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Introducing reproductive life plan-based information in contraceptive counselling: an RCT
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
2013 (English)In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 28, no 9, 2450-2461 p.Article in journal (Refereed) Published
Abstract [en]

Can reproductive life plan (RLP)-based information in contraceptive counselling before pregnancy increase womens knowledge of reproduction, and of the importance of folic acid intake in particular? The RLP-based information increased womens knowledge of reproduction including knowledge of folic acid intake. Many women have insufficient knowledge of reproduction, including a health-promoting lifestyle prior to conception, and highly educated women in particular postpone childbearing until an age when their fertile capacity has started to decrease. The study was an randomized controlled trial with one intervention group (IG) and two control groups (CG1, CG2). A sample size calculation indicated that 82 women per group would be adequate. Recruitment took place during 3 months in 2012 and 299 women were included. The women were randomized in blocks of three. All groups received standard care (contraceptive counselling, Chlamydia testing, cervical screening). In addition, women in the IG were given oral and written RLP-based information about reproduction. A total of 299 out of 338 (88) Swedish-speaking women visiting a Student Health Centre were included (mean age 23 years); response rate was 88. Before the counselling, women in the IG and the CG1 completed a baseline questionnaire, including questions about lifestyle changes in connection to pregnancy planning, family planning intentions and knowledge of reproduction (e.g. the fecundity of an ovum). At follow-up 2 months after inclusion, a structured telephone interview was performed in all groups (n 262, 88 participation rate). There was no difference between the groups regarding the mean knowledge score at baseline. The IG scored higher at follow-up than at baseline (P 0.001); the mean increased from 6.4 to 9.0 out of a maximum 20 points. The women in the CG1 scored no differently at follow-up than at baseline. The difference in the knowledge score between the IG and the two CGs was significant (P 0.001), whereas no difference was shown between the two CGs. There was no difference between the groups at baseline regarding how many women could mention folic acid intake among the things to do when planning to get pregnant. At follow-up, 22 in the IG, 3 in CG1 and 1 in CG2 mentioned folic acid intake (P 0.001). At follow-up, more women in the IG also wished to have their last child earlier in life (P 0.001) than at baseline, while there was no difference in the CG1. As the study sample consisted of university students, it is possible that the effect of the intervention was connected to a high level of education and conclusions for all women of reproductive age should be drawn with caution. The provision of RLP-based information seems to be a feasible tool for promoting reproductive health. Study funding was received from the Faculty of Medicine, Uppsala University, Sweden. There are no conflicts of interest. ClinicalTrial.gov Identifier NCT01739101.

Place, publisher, year, edition, pages
2013. Vol. 28, no 9, 2450-2461 p.
Keyword [en]
health education, reproductive health, fertility, pregnancy
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-208057DOI: 10.1093/humrep/det279ISI: 000323596400017OAI: oai:DiVA.org:uu-208057DiVA: diva2:651102
Available from: 2013-09-24 Created: 2013-09-23 Last updated: 2016-01-13Bibliographically approved
In thesis
1. Preconception Health and Care: A Window of Opportunity
Open this publication in new window or tab >>Preconception Health and Care: A Window of Opportunity
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Rådgivning inför graviditet : Ett gyllene tillfälle
Abstract [en]

Women’s health and lifestyle before pregnancy can influence both the fertility and the health of mother and child. The overall aim of this thesis was to explore current preconception health and care and evaluate a new tool for preconception care.

Study I was a qualitative descriptive analysis of preconception recommendations in six European countries. All six countries had guidelines for high-risk women, but guidelines for healthy women were fragmented and inconsistent. Guidelines regarding nutrition and lifestyle differed between countries. Preconception care was offered to high-risk women but otherwise on an opportunistic basis.

Study II was a cross sectional study measuring pregnancy planning among 3390 pregnant women at antenatal clinics. Three out of four pregnancies were very or fairly planned and 12 % fairly or very unplanned. Women with planned pregnancies were more likely to have a higher socioeconomic status and to have longer relationships than women with unplanned pregnancies. The level of pregnancy planning was associated with planning behavior, such as information seeking and intake of folic acid, but without a reduction in alcohol consumption.

Study III was a randomized controlled trial evaluating the Reproductive Life Plan (RLP) as a health promoting tool in contraceptive counselling. Women (n=299) at a student health center were randomized to standard care or standard care plus RLP. RLP-based counselling increased women’s knowledge of both reproduction and folic acid intake prior to pregnancy, affected the women’s RLP and was appreciated by the women.

Study IV explored the adaption of RLP among midwives using mixed methods with focus group interviews and a questionnaire. Midwives generally adopted the RLP in contraceptive counselling, had predominantly positive experiences of the RLP and considered it a feasible tool for promoting reproductive health.

In conclusion, preconception care is a public health issue. Pregnancy planning is associated with socioeconomic background, and preventive measures could have great health benefits both for women of reproductive age and their future children. There is a need for both national and European cohesive evidence-based preconception care guidelines. The RLP is a feasible tool for promoting preconception health and can potentially form the missing link between contraceptive counselling and antenatal care. 

Abstract [sv]

Kvinnors hälsa och levnadsvanor före graviditet kan påverka både fertiliteten och hälsan hos moder och barn. Avhandlingens övergripande syfte var att utforska hälsa och rådgivning/vård inför graviditet och att utvärdera en ny metod för rådgivning.

Studie I var en kvalitativ deskriptiv analys av riktlinjer för hälsa och rådgivning inför graviditet i sex europeiska länder. Alla länder hade riktlinjer för kvinnor med kroniska sjukdomar, men det fanns få och fragmenterade riktlinjer för friska kvinnor och för män. Ländernas riktlinjer för nutrition och levnadsvanor skiljde sig delvis åt. Vård inför graviditet erbjöds bara rutinmässigt till kvinnor med kroniska sjukdomar.

Studie II var en tvärsnittstudie som mätte graviditetsplanering bland 3390 gravida kvinnor vid inskrivning i mödravården. Tre av fyra graviditeter var mycket/ganska planerade och 12 % mycket/ganska oplanerade. Kvinnor med planerade graviditeter hade med större sannolikhet en högre socioekonomisk status och längre förhållanden än kvinnor med oplanerade graviditeter. Det fanns samband mellan hur planerad graviditeten var och planeringsbeteende såsom informations­sökning och folsyra­intag, men inte med alkoholkonsumtion.

Studie III var en interventionsstudie för att utvärdera Reproduktiv livsplan (RLP), ett hälsofrämjande samtalsunderlag i preventivmedelsrådgivning. Kvinnor som besökte en studentmottagning för preventivmedelsrådgivning lottades till sedvanlig vård eller sedvanlig vård med RLP. Preventivmedelsrådgivning baserad på konceptet Reproduktiv livsplan (RLP) ökade kvinnors kunskaper både om reproduktion och folsyra, påverkade kvinnornas RLP och uppskattades av kvinnorna.

I Studie IV kombinerades fokusgrupper med en enkät för att undersöka anammandet av RLP bland barnmorskor. Barnmorskorna anammade överlag RLP i sin preventivmedels­rådgivning, hade övervägande positiva upplevelser av det och ansåg att det var ett användbart verktyg för reproduktivt hälsofrämjande.

Hälsa och rådgivning inför graviditet kan sammanfattningsvis beskrivas som en folkhälsofråga, och förebyggande insatser kan ge hälsovinster för både kvinnor i reproduktiv ålder och deras framtida barn. Det behövs både nationella och europeiska evidensbaserade riktlinjer. RLP-baserad preventivedelsrådgivning tycks vara ett användbart verktyg för att främja hälsa och kan potentiellt överbrygga glappet mellan preventivmedelsrådgivning och mödrahälsovård. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 71 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1160
National Category
Medical and Health Sciences
Research subject
Medical Science
urn:nbn:se:uu:diva-265542 (URN)978-91-554-9402-5 (ISBN)
Public defence
2015-12-18, Universitetshuset, Sal X, Biskopsgatan 3, Uppsala, 09:00 (Swedish)
Available from: 2015-11-26 Created: 2015-10-31 Last updated: 2016-01-13

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