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Preconception health interventions delivered in public health and community settings: A systematic review

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Abstract

OBJECTIVES: The objective of this systematic review was to assess the effects of preconception health interventions, delivered to individuals of reproductive age in public health and community settings, on reproductive, maternal, and child health outcomes.

METHODS: A search of Ovid MEDLINE, CINAHL, EMBASE, PsychINFO, Scopus, Gender Studies Database, and SocINDEX from July 1999 through July 2016 was performed. We included studies that reported original data, used an interventional study design, included reproductive-aged women or men, were written in English, and were published in peer-reviewed journals. Two reviewers independently used standardized instruments for data extraction and quality assessment. A narrative synthesis was performed.

SYNTHESIS: Twelve studies met the inclusion criteria. These studies included randomized controlled trials and quasi-experimental, pre-post, and time- series designs. Most studies were conducted in the United States; all but one study included only women. Interventions were mainly educational initiatives focused on nutrition, immunization, and lifestyle behaviours and were delivered in a single contact. The studies reported positive effects on health knowledge (n = 9), behaviour change (n = 4), and health outcomes (n = 1). Study quality was weak (n = 11) or moderate (n = 1), with limitations related to selection bias, blinding, data collection methods, and participant attrition.

CONCLUSION: To develop a comprehensive, standardized approach to preconception health promotion and care in Canada, there is a clear need for high- quality research evaluating the effectiveness of preconception health interventions. Studies should use a health equity lens that includes all individuals of reproductive age and addresses the broad determinants of preconception health.

Résumé

OBJECTIFS : Cette revue systématique vise à évaluer les effets d’interventions sanitaires préconceptionnelles, menées auprès de personnes en âge de procréer dans des contextes communautaires et de santé publique, sur les résultats de santé reproductive, maternelle et infantile.

MÉTHODE : Nous avons interrogé les bases de données Ovid MEDLINE, CINAHL, EMBASE, PsychINFO, Scopus, Gender Studies Database et SocINDEX entre juillet 1999 et juillet 2016. Nous avons inclus les études faisant état de données originales, utilisant un plan d’étude interventionnelle, incluant des femmes ou des hommes en âge de procréer, rédigées en anglais et parues dans des revues à comité de lecture. Deux évaluatrices ont utilisé de façon indépendante des instruments normalisés pour extraire les données et en évaluer la qualité. Une synthèse narrative a été effectuée.

SYNTHÈSE : Douze études ont répondu aux critères d’inclusion. Il s’agissait d’essais comparatifs randomisés, de démarches quasi expérimentales, d’études avant/après et d’analyses de séries chronologiques. La plupart avaient été menées aux États-Unis; toutes sauf une n’incluaient que des femmes. Les interventions étaient principalement des initiatives pédagogiques axées sur la nutrition, la vaccination et les comportements liés au mode de vie, et elles avaient été menées en un seul contact. Les études ont fait état d’effets positifs sur les connaissances en santé (n = 9), sur les changements de comportements (n = 4) et sur les résultats de santé (n = 1). Leur qualité était faible (n = 11) ou modérée (n = 1), avec des contraintes liées au biais de sélection, à l’insu, aux méthodes de collecte de données et à l’attrition des participantes.

CONCLUSION : Pour élaborer une méthode globale et normalisée d’aborder la promotion de la santé et les soins préconceptionnels au Canada, il est clairement nécessaire d’avoir des études de haute qualité qui évaluent l’efficacité des interventions sanitaires préconceptionnelles. Ces études devraient utiliser un prisme d’équité en santé qui inclut toutes les personnes en âge de procréer et qui aborde les grands déterminants de la santé préconceptionnelle.

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References

  1. World Health Organization. Pre-Conception Care: Maximizing the Gains for Maternal and Child Health. Geneva, Switzerland: World Health Organization, 2013.

    Google Scholar 

  2. Alberta Perinatal Health Program. 2014 Preconception Health Framework. Edmonton, AB: Alberta Perinatal Health Program, 2007.

    Google Scholar 

  3. World Health Organization. Meeting to Develop a Global Consensus on Preconception Care to Reduce Maternal and Childhood Mortality and Morbidity. Geneva, Switzerland: World Health Organization, 2012.

    Google Scholar 

  4. Atrash HK, Johnson K, Adams MM, Cordero JF, Howse J. Preconception care for improving perinatal outcomes: The time to act. Matern Child Health J 2006;10:S3–11. PMID: 16773452. doi: 10.1007/s10995-006-0100-4.

    Article  PubMed  Google Scholar 

  5. Centers for Disease Control and Prevention. Preconception Health and Health Care: Information for Health Professionals. Washington, DC: Centers for Disease Control, 2012.

    Google Scholar 

  6. Chandranipapongse W, Koren G. Preconception counseling for preventable risks. Can Fam Physician 2013;59:737–39. PMID: 23851536.

    PubMed  PubMed Central  Google Scholar 

  7. Grosse SD, Sotnikov SV, Leatherman S, Curtis M. The business case for preconception care: Methods and issues. Matern Child Health J 2006;10:S93–99. PMID: 16786418. doi: 10.1007/s10995-006-0101-3.

    Article  PubMed  Google Scholar 

  8. Allen VM, Armson BA, Wilson RD, Johnson JA, Blight C, Gagnon A, et al. Teratogenicity associated with pre-existing and gestational diabetes. J Obstet Gynaecol Can 2007;29:927–44. PMID: 17977497. doi: 10.1016/S1701-2163 (16)32653-6.

    Article  PubMed  Google Scholar 

  9. Yi Y, Lindemann M, Colligs A, Snowball C. Economic burden of neural tube defects and impact of prevention with folic acid: A literature review. Eur J Pediatr 2011;170:1391–400. PMID: 21594574. doi: 10.1007/s00431-011-1492-8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Herman WH, Janz NK, Becker MP, Charron-Prochownik D. Diabetes and pregnancy: Preconception care, pregnancy outcomes, resource utilization and costs. Obstet Gynecol Surv 1999;54:489–91.

    Article  Google Scholar 

  11. Dubois L, Girard M, Tatone-Tokuda F. Determinants of high birth weight by geographic region in Canada. Chronic Dis Can 2007;28:63–70. PMID: 17953799.

    PubMed  Google Scholar 

  12. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384:980–1004. PMID: 24797575. doi: 10. 1016/S0140-6736(14)60696-6.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Finer LB, Zolna, MR. Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception 2011;84:478–85. PMID: 22018121. doi: 10.1016/j.contraception.2011.07.013.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Moos MK, Dunlop AL, Jack BW, Nelson L, Coonrod DV, Long R, et al. Healthier women, healthier reproductive outcomes: Recommendations for the routine care of all women of reproductive age. Am J Obstet Gynecol 2008; 199:S280–89. PMID: 19081422. doi: 10.1016/j.ajog.2008.08.060.

    Article  PubMed  Google Scholar 

  15. Wise, PH. Transforming preconceptional, prenatal, and interconceptional care into a comprehensive commitment to women’s health. Womens Health Issues 2008;18:S13–18. PMID: 18951817. doi: 10.1016/j.whi.2008.07.014.

    Article  PubMed  Google Scholar 

  16. Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn, JE. Continuum of care for maternal, newborn, and child health: From slogan to service delivery. Lancet 2007;370:1358–69. PMID: 17933651. doi: 10.1016/ S0140-6736(07)61578-5.

    Article  PubMed  Google Scholar 

  17. Ontario Ministry of Health and Long-Term Care Healthy Kids Panel. No Time to Wait: The Healthy Kids Strategy. Toronto, ON: Queen’s Printer for Ontario, 2013.

    Google Scholar 

  18. Ontario Public Health Association. SHIFT: Enhancing the Health of Ontarians: A Call to Action for Preconception Health Promotion & Care. Toronto, ON: Ontario Public Health Association, 2014.

    Google Scholar 

  19. Ontario Ministry of Health and Long-Term Care. Ontario Public Health Standards 2008. Toronto, ON: Ontario Ministry of Health and Long-Term Care, 2008.

    Google Scholar 

  20. Hussein N, Kai J, Qureshi N. The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review. Eur J Gen Pract 2016;22:42–52. PMID: 26610260. doi: 10.3109/13814788.2015.1099039.

    Article  PubMed  Google Scholar 

  21. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009;6(7):e1000097. PMID: 19621072. doi: 10.1371/journal.pmed.1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Korenbrot CC, Steinberg A, Bender C, Newberry S. Preconception care: A systematic review. Matern Child Health J 2002;6(2):75–88. doi: 10.1023/A: 1015460106832.

    Article  PubMed  Google Scholar 

  23. Armijo-Olivo S, Stiles CR, Hagen NA, Biondo PD, Cummings, GG. Assessment of study quality for systematic reviews: A comparison of the cochrane collaboration risk of bias tool and the effective public health practice project quality assessment tool: Methodological research. J Eval Clin Pract 2012; 18(1):12–18. PMID: 20698919. doi: 10.1111/j.1365-2753.2010.01516.x.

    Article  PubMed  Google Scholar 

  24. Agricola E, Pendolfi E, Gonfiantini MV, Gesualdo F, Romano M, Carloni E, et al. A cohort study of a tailored web intervention for preconception care. BMC Med Inform Decis Mak 2014;14(33). PMID: 24731520. doi: 10.1186/1472-6947-14-33.

    Google Scholar 

  25. Bimla Schwarz E, Sobota M, Gonzales R, Gerbert B. Computerized counseling for folate knowledge and use: A randomized controlled trial. Am J Prev Med 2008;35(6):568–71. PMID: 19000845. doi: 10.1016/j.amepre.2008.06.034.

    Article  Google Scholar 

  26. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, et al. “Folate before pregnancy”: The impact on women and health professionals of a population-based health promotion campaign in South Australia. Med J Aust 2001;174(12):631–36. PMID: 11480683.

    Article  CAS  PubMed  Google Scholar 

  27. DeJoy, SB. Pilot test of a preconception and midwifery care promotion program for college women. J Midwifery Womens Health 2014;59(5):523–27. PMID: 24890731. doi: 10.1111/jmwh.12106.

    Article  PubMed  Google Scholar 

  28. Hillemeier MM, Downs DS, Feinberg ME, Weisman CS, Chuang CH, Parrott R, et al. Improving women’s preconceptional health: Findings from a randomized trial of the strong healthy women intervention in the Central Pennsylvania women’s health study. Womens Health Issues 2008;18(Suppl 6):S87–96. PMID: 19059553. doi: 10.1016/j.whi.2008.07.008.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hussaini KS, Hamm E, Means T. Using community-based participatory mixed methods research to understand preconception health in African American communities of Arizona. Matern Child Health J 2013;17(10):1862–71. PMID: 23229170. doi: 10.1007/s10995-012-1206-5.

    Article  PubMed  Google Scholar 

  30. King KW, Freimuth V, Lee M, Johnson-Turbes, CA. The effectiveness of bundled health messages on recall. Am J Health Promot 2013;27(Suppl 3):S28–35. PMID: 23286660. doi: 10.4278/ajhp.120113-QUAN-27.

    Article  Google Scholar 

  31. Mackert M, Kim E, Guadagmo M, Donovan-Kicken E. Using Twitter for prenatal health promotion: Encouraging a multivitamin habit among college-aged females. Stud Health Technol Inform 2012;182:93–103. PMID: 23138084. doi: 10.3233/978-1-61499-152-6-93.

    PubMed  Google Scholar 

  32. Milan JE, White, AA. Impact of a stage-tailored, web-based intervention on folic acid-containing multivitamin use by college women. Am J Health Promot 2010;24(6):388–95. PMID: 20594096. doi: 10.4278/ajhp.071231143.

    Article  PubMed  Google Scholar 

  33. Wade GH, Herrman J, McBeth-Snyder L. A preconception care program for women in a college setting. MCN Am J Matern Child Nurs 2012;37(3):164–70. PMID: 22417917. doi: 10.1097/NMC.0b013e31824b59c7.

    Article  PubMed  Google Scholar 

  34. Watson M, Watson L, Bell R, Halliday J. The increasing knowledge of the role of periconceptional folate in Victorian women of child-bearing age: Follow-up of a randomized community intervention trial. AustN Z J Public Health 2001; 25(5):389–95. PMID: 11688615. doi: 10.1111/j.1467-842X.2001.tb00280.x.

    Article  CAS  Google Scholar 

  35. Williams P, McHenery J, McMahon A, Anderson H. Impact evaluation of a folate education campaign with and without the use of a health claim. Aust N Z J Public Health 2001;25(5):396–404. PMID: 11688616. doi: 10.1111/j.1467- 842X.2001.tb00281.x.

    Article  CAS  PubMed  Google Scholar 

  36. Alter DA, Naylor CD, Austin PA, Tu, JV. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med 1999;341:1359–67. PMID: 10536129. doi: 10.1056/NEJM199910283411806.

    Article  CAS  PubMed  Google Scholar 

  37. McKeary M, Newbold B. Barriers to care: The challenges for Canadian refugees and their health care providers. J Refug Stud 2010;23(4):523–45. doi: 10.1093/jrs/feq038.

    Article  Google Scholar 

  38. Whitworth M, Dowswell T. Routine pre-pregnancy health promotion for improving pregnancy outcomes. Cochrane Database Syst Rev 2009;7(4): CD007536. PMID: 19821424. doi: 10.1002/14651858.CD007536.pub2.

    Google Scholar 

  39. Thiese, MS. Observational and interventional study design types: An overview. Biochem Med (Zagreb) 2014;24(2):199–210. PMID: 24969913. doi: 10.11613/BM.2014.022.

    Article  Google Scholar 

  40. Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS, et al. Recommendations to improve preconception health and health care — United States. MMWRRecomm Rep 2006;55(6):1–23. PMID: 16617292.

    Google Scholar 

  41. Best Start Resource Centre. Preconception Health: Awareness and Behaviours in Ontario. Toronto, ON: Best Start Resource Centre, 2009.

    Google Scholar 

  42. World Health Organization. The World Health Report 2001: MentalHealth: New Understanding, New Hope. Geneva, Switzerland: World Health Organization, 2001.

    Google Scholar 

  43. Goodman, JH. Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. JAN 2004; 45(1):26–35. doi: 10.1046/j.1365-2648.2003.02857.x.

    Article  Google Scholar 

  44. Public Health Agency of Canada. Congenital Anomalies in Canada 2013. Ottawa, ON: Public Health Agency of Canada, 2013.

    Google Scholar 

  45. Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman, PA. Socioeconomic disparities in adverse birth outcomes: A systematic review. Am J Prev Med 2010; 39(3):263–72. PMID: 20709259. doi: 10.1016/j.amepre.2010.05.012.

    Article  PubMed  Google Scholar 

  46. Mill C, Enders J, Montanaro C, Moore, KM. Delayed parenthood on the rise: A call for upstream preconception health promotion in Canada. Can J Public Health 2016;107(3):e333-35. PMID: 27763852. doi: 10.17269/cjph.107.5497.

    Google Scholar 

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Authors and Affiliations

  1. Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, 1265 Military Trail, Scarborough, ON, M1C 1A5, Canada

    Hilary K. Brown PhD

  2. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Hilary K. Brown PhD & Sarah Edwards PhD

  3. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada

    Hilary K. Brown PhD & Cindy-Lee Dennis PhD

  4. Alberta Health Services, Edmonton, AB, Canada

    Melissa Mueller BA & Sarah Edwards PhD

  5. Toronto Public Health, Toronto, ON, Canada

    Melissa Mueller BA & Catriona Mill RN, MHSc, CCHN(c)

  6. Ontario Public Health Association, Toronto, ON, Canada

    Catriona Mill RN, MHSc, CCHN(c) & Joanne Enders BScN, RN

  7. Region of Waterloo Public Health and Emergency Services, Waterloo, ON, Canada

    Joanne Enders BScN, RN

  8. Department of Family and Community Medicine, Homer Stryker M.D. School of Medicine, Western Michigan University, Kalamazoo, MI, Canada

    Lisa Graves MD

  9. Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Deanna Telner MD, MEd, CCFP, FCFP

  10. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Cindy-Lee Dennis PhD

  11. Department of Psychiatry, Faculty of Medicine, Toronto, ON, Canada

    Cindy-Lee Dennis PhD

  12. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Cindy-Lee Dennis PhD

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  1. Hilary K. Brown PhD
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  2. Melissa Mueller BA
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Conflicts of Interest: None to declare.

Acknowledgements: The authors thank Jorden Smith-Habib for performing the database searches and Natalie Bourdages, Shelley Charbonneau, Josée Dion-St. Pierre and Kimberley Marshall for reviewing previous versions of the manuscript.

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Brown, H.K., Mueller, M., Edwards, S. et al. Preconception health interventions delivered in public health and community settings: A systematic review. Can J Public Health 108, 388–397 (2017). https://doi.org/10.17269/CJPH.108.6029

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