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EFPC Conference 9-10 September 2013, Istanbul
Workshop Preconception Care
Denhard de Smit, PhD, Health Care researcher/EpidemiologistManaging director Research and Projects, MediClara Projects BV,
Abcoude NL
Arzu Uzuner, MD PhD, Associate Professor of Family MedicineMarmara University Hospital Pendik Training and Research
Hospital, Istanbul TR
1. Introduction
Today’s programme
1. Introduction 01-05
a. Agendab. Today’s participants
WGWG
2. Preconception care: headlines 06-15
a. The health issues of interestb. Involvement of PC, PH and specialist care c. Policy development: examples and events
DSDSDS
3. Primary care involvement in preconception care 16-55
a. Objectives for primary careb. Opportunities and requirementsc. Role of EFPC-network
16-3031-4546-55
5. Summary and closing 56-60
IntroductionIntroduction
Today’s participants
Who is who?
Name, country
Profession, current position and experience
Main reason to attend this workshop?
IntroductionIntroduction
2. Preconception care: headlines
General definition (1)
“Preconception care is defined in this advisory report as the entire raft of measures to promote the health of the mother-to-be and her child. If they are to be effective, these measures should preferably be undertaken prior to conception. Preconception care is therefore multidisciplinary, encompassing lifestyle (including food, drink, tobacco and other recreational drugs), working conditions, illness, medication and genetic factors.”
Health Council of the Netherlands. Preconception care: a good beginning. The Hague: Health Council of the Netherlands, 2007; publication no. 2007/19.
Preconception care: headlinesPreconception care: headlines
General definition (2)
Modified CDC definition by consensus:“A set of interventions and/or programme that aim to identify and enable informed decision-making to modify biomedical, behavioural, and (psycho) social risks to parental health and the health of their future child, through counselling, prevention and management, emphasizing those factors that must be acted on before conception or early in pregnancy to have maximal impact and/or choice.”
Dutch consensus meeting on Preconception Care. January/April 2012. The Netherlands. [To be published].
An overwiewAn overwiewPreconception care: headlinesPreconception care: headlines
a. The health issues of interest
Preconception care: headlinesPreconception care: headlines
The health issues … (1)
From the Dutch health council report
Food, alcohol, tobacco and other recreational drugs
• Folic Acid suppletion (general population 0,4 mg; increased risk 4,0 mg)
• Vitamin D suppletion (if needed)• Vitamin A (prevent too high intake)• Alcohol (fertility, FAS)• Tobacco (fertility, birth weight)
Working conditions• Chemical agents (pesticides, solvents, …)• Stress
An overwiewAn overwiewPreconception care: headlinesPreconception care: headlines
The health issues … (2)
Illness and medication• Infectious diseases (Vaccination, treatment and prevention)• Chronic diseases ilke diabetes, epilepsy, depression
(optimization of medication)• Teratogenic drugs (pregnancy prevention)• Obesity, anorexia and maternal/paternal age
Genetic factors• Extend range of options in the case of unfavourable genetic
background– Known increased risks (genetic diagnosis/counselling done
previously)– Indications from family history – Carrier screening (cystic fibrosis, hemoglobinopathies)
An overwiewAn overwiewPreconception care: headlinesPreconception care: headlines
The health issues … (3)
Additional issues that can/should be dealt with in the preconception period
Personal preparation for pregnancy?• Prenatal screening options (Down screening, 20-wk
ultrasound)
Medical preparation for pregnancy• Obstetric history• Increased risks from pre-existing disease
Timely uptake of prenatal care
An overwiewAn overwiewPreconception care: headlinesPreconception care: headlines
b. Involvement of PC, PH and specialist care
Preconception care: headlinesPreconception care: headlines
The involvement of primary care, public health and specialist care
“Preconception care has various, complementary forms. Some are aimed at individual parents-to-be, while others may, for example, collectively target all women of child-bearing age”.
and
“ … the various components of the programme … should not be provided as separate elements but as an integrated healthcare concept.”
An overwiewAn overwiewPreconception care: headlinesPreconception care: headlines
The involvement of … (1)
Care sectors
• Folic acid PH• Genetic risk assessment PC, SC• “Lifestyle” PH, PC, SC • Preconception consultation PC, SC• Promotion of preconception consultation
PH, PC
An overwiewAn overwiewPreconception care: headlinesPreconception care: headlines
The involvement of … (2)
Primary care workers
• GP’s: (promotion of) preconception consultation and follow-up as appropriate
• Midwives, nurses: preconception consultation and follow-up as appropriate
• Pharmacists: FA-education, medication surveillance, promotion of preconception consultation
An overwiewAn overwiew
The involvement of … (3)
An overwiewAn overwiew
Prevalences of risks/disorders
NTD’s• Affected pregnancies: ~1 in 1000• In Europe ~4.500 cases/year• 70% TOP
Cystic fibrosis• Cases: 1 in 3600 newborns• Couples at risk: 1 in 900
Medication use first trimester• 40 in 100 >= 1 prescription
An overwiewAn overwiew
a. Developments: implementation and events
Developments: ….Developments: ….
Developments: implementation and events
Existing implementation in HungaryProgramme development 1984-1994Current implementation by specialized nurses
Developments in The NetherlandsMinistry of Health reply to Health Council report (2007)Coordination of resources for public information (RIVM)Major role for midwives in preconception consultation?GP- Standard available (2011)
Implementation in ItalyActive implementation e.g. in Veneto region (2010)
An overwiewAn overwiewDevelopments: ….Developments: ….
Developments …(2)
Scientific eventsEuropean congresses on Preconception Health and Prevention of Birth defects (Budapest, 2008; Brussels, 2010; Rotterdam, 2012; Budapest, 2014)
Preparing for Life InitiativeInternational initiative group 2010Alignment with WHO objectives and strategiesGlobal ambitions
An overwiewAn overwiewDevelopments: ….Developments: ….
PfL Mission
The overall objective of Preparing for Life is to initiate an international awareness and prevention program to reduce common known risks of adverse health effects for the parents-to-be, the fetus or neonate by addressing women and men at child-bearing age, in both developed and developing countries. This objective follows the 4th and 5th UN- millennium development goal to "reduce child mortality by two/thirds'' and “reduce the maternal mortality ratio by two three quarters”.
www.preparingforlife.net
Developments: ….Developments: ….
3. Primary care involvement in preconception care in Europe
Primary care involvementPrimary care involvement
a. Objectives for primary care
Primary care involvementPrimary care involvement
b. Opportunities and requirements
Primary care involvementPrimary care involvement
c. Role of EFPC-network
Primary care involvementPrimary care involvement
