Preconception care in primary care: supporting patients to have healthier pregnancies and babies

[摘要] Primary care teams have an important role to play in supporting their patients to have healthy pregnancies and babies if and when they choose to. Improvements in the care for pregnant women in the last decades have successfully reduced maternal and infant morbidity and mortality rates. However, the frequency of adverse pregnancy outcomes and the potentially life-long and intergenerational consequences for mothers and children remains unacceptably high. It is important to recognise that the main drivers of adverse pregnancy outcomes have their origins before pregnancy. For example, in the UK, 1 in 2 pregnancies are unintended, almost 3 in 4 maternal deaths are in women with pre-existing medical conditions,1 and 1 in 5 preterm births are attributable to socioeconomic deprivation.2 Nonetheless, there are important opportunities during routine interactions and appointments for primary care teams to address risks in women of reproductive age (and their partners), particularly the risk of unintended pregnancy and those relating to an intended pregnancy.‘MAKING EVERY CONTACT COUNT’ In line with National Institute for Health and Care Excellence guidance on preconception care, primary care teams are encouraged to initiate discussions about preconception health when appropriate, and to assess, manage, and potentially optimise a range of physical and mental health conditions, health behaviours, and social needs prior to pregnancy.3 Discussing pregnancy intentions is acceptable to most patients, particularly during visits for contraception, cervical screening, postnatal appointments, and long-term condition and medication reviews.Our analysis of common preconception care needs of women of reproductive age in general practice in England showed nine in ten women have at least one risk factor4 that, if minimised or well-controlled before conception, may reduce risks in a future pregnancy.5 While the needs of individual patients will vary widely, the generally poor preconception health and wellbeing of women of reproductive age highlights the need to make every contact count.

[学科分类] 卫生学