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Preconception Health and Care: A Window of Opportunity
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.ORCID iD: 0000-0002-2753-9140
2015 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Rådgivning inför graviditet : Ett gyllene tillfälle (Swedish)
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: urn:nbn:se:uu:diva-265542ISBN: 978-91-554-9402-5OAI: oai:DiVA.org:uu-265542DiVA: diva2:866184
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
List of papers
1. Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom
Open this publication in new window or tab >>Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom
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2015 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 20, no 2, 77-87 p.Article in journal (Refereed) Published
Abstract [en]

Objectives Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries. Methods In 2013, an electronic search and investigation was undertaken of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. Findings were compared within five categories: Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites. Results All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations for healthy women and men were fragmented and inconsistent. Preconception guidance was often included in antenatal and pregnancy guidelines. Differences between countries were seen with regard to nutritional and lifestyle advice particularly in relation to fish, caffeine and alcohol consumption, and vitamin supplementation. Conclusions Current guidelines are heterogeneous. Collaborative research across Europe is required in order to develop evidence-based guidelines for preconception health and care. There is a need to establish a clear strategy for promoting advice and guidance within the European childbearing population.

Preconception care, Pre-pregnancy health and care, Pregnancy, Policy, Guidelines, Europe
National Category
urn:nbn:se:uu:diva-252391 (URN)10.3109/13625187.2014.990088 (DOI)000351398300002 ()25548961 (PubMedID)
Available from: 2015-05-06 Created: 2015-05-06 Last updated: 2016-08-22
2. Is pregnancy planning associated with background characteristics and pregnancy planning behavior?
Open this publication in new window or tab >>Is pregnancy planning associated with background characteristics and pregnancy planning behavior?
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(English)Manuscript (preprint) (Other academic)
Planned pregnancy, unplanned pregnancy, preconception care, folic acid, health behavior.
National Category
Medical and Health Sciences
urn:nbn:se:uu:diva-265541 (URN)
The Swedish Pregnancy Planning (SWEPP) study
Available from: 2015-10-31 Created: 2015-10-31 Last updated: 2016-01-13
3. Introducing reproductive life plan-based information in contraceptive counselling: an RCT
Open this publication in new window or tab >>Introducing reproductive life plan-based information in contraceptive counselling: an RCT
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.

health education, reproductive health, fertility, pregnancy
National Category
Medical and Health Sciences
urn:nbn:se:uu:diva-208057 (URN)10.1093/humrep/det279 (DOI)000323596400017 ()
Available from: 2013-09-24 Created: 2013-09-23 Last updated: 2016-01-13Bibliographically approved
4. Midwives' adoption of the reproductive life plan in contraceptive counselling: a mixed methods study
Open this publication in new window or tab >>Midwives' adoption of the reproductive life plan in contraceptive counselling: a mixed methods study
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2015 (English)In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 30, no 5, 1146-1155 p.Article in journal (Refereed) Published
Abstract [en]

STUDY QUESTION: How is the reproductive life plan (RLP) adopted in midwifery contraceptive counselling? SUMMARY ANSWER: A majority of midwives adopted the RLP in their counselling, had predominantly positive experiences and considered it a feasible tool for promoting reproductive health. WHAT IS KNOWN ALREADY: The RLP is a health-promoting tool recommended by the Centers for Disease Control and Prevention in the USA for improving preconception health. It was recently used in a clinical setting in Sweden and was found to increase women's knowledge about fertility and to influence women's wishes to have their last child earlier in life. STUDY DESIGN, SIZE, DURATION: An exploratory mixed methods study among 68 midwives who provided contraceptive counselling in primary health care to at least 20 women each during the study period. Midwives received an introduction and materials for using the RLP in contraceptive counselling. Three months later, in the spring of 2014, they were invited to complete a questionnaire and participate in a focus group interview about their adoption of the RLP. PARTICIPANTS/MATERIALS, SETTING, METHODS: Data collection was through a questionnaire (n = 53 out of 68; participation rate 78%) and five focus group interviews (n = 22). Participants included both younger and older midwives with longer and shorter experiences of contraceptive counselling in public and private health care in one Swedish county. Quantitative data were analysed for differences between users and non-users, and qualitative data were analysed by qualitative content analysis to explore the midwives experiences and opinions of using the RLP. MAIN RESULTS AND THE ROLE OF CHANCE: Sixty-eight per cent of midwives had used the RLP in their contraceptive counselling. Four categories emerged through the focus group interviews: (i) A predominantly positive experience; (ii) The RLP-a health-promoting tool; (iii) individual and societal factors influence the RLP counselling; and (4) long-term implementation comprises opportunities, risks and needs. The most common reason for not using the RLP was lack of information. LIMITATIONS, REASONS FOR CAUTION: There was general lack of experience of using the RLP with women from different cultural backgrounds, with non-Swedish speaking women and, when a partner was present. Due to the non-random sample, the limited knowledge about non-responders and a short follow-up period, results apply to short-term implementations and might not fully apply to long-term implementation. WIDER IMPLICATIONS OF THE FINDINGS: The use of RLP in contraceptive counselling appears a feasible way of promoting reproductive health. Results from the USA and Sweden indicate it is a promising tool for midwives and other health professionals involved in reproductive counselling, which deserves to be explored in other nations.

family planning, contraceptive counselling, planned pregnancy, unplanned pregnancy, preconception care
National Category
Obstetrics, Gynecology and Reproductive Medicine
urn:nbn:se:uu:diva-256536 (URN)10.1093/humrep/dev048 (DOI)000354792100015 ()25771220 (PubMedID)
Available from: 2015-06-25 Created: 2015-06-24 Last updated: 2016-01-13Bibliographically approved

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