS data captured the pathway from long-acting reversible contraception removal to pregnancy and included body mass index; to identify the suitable components of a preconception weight loss intervention; and to engage with key stakeholders to determine the acceptability and feasibility of asking women with overweight/obesity to delay the removal of their long-acting reversible contraception in order to take part in a preconception weight loss intervention. DESIGN This was a preparatory mixed-methods study, assessing the acceptability and feasibility of a potential intervention, using routine NHS data and purposefully collected qualitative data. PARTICIPANTS The NHS routine data included all women with a long-acting reversible contraception code. There were three groups of participants in the surveys and interviews: health-care practitioners who remove long-acting reversible contraception; weight management consultants; and women of reproductive age with experience of overweight/obesity and of using long-acting reversible contraception. SETTING UK-based health-care practitioners recruited at professional meetings; and weight management consultants and contraceptive users recruited via social media. DATA SOURCES Anonymised routine data from UK sexual health clinics and the Clinical Practice Research Datalink, including the Pregnancy Register; and online surveys and qualitative interviews with stakeholders. RESULTS The records of 2,632,871 women aged 16-48 years showed that 318,040 had at least one long-acting reversible contraception event, with 62% of records including a body mass index. Given the identified limitations of the routine NHS data sets, it would not be feasible to reliably identify women with overweight/obesity who request a long-acting reversible contraception removal with an intention to become pregnant. Online surveys were completed by 100 health-care practitioners, four weight management consultants and 243 contraceptive users. Ten health-care practitioners and 20 long-acting reversible contraception users completed qualitative interviews. A realist-informed approach generated a hypothesised programme theory. The combination of weight discussions and the delay of long-acting reversible contraception removal was unacceptable as an intervention to contraceptive users for ethical and practical reasons. However, a preconception health intervention incorporating weight loss could be acceptable, and one potential programme is outlined. LIMITATIONS There was very limited engagement with weight management consultants, and the sample of participating stakeholders may not be representative. CONCLUSIONS An intervention that asks women to delay long-acting reversible contraception removal to participate in a preconception weight loss intervention would be neither feasible nor acceptable. A preconception health programme, including weight management, would be welcomed but requires risk communication training of health-care practitioners. FUTURE WORK Work to improve routine data sets, increase awareness of the importance of preconception health and overcome health-care practitioner barriers to discussing weight as part of preconception care is a priority. TRIAL REGISTRATION This trial is registered as ISRCTN14733020. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 1.
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Affiliation(s)
- Susan Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Josie Henley
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mandy Lau
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Freya Davies
- The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Caroline Scherf
- Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
| | - Zoë Couzens
- Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
| | - Leah Morantz
- 1Centre for Trials Research, Cardiff University, Cardiff, UK
- 2The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
- 3School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
- 4Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
- 5Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
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Smith L, Hilton A, Walker J, Alfred L, Ahankari A, Schölin L. Prevention of alcohol related harm though preconception care: A scoping review of barriers and enablers. DIALOGUES IN HEALTH 2022; 1:100040. [PMID: 38515881 PMCID: PMC10953971 DOI: 10.1016/j.dialog.2022.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 03/23/2024]
Abstract
Objective To understand the perspectives of healthcare practitioners and women of reproductive age regarding addressing prevention of an alcohol exposed pregnancy before conception. Methods A scoping review of mixed methods, qualitative and quantitative research was conducted. Medline, CINAHL, EMBASE and PsychInfo databases were searched for literature published by March 2022. Data were extracted and synthesized. Results Twenty-three studies were included. Views varied between healthcare practitioners and women about addressing alcohol with women before pregnancy. Healthcare practitioners agreed prevention was important but believed they were ill-prepared to provide support, and that it might be intrusive if women were not contemplating pregnancy. Whereas women would welcome advice from healthcare practitioners, particularly if offered during appointments or visits for services related to reproductive health. A knowledge deficit about pregnancy and fetal harms from alcohol was expressed by both healthcare practitioners and women. Conclusions Investment in alcohol education and skills training for healthcare professionals is required to ensure a coherent message is communicated across services, and that shared decision making about healthcare between service users and health professionals is facilitated. Future research should explore implementation of interventions to prevent alcohol exposed pregnancy in settings where women are seeking reproductive health support.
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Affiliation(s)
- Lesley Smith
- Institute of Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Andrea Hilton
- Department of Paramedical, Perioperative and Advanced Practice, University of Hull, Hull, UK
| | - Jayne Walker
- Department of Paramedical, Perioperative and Advanced Practice, University of Hull, Hull, UK
| | - Lolita Alfred
- Department of Nursing, City, University of London, London, UK
| | - Anand Ahankari
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Lisa Schölin
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
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Martín-Rodríguez A, Bustamante-Sánchez Á, Martínez-Guardado I, Navarro-Jiménez E, Plata-SanJuan E, Tornero-Aguilera JF, Clemente-Suárez VJ. Infancy Dietary Patterns, Development, and Health: An Extensive Narrative Review. CHILDREN 2022; 9:children9071072. [PMID: 35884056 PMCID: PMC9319947 DOI: 10.3390/children9071072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/03/2022] [Accepted: 07/16/2022] [Indexed: 11/27/2022]
Abstract
Correct dietary patterns are important for a child’s health from birth to adulthood. Understanding a child’s health as a state of entire physical, mental, and social well-being is essential. However, reaching adulthood in a complete health proper state is determined by feeding and dietary habits during preconception, pregnancy, or children infancy. Different factors, such as the mother’s lifestyle, culture, or socioeconomic status, are crucial during all these phases. In this review, we aimed to assess the long-term associations between infancy dietary patterns and health and their influence on development and growth. To reach this objective, a consensus critical review was carried out using primary sources such as scientific articles, and secondary bibliographic indexes, databases, and web pages. PubMed, SciELO, and Google Scholar were the tools used to complete this research. We found that high-income countries promote high-calorie foods and, consequently, obesity problems among children are rising. However, undernutrition is a global health issue concerning children in low- and middle-income countries; thus, parental socioeconomic status in early life is essential to children’s health and development, showing that biological, social, and environmental influences are increased risk factors for chronic diseases. This narrative review is aimed to collect evidence for early nutritional intervention and future disease prevention.
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Affiliation(s)
| | - Álvaro Bustamante-Sánchez
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.-R.); (V.J.C.-S.)
- Correspondence: (Á.B.-S.); (J.F.T.-A.); Fax: +34-911-413-585 (J.F.T.-A.)
| | | | | | | | - José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.-R.); (V.J.C.-S.)
- Correspondence: (Á.B.-S.); (J.F.T.-A.); Fax: +34-911-413-585 (J.F.T.-A.)
| | - Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.-R.); (V.J.C.-S.)
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
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Okemo JK, Kamya D, Mwaniki AM, Temmerman M. Determinants of preconception care among pregnant women in an urban and a rural health facility in Kenya: a qualitative study. BMC Pregnancy Childbirth 2021; 21:752. [PMID: 34743694 PMCID: PMC8573977 DOI: 10.1186/s12884-021-04201-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Preconception care (PCC) is a form of preventive health care that is offered to women and couples before conception, with the aim of improving their health status and mitigating various risk factors that could contribute to poor maternal and child health outcomes. The levels of PCC utilization are still low globally, especially in developing countries and in rural areas. Little is known regarding PCC use in Kenya that could help in addressing this shortfall. This study aimed to qualitatively assess the determinants of PCC in urban and rural settings in Kenya. Methods A qualitative approach was employed to assess determinants of PCC using a semi-structured interview guide. The study was conducted from May to October 2017. Selected pregnant women seeking antenatal care (ANC) were recruited by quota sampling, at the Mother and Child Health (MCH) clinics in Aga Khan University Hospital, Nairobi (AKUH, N-urban) and Maragua Level Four Hospital (MLFH-rural). The interviews were thereafter transcribed verbatim and analyzed thematically. Findings A total of 26 women were invited, of whom 21 accepted to participate in in-depth interviews (IDIs). Saturation of themes occurred with 13 interviews (7 at AKUH and 6 at MLFH). Transcription, coding and thematic analysis of the IDIs yielded 12 themes. Eleven of these themes were identified as determinants of PCC. The twelfth theme contained suggested strategies of increasing PCC awareness and utilization, such as using the media, setting up PCC clinics and integrating PCC into other clinics. The dominant themes were awareness about PCC and attitudes towards PCC and pregnancy. The broad determinants of PCC were similar in urban and rural settings – with a few notable exceptions. For example, in the rural setting, women’s level of education and a pervasive history of poor interactions with healthcare providers were major determinants of PCC. Conclusion From this study we conclude that women’s lack of awareness about PCC, in conjunction with attitudes towards PCC and pregnancy impact strongly on its utilization. This lack of awareness could be addressed through health education programs for both the public and for healthcare providers, as well as integrating PCC in the curricula of the later. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04201-w.
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Affiliation(s)
- J K Okemo
- Aga Khan University, Nairobi, Kenya.
| | - D Kamya
- Aga Khan University, Nairobi, Kenya
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Kandel P, Lim S, Pirotta S, Skouteris H, Moran LJ, Hill B. Enablers and barriers to women's lifestyle behavior change during the preconception period: A systematic review. Obes Rev 2021; 22:e13235. [PMID: 33754474 DOI: 10.1111/obr.13235] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/24/2021] [Indexed: 12/16/2022]
Abstract
Healthy lifestyle behaviors during the preconception period are important to optimize maternal and child outcomes, including weight. However, the majority of women do not have optimal preconception lifestyle behaviors. This systematic review explored enablers and barriers to women's preconception lifestyle behaviors using the Capability, Opportunity, Motivation, Behaviour (COM-B) model and Theoretical Domains Framework (TDF). Preconception was defined as the time before conception, capturing planned and unplanned pregnancies. Medline Complete, EMBASE, PsycINFO, and CINAHL were searched for peer-reviewed, quantitative and qualitative primary studies (English, 2006-2020) that explored enablers and barriers to lifestyle behaviors (diet, physical activity, smoking, alcohol use, supplement intake). Forty-two studies (of 3406) were included, assessing supplement use (n = 37), diet (n = 10), smoking (n = 10), alcohol use (n = 8), and physical activity (n = 5). All three COM-B components were identified only for diet and supplement use. Of the 14 TDF domains, 7 were identified: knowledge, beliefs about capabilities, beliefs about consequences, goals, intentions, social support, and environmental context and resources. The presence/absence of knowledge on healthy behaviors was the most commonly assessed enabler/barrier. Future studies should explore a wider range of factors influencing preconception women's capability, opportunity, and motivation to modify their lifestyle behaviors.
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Affiliation(s)
- Pragya Kandel
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Stephanie Pirotta
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Warwick Business School, University of Warwick, Coventry, UK
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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Ojifinni OO, Ibisomi L. Preconception care practices in Nigeria: a descriptive qualitative study. Reprod Health 2020; 17:172. [PMID: 33148313 PMCID: PMC7640668 DOI: 10.1186/s12978-020-01030-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background Preconception care is a specialized care targeted at women of reproductive age before pregnancy to detect, treat or counsel them about pre-existing medical and social conditions that may militate against safe motherhood and positive pregnancy outcome. In spite of the known need for preconception care in Nigeria, routine preconception care services are not available in the country. This study explores existing preconception care practices in the country in order to encourage building on it and formalising it for inclusion in routine maternal and child health services in the country. Methods Forty-one in-depth interviews and 10 focus group discussions were conducted in this descriptive qualitative study to explore the existing preconception care services from the perspectives of community members (women and men in the reproductive age group), community and religious leaders, health care professionals as well as policy makers. Thematic analysis was carried out using MAXQDA 2018. Results Participants stated that there are no defined preconception care services in the health care system nor are there any structures or guidelines for preconception care in the country. Preconception care services are however provided when health workers perceive a need or when clients demand for it. The services provided include health information, education and counselling, treatment modification, medical check-up and screening. Outside of the health system, there are some traditional, religious and other practices with similar bearing to preconception care which the participants believed could be included as preconception care services. These include premarital counselling services by religious bodies, family life and HIV education within the secondary school system and some screening and outreach services provided by non-governmental and some governmental agencies. Conclusion There is a need to provide structure and guidelines for preconception care services in the country so that the services can be properly streamlined. This structure can also involve practices that are currently not within the health system.
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Affiliation(s)
| | - Latifat Ibisomi
- Division of Epidemiology and Biostatistics, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Nigerian Institute of Medical Research, Lagos, Nigeria
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Nkrumah I, North M, Kothe E, Chai TL, Pirotta S, Lim S, Hill B. The Relationship Between Pregnancy Intentions and Diet or Physical Activity Behaviors in the Preconception and Antenatal Periods: A Systematic Review and Meta-Analysis. J Midwifery Womens Health 2020; 65:660-680. [PMID: 32592533 DOI: 10.1111/jmwh.13112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Healthy preconception and antenatal diet and physical activity behaviors may optimize maternal and offspring outcomes. These behaviors are thought to be linked to pregnancy intentions. The aim of this study was to conduct a systematic review and meta-analysis to determine the association between women's pregnancy intentions and diet or physical activity behaviors in the preconception and antenatal periods. METHODS MEDLINE Complete, PsycINFO, CINAHL Complete, Global Health, Embase, and INFORMIT: Health Subset were searched in September 2018 for studies that evaluated relationships between pregnancy intentions and dietary and physical activity behaviors. Risk of bias was assessed, and random effects meta-analyses were conducted for dietary (food groups; energy and macronutrients; diet quality; and caffeine, iodine, and folate intake) and physical activity outcomes. RESULTS Of 2623 screened records, 19 eligible studies were identified. The overall risk of bias was moderate to high. Twelve studies measured diet and physical activity behaviors during preconception, 5 during pregnancy, and 2 across both periods. Eleven studies measured pregnancy intention retrospectively, and 8 prospectively measured pregnancy intention. The number of studies available for meta-analyses of individual dietary and physical activity outcomes ranged from 2 to 5. Pregnancy intentions were not associated with preconception fruit, vegetable, or caffeine intake or physical activity. Antenatally, women with intended pregnancies were more likely to report healthier diets, lower caffeine intake, and higher physical activity. Insufficient studies were available to conduct subgroup comparisons for prospective or retrospective assessment. DISCUSSION Pregnancy intentions were not associated with preconception diet or physical activity behaviors. In contrast, antenatally, women with intended pregnancies demonstrated better diet and physical activity behaviors. Given the small number of studies available for meta-analyses, further research is needed to consolidate our findings. Meanwhile, health professionals can assess women's pregnancy intentions during preconception and pregnancy and encourage a healthy lifestyle.
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Affiliation(s)
- Isaac Nkrumah
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Garden City University College, Kumasi, Ghana
| | - Madelon North
- School of Psychology, Deakin University, Geelong, Australia
| | - Emily Kothe
- School of Psychology, Deakin University, Geelong, Australia
| | - Tze Lin Chai
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stephanie Pirotta
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Mohammed H, Roberts CT, Grzeskowiak LE, Giles L, Leemaqz S, Dalton J, Dekker G, Marshall HS. Psychosocial determinants of pertussis and influenza vaccine uptake in pregnant women: A prospective study. Vaccine 2020; 38:3358-3368. [DOI: 10.1016/j.vaccine.2020.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 11/24/2022]
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Nascimento NDC, Borges ALV, Fujimori E. Preconception health behaviors among women with planned pregnancies. Rev Bras Enferm 2019; 72:17-24. [PMID: 31851230 DOI: 10.1590/0034-7167-2017-0620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 06/08/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To identify determinants of preconception preparation among women with planned pregnancies. METHOD A cross-sectional study with a probabilistic sample of 264 women between 18 and 49 years of age who had or were undergoing planned pregnancies, and were users of two School Health Centers in the city of São Paulo. Analysis was conducted through univariate and multiple logistic regression of three variable blocks: 1) social and demographic characteristics; 2) sexual and reproductive characteristics; 3) preexisting health conditions. RESULTS Women with higher education, belonging to economic groups A and B, and older women with infertility were more likely to perform preconception training. CONCLUSION Preconception care has a strong social determination, as women with more favorable social profiles are more likely to perform it. Experience with infertility is also instrumental in the likelihood of preconception care.
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Jawad A, Patel D, Brima N, Stephenson J. Alcohol, smoking, folic acid and multivitamin use among women attending maternity care in London: A cross-sectional study. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 22:100461. [PMID: 31494357 DOI: 10.1016/j.srhc.2019.100461] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 08/05/2019] [Accepted: 08/27/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study describes the patterns of change in health behaviours that pregnant women adopt before and during pregnancy. STUDY DESIGN A cross-sectional survey of pregnant women asked questions about pregnancy planning, health knowledge, and health behaviour. Analysis was descriptive with associations examined using logistic regression models. MAIN OUTCOME MEASURES Health behaviours before and during pregnancy (smoking, alcohol consumption, and folic acid and multivitamin (supplement) intake), and recall of healthcare professional advice. RESULTS 1173 women completed the survey (mean age 32 ± 5 years, 68% white) of whom 73% indicated that their pregnancy was highly planned. 38% of women reported having never smoked, 45% quit smoking before becoming pregnant, and fewer (5%, 95% CI 3-6%) reported currently smoking. Current smokers reported reduced cigarette consumption compared to pre-pregnancy, and higher recall of health professional information. Nine percent (95% CI 5-8%) reported currently drinking, reducing the number of units consumed from 6 units weekly before pregnancy (IQR 2-10) to 1 unit weekly during pregnancy (IQR 1-2, p < 0.001). Most (62%) women were currently taking supplements, of whom 81% reported daily use. Women with more planned pregnancies had higher odds of adopting healthier behaviours of stopping smoking or drinking before pregnancy compared to those who stopped during pregnancy or continued the behaviour. CONCLUSIONS Most women adopted one or more healthy behaviours during pregnancy, with a small minority continuing to smoke or drink alcohol. For women who continued smoking in pregnancy and recalled information from health professionals, additional tailored approaches need to be explored.
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Affiliation(s)
- Aalaa Jawad
- Public Health Training Programme, Stewart House, London WC1B 5DN, United Kingdom.
| | - Dilisha Patel
- Reproductive Medicine, Institute for Women's Health, UCL, London, United Kingdom.
| | | | - Judith Stephenson
- Reproductive Medicine, Institute for Women's Health, UCL, London, United Kingdom.
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Lang AY, Hall JA, Boyle JA, Harrison CL, Teede H, Moran LJ, Barrett G. Validation of the London Measure of Unplanned Pregnancy among pregnant Australian women. PLoS One 2019; 14:e0220774. [PMID: 31393966 PMCID: PMC6687283 DOI: 10.1371/journal.pone.0220774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/23/2019] [Indexed: 01/30/2023] Open
Abstract
Introduction Globally, over half of pregnancies in developed countries are unplanned. Identifying and understanding the prevalence and complexity surrounding pregnancy preparation among Australian women is vital to enable sensitive, responsive approaches to addressing preconception and long-term health improvements for these women with varying motivation levels. Aim This study evaluated the reliability and validity of a comprehensive pregnancy planning/intention measure (London Measure of Unplanned Pregnancy) in a population of pregnant women (over 18 years of age) in Australia. Methods A psychometric evaluation, within a cross-sectional study comprising cognitive interviews (to assess comprehension and acceptability) and a field test. Pregnant women aged over 18 years were recruited in early pregnancy (approximately 12 weeks’ gestation). Reliability (internal consistency) was assessed using Cronbach’s alpha, corrected item-total correlations and inter-item correlations, and stability via a test-retest. Construct validity was assessed using principal components analysis and hypothesis testing. Results Six women participated in cognitive interviews and 317 in the field test. The London Measure of Unplanned Pregnancy was acceptable and well comprehended. Reliability testing demonstrated good internal consistency (alpha = 0.81, all corrected item-total correlations >0.20, all inter-item correlations positive) and excellent stability (weighted kappa = 0.92). Validity testing confirmed the unidimensional structure of the measure and all hypotheses were confirmed. Conclusions The London Measure of Unplanned Pregnancy is a valid and reliable measure of pregnancy planning/intention for the Australian population. Implementation of this measure into all maternity healthcare, research and policy settings will provide accurate population-level pregnancy planning estimates to inform, monitor and evaluate interventions to improve preconception health in Australia.
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Affiliation(s)
- Adina Y. Lang
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer A. Hall
- Research Department of Reproductive Health, UCL EGA Institute for Women’s Health, University College London, London, United Kingdom
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Geraldine Barrett
- Research Department of Reproductive Health, UCL EGA Institute for Women’s Health, University College London, London, United Kingdom
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Lang AY, Bartlett R, Robinson T, Boyle JA. Perspectives on preconception health among migrant women in Australia: A qualitative study. Women Birth 2019; 33:334-342. [PMID: 31280974 DOI: 10.1016/j.wombi.2019.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cultural beliefs, practices and experiences significantly influence pregnancy preparation. Limited in-depth information exists regarding how women from migrant and refugee backgrounds (migrant women) prepare for pregnancy. This study explored pregnancy planning, preconception lifestyles, awareness, experiences and healthcare needs of migrant women in Australia. METHODS Semi-structured interviews and focus groups were conducted with 25 women recruited through a diverse community in Melbourne, Australia (November 2017-February 2018). Discussions explored pregnancy planning, preconception health awareness, experiences and information needs. Qualitative data was analysed iteratively, through content and thematic analysis. FINDINGS Four themes were identified: pregnancy planning experiences and perspectives, preconception health awareness and behaviours, social and cultural influences on pregnancy planning, and health information needs. Women had limited understanding of the concept or importance of preconception health, limited access to preconception health information and most women with children had experienced at least one unplanned pregnancy. Cultural mores constrained community discussion of preconception health in the context of sexual and reproductive health. Social factors emerged as predominant preconception concerns. Women reported wanting more information on preconception health through multiple, broad-reaching avenues, paired with timely, sensitive healthcare engagement. CONCLUSION Information for women addressing preconception health and pregnancy planning is limited. Our study demonstrates additional cultural and social nuances that need to be understood when working with migrant women. Discomfort raising reproductive and preconception health discussions with healthcare providers was a reported concern. Integration of culturally-sensitive preconception care within routine client assessments warrants exploration. Emphasis of the importance of preconception care for all women is needed.
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Affiliation(s)
- Adina Y Lang
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Ground Floor, 43-51 Kanooka Grove, Clayton, Victoria 3186, Australia.
| | - Rebeccah Bartlett
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Ground Floor, 43-51 Kanooka Grove, Clayton, Victoria 3186, Australia.
| | - Tracy Robinson
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Ground Floor, 43-51 Kanooka Grove, Clayton, Victoria 3186, Australia.
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Ground Floor, 43-51 Kanooka Grove, Clayton, Victoria 3186, Australia.
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McKee CL, Stapleton P, Pidgeon AM. Delphi Expert Parent Study: Factors Needed for 21st Century Pre- and Perinatal Parenting Programs. J Perinat Educ 2019; 28:163-179. [PMID: 31341375 PMCID: PMC6613731 DOI: 10.1891/1058-1243.28.3.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Using Delphi methodology, the current study utilized a panel of "expert" parents (N = 23 after three rounds) to examine nine content-based and logistical factors perceived to be important when developing pre-and perinatal (PPN) parenting programs for the modern day. The aim was to attain consensus on 235 items generated from literature and panelists. Consensus was reached on 126 items (53.62%). The most notable related to needs-based content, barriers to fathers' attendance, and groups of parents who may benefit most from programs. Consistent with the literature, clarity was not achieved for appropriate timing and length of programs. With the diversity of recommendations, next steps involve developing a range of programs that use randomized clinical trials with control groups, effective sample sizes, and are pre-and posttested.
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16
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Sijpkens MK, van Voorst SF, de Jong-Potjer LC, Denktaş S, Verhoeff AP, Bertens LCM, Rosman AN, Steegers EAP. The effect of a preconception care outreach strategy: the Healthy Pregnancy 4 All study. BMC Health Serv Res 2019; 19:60. [PMID: 30674306 PMCID: PMC6343258 DOI: 10.1186/s12913-019-3882-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/07/2019] [Indexed: 12/17/2022] Open
Abstract
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. Electronic supplementary material The online version of this article (10.1186/s12913-019-3882-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Meertien K Sijpkens
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Sabine F van Voorst
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Lieke C de Jong-Potjer
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Semiha Denktaş
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Social and Behavioral Sciences, Erasmus University College, Erasmus University Rotterdam, Nieuwemarkt 1A, 3011, HP, Rotterdam, The Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062, PA, Rotterdam, The Netherlands
| | - Arnoud P Verhoeff
- Department of Sociology, University of Amsterdam, P.O. Box 15508, 1001, NA, Amsterdam, The Netherlands.,Department of Epidemiology, Health Promotion and Care Innovation, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018, WT, Amsterdam, The Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Ageeth N Rosman
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
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Rundle R, Soltani H, Duxbury A. Exploring the views of young women and their healthcare professionals on dietary habits and supplementation practices in adolescent pregnancy: a qualitative study. BMC Nutr 2018; 4:45. [PMID: 32153906 PMCID: PMC7050931 DOI: 10.1186/s40795-018-0254-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background Nutrition is a modifiable factor affecting foetal growth and pregnancy outcomes. Inadequate nutrition is of particular concern in adolescent pregnancies with poor quality diet and competing demands for nutrients. The aim of this study was to explore knowledge and understanding of nutrition advice during adolescent pregnancy, and identify barriers and facilitators to dietary change and supplementation use in this vulnerable population. Methods Semi-structured interviews were conducted with young women and key antenatal healthcare providers: midwives, family nurses and obstetricians. Doncaster, Manchester and London were chosen as sites offering different models of midwifery care alongside referral to the Family Nurse Partnership programme. Results A total of 34 young women (adolescents aged 16–19 years) and 20 health professionals were interviewed. Young women made small changes to their dietary intake despite limited knowledge and social constraints. Supplementation use varied; the tablet format was identified by few participants as a barrier but forgetting to take them was the main reason for poor adherence. Health professionals provided nutrition information but often lack the time and resources to tailor this appropriately. Young women’s prime motivator was a desire to have a healthy baby; they wanted to understand the benefits of supplementation and dietary change in those terms. Conclusion Pregnancy is a window of opportunity for improving nutrition but often constrained by social circumstances. Health professionals should be supported in their role to access education, training and resources which build their self-efficacy to facilitate change in this vulnerable population group beyond the routine care they provide. Electronic supplementary material The online version of this article (10.1186/s40795-018-0254-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel Rundle
- 1Food and Nutrition Group, Sheffield Business School, Sheffield Hallam University, City Campus, Howard Street, Sheffield, S1 1WB UK
| | - Hora Soltani
- 2Centre for Health and Social Care Research, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Alexandra Duxbury
- 2Centre for Health and Social Care Research, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Allan HT, Mounce G, Crespo E, Shawe J. Preconception care for infertile couples: Nurses' and midwives' roles in promoting better maternal and birth outcomes. J Clin Nurs 2018; 27:4411-4418. [PMID: 29943889 DOI: 10.1111/jocn.14586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/18/2018] [Accepted: 06/16/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Preconception care promotes better maternal outcomes, may assist in preventing birth defects and improves fertility awareness among healthy childbearing couples. Yet, the significance of preconception care for infertile couples is undeveloped area of practice in Europe. AIMS AND OBJECTIVES To discuss the importance of nurses and midwives in providing preconception care to infertile couples in the United Kingdom and Spain. DESIGN Discursive paper. METHOD A comparison of different midwifery and nursing approaches to preconception care for infertile couples in two European countries. FINDINGS At present, infertile couples' needs for preconception care are not routinely identified or understood. There is an opportunity for these needs to be considered and identified by nurses at the time of investigation for infertility or when planning pregnancy with assisted conception. CONCLUSIONS We argue that, by providing preconception care, nurses and midwives have an opportunity to deliver important advice to infertile couples in both primary care and specialist infertility services.
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Affiliation(s)
| | - Ginny Mounce
- University of Oxford/Oxford Fertility, Oxford, UK
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Stephenson J, Heslehurst N, Hall J, Schoenaker DAJM, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M, Kumaran K, Yajnik CS, Baird J, Mishra GD. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet 2018; 391:1830-1841. [PMID: 29673873 PMCID: PMC6075697 DOI: 10.1016/s0140-6736(18)30311-8] [Citation(s) in RCA: 620] [Impact Index Per Article: 103.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/03/2017] [Accepted: 01/31/2018] [Indexed: 12/15/2022]
Abstract
A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from low-income, middle-income, and high-income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high-income and low-income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Several studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little effect on maternal and newborn health outcomes. Comparatively few interventions have been made for preconception diet and lifestyle. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that it is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and actions at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases. Alongside continued efforts to reduce smoking, alcohol consumption, and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly, health professionals should be alerted to ways of identifying women who are planning a pregnancy.
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Affiliation(s)
- Judith Stephenson
- Institute for Women's Health, University College London, London, UK.
| | - Nicola Heslehurst
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jennifer Hall
- Institute for Women's Health, University College London, London, UK
| | | | - Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Lucilla Poston
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, UK
| | | | - Sarah R Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Kalyanaraman Kumaran
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - Chittaranjan S Yajnik
- Diabetes Unit, King Edward Memorial Hospital and Research Centre, Pune, Maharashtra, India
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Gita D Mishra
- School of Public Health, University of Queensland, Herston, QLD, Australia
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Ben Natan M, Brandin Rimkus A, Tseytlin Eryomine A. Factors associated with intention of Israeli-born women and immigrant women from the Former Soviet Union to take folic acid before and during pregnancy. Int J Nurs Pract 2018; 24:e12622. [PMID: 29417703 DOI: 10.1111/ijn.12622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/24/2017] [Accepted: 12/27/2017] [Indexed: 11/27/2022]
Abstract
AIM Folic acid supplementation before and during pregnancy decreases rates of neural tube defects. However, many women fail to adhere to folic acid supplementation recommendations. This study explored factors associated with women's intention to take folic acid before and during pregnancy, using the Theory of Planned Behaviour, with an emphasis on differences between Israeli-born women and immigrant women from the Former Soviet Union. METHODS In this cross-sectional study, 100 Israeli born-women and 100 women from the Former Soviet Union of childbearing age completed a questionnaire, based on the Theory of Planned Behaviour. RESULTS The findings indicated a significant difference in the rates at which Israeli-born and FSU-born women took folic acid before and during pregnancy, as well as a significant difference in their intention to take folic acid supplementation in future pregnancies. The theoretical model explained 88.7% of variance in women's intention to take folic acid, with the most influential variable being behavioural attitudes towards taking folic acid. CONCLUSION The study emphasizes the need to increase knowledge and change attitudes and beliefs about folic acid supplementation among women and their significant others, as well as the importance of cultural, language, and economic barriers when treating Former Soviet Union immigrant populations.
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Affiliation(s)
- Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
| | - Alina Brandin Rimkus
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
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21
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M'hamdi HI, Sijpkens MK, de Beaufort I, Rosman AN, Steegers EA. Perceptions of pregnancy preparation in women with a low to intermediate educational attainment: A qualitative study. Midwifery 2018; 59:62-67. [PMID: 29396381 DOI: 10.1016/j.midw.2018.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 12/07/2017] [Accepted: 01/03/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE in the promotion of periconceptional health, appropriate attention has to be given to the perceptions of those who are most vulnerable, such as women with a relatively low socioeconomic status based on their educational attainment. The aim of this study was to explore these women's perceptions of pregnancy preparation and the role they attribute to healthcare professionals. DESIGN we conducted semi-structured interviews with women with a low to intermediate educational attainment and with a desire to conceive, of which a subgroup had experience with preconception care. Thematic content analysis was applied on the interview transcripts. FINDINGS the final sample consisted of 28 women. We identified four themes of pregnancy preparation perceptions: (i)"How to prepare for pregnancy?", which included health promotion and seeking healthcare; (ii) "Why prepare for pregnancy?", which mostly related to fertility and health concerns; (iii) "Barriers and facilitators regarding pregnancy preparation", such as having limited control over becoming pregnant as well as the health of the unborn; (iv) "The added value of preconception care", reported by women who had visited a consultation, which consisted mainly of reassurance and receiving information. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE the attained insights into the perceptions of women with a low to intermediate education are valuable for adapting the provision of preconception care to their views. We recommend the proactive offering of preconception care, including information on fertility, to stimulate adequate preparation for pregnancy and contribute to improving perinatal health among women who are socioeconomically more vulnerable.
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Affiliation(s)
- Hafez Ismaili M'hamdi
- Department of Medical Ethics and Philosophy of Medicine, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Meertien K Sijpkens
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Inez de Beaufort
- Department of Medical Ethics and Philosophy of Medicine, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Ageeth N Rosman
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Eric Ap Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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Ojukwu O, Patel D, Stephenson J, Howden B, Shawe J. General practitioners' knowledge, attitudes and views of providing preconception care: a qualitative investigation. Ups J Med Sci 2016; 121:256-263. [PMID: 27646963 PMCID: PMC5098490 DOI: 10.1080/03009734.2016.1215853] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/08/2016] [Accepted: 07/16/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Preconception health and care aims to reduce parental risk factors before pregnancy through health promotion and intervention. Little is known about the preconception interventions that general practitioners (GPs) provide. The aim of this study was to examine GPs' knowledge, attitudes, and views towards preconception health and care in the general practice setting. METHODS As part of a large mixed-methods study to explore preconception care in England, we surveyed 1,173 women attending maternity units and GP services in London and interviewed women and health professionals. Seven GPs were interviewed, and the framework analysis method was used to analyse the data. FINDINGS Seven themes emerged from the data: Knowledge of preconception guidelines; Content of preconception advice; Who should deliver preconception care?; Targeting provision of preconception care; Preconception health for men; Barriers to providing preconception care; and Ways of improving preconception care. A lack of knowledge and demand for preconception care was found, and although reaching women before they are pregnant was seen as important it was not a responsibility that could be adequately met by GPs. Specialist preconception services were not provided within GP surgeries, and care was mainly targeted at women with medical conditions. GPs described diverse patient groups with very different health needs. CONCLUSION Implementation of preconception policy and guidelines is required to engage women and men and to develop proactive delivery of care with the potential to improve pregnancy and neonatal outcomes. The role of education and of nurses in improving preconception health was acknowledged but remains under-developed.
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Affiliation(s)
- Obiamaka Ojukwu
- Institute for Women’s Health, University College London, London, United Kingdom
| | - Dilisha Patel
- Institute for Women’s Health, University College London, London, United Kingdom
| | - Judith Stephenson
- Institute for Women’s Health, University College London, London, United Kingdom
| | - Beth Howden
- University of Bristol, Bristol, United Kingdom
| | - Jill Shawe
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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Hill B, McPhie S, Moran LJ, Harrison P, Huang TTK, Teede H, Skouteris H. Lifestyle intervention to prevent obesity during pregnancy: Implications and recommendations for research and implementation. Midwifery 2016; 49:13-18. [PMID: 27756642 DOI: 10.1016/j.midw.2016.09.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/12/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
Maternal obesity and excessive gestational weight gain (GWG) are significant contributors to the global obesity epidemic. However, isolated lifestyle interventions to address this in pregnancy appear to have only modest benefit and responses can be variable. This paper aims to address the question of why the success of lifestyle interventions to prevent excessive GWG is suboptimal and variable. We suggest that there are inherent barriers to lifestyle change within pregnancy as a life stage, including the short window available for habit formation; the choice for women not to prioritise their weight; competing demands including physiological, financial, relationship, and social situations; and lack of self-efficacy among healthcare professionals on this topic. In order to address this problem, we propose that just like all successful public health approaches seeking to change behaviour, individual lifestyle interventions must be provided in the context of a supportive environment that enables, incentivises and rewards healthy changes. Future research should focus on a systems approach that integrates the needs of individuals with the context within which they exist. Borrowing from the social marketing principle of 'audience segmentation', we also need to truly understand the needs of individuals to design appropriately tailored interventions. This approach should also be applied to the preconception period for comprehensive prevention approaches. Additionally, relevant policy needs to reflect the changing evidence-based climate. Interventions in the clinical setting need to be integrally linked to multipronged obesity prevention efforts in the community, so that healthy weight goals are reinforced throughout the system.
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Affiliation(s)
- Briony Hill
- Deakin University, GEELONG, Australia, School of Psychology, Locked Bag 20000, Geelong, VIC 3220, Australia.
| | - Skye McPhie
- Deakin University, GEELONG, Australia, School of Psychology, Locked Bag 20000, Geelong, VIC 3220, Australia.
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Locked bag 29, Clayton 3168, Australia.
| | - Paul Harrison
- Deakin University, GEELONG, Australia, Deakin Business School, Locked Bag 20000, Geelong, VIC 3220, Australia.
| | - Terry T-K Huang
- Graduate School of Public Health and Health Policy, City University of New York, 55W. 125th Street, New York, NY 10027, United States.
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Locked bag 29, Clayton 3168, Australia.
| | - Helen Skouteris
- Deakin University, GEELONG, Australia, School of Psychology, Locked Bag 20000, Geelong, VIC 3220, Australia.
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