Preconception care: screening and management of chronic disease and promoting psychological health

Abstract

IntroductionA large proportion of women around the world suffer from chronic diseases including mental health diseases. In the United States alone, over 12% of women of reproductive age suffer from a chronic medical condition, especially diabetes and hypertension. Chronic diseases significantly increase the odds for poor maternal and newborn outcomes in pregnant women.MethodsA systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for preventing and managing chronic diseases and promoting psychological health on maternal, newborn and child health outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.ResultsMaternal prepregnancy diabetic care is a significant intervention that reduces the occurrence of congenital malformations by 70% (95% Confidence Interval (CI): 59-78%) and perinatal mortality by 69% (95% CI: 47-81%). Furthermore, preconception management of epilepsy and phenylketonuria are essential and can optimize maternal, fetal and neonatal outcomes if given before conception. Ideally changes in antiepileptic drug therapy should be made at least 6 months before planned conception. Interventions specifically targeting women of reproductive age suffering from a psychiatric condition show that group-counseling and interventions leading to empowerment of women have reported non-significant reduction in depression (economic skill building: Mean Difference (MD) -7.53; 95% CI: -17.24, 2.18; counseling: MD-2.92; 95% CI: -13.17, 7.33).ConclusionWhile prevention and management of the chronic diseases like diabetes and hypertension, through counseling, and other dietary and pharmacological intervention, is important, delivering solutions to prevent and respond to women’s psychological health problems are urgently needed to combat this leading cause of morbidity.

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

“…Alcohol, tobacco, and caffeine exposure are associated with adverse maternal and child health outcomes [269]. Such consumptions are modifiable risk factors for LBW and preterm birth, and, therefore, they are important targets for prevention strategies.…”

“…The risk of having a preterm birth or an SGA infant is increased in mothers with chronic diseases [268]. Preconception care for women with underlying chronic diseases is crucial to plan a healthy pregnancy in terms of maximization of maternal health, making medication adjustments and timing of pregnancy [269]. The prevalence of chronic diseases in women of reproductive age is not comprehensively described globally, but it has increased in recent years and may be compounded by increasing maternal age [119].…”

“…3 Identify and treat diseases and complications (e.g., preexisting diabetes, renal insufficiency, hypertension, anemia, and infections) that may affect maternal, fetal, and neonatal health before conception [121,269,277,278,279,280,281]. …”

Preconception health and care (PHC)—a strategy for improved maternal and child health

“…Thus the evidence for improved pregnancy outcomes is indirect at best. The best evidence for important benefits of preconception care is for diabetic women, for whom good metabolic control before pregnancy will decrease the risk of malformations (7). …”

Consultation préconceptionnelle et psychopathologie

“…En effet, des épisodes de dépression anté-et post-natales ont un impact sérieux sur la vie de famille, la relation mère-enfant et la future santé mentale de l'enfant [3]. Selon plusieurs études, l'existence de troubles psychiatriques préexis-tants est l'un des meilleurs prédicteur de dépression du postpartum [4,5].…”