Actively preparing for pregnancy is associated with healthier lifestyle of women during the preconception period

Highlights

• Two-thirds of women seek preconception health information to prepare for pregnancy.

• Information seeking is related to positive changes in preconception lifestyle.

• PCC consultation increases the likelihood of preconception smoking cessation.

Abstract

Objective

To assess whether actively preparing for pregnancy by women is associated with lifestyle changes during the preconception period.

Design

retrospective cross-sectional study.

Setting

primary care community midwifery practice in the Netherlands.

Participants

convenience sample of 283 women who received antenatal care.

Measurements and findings

the association between pregnancy preparation (defined as searching for information and/or consulting a healthcare provider) and preconception lifestyle changes (healthier diet, folic acid, alcohol and tobacco cessation) was measured and adjusted for age, body mass index and educational level. Almost 60% (n=160) of women acquired preconception information themselves and 25% (n=68) consulted a healthcare provider regarding their pregnancy wish. The former group was significantly more likely to quit drinking (adjusted OR 5.46 (95% CI 1.76–16.96)), improve their diet (adjusted OR 7.84 (95% CI 3.03–20.30)) and use folic acid (adjusted OR 3.90 (95% CI 2.00–7.62)) compared with women who did not prepare for pregnancy. Effect sizes were even larger for women who (also) consulted a healthcare provider with regard to folic acid use, healthier diet and smoking cessation.

Key conclusions

gathering preconception information, either by women themselves or by means of a PCC consult, is associated with women positively changing lifestyles during the preconception period.

Implications for practice

we recommend to not solely focus interventions on increasing the uptake of PCC consults, yet providing a suitable offer of preconception health information, which enables women to properly inform themselves.

Introduction

Preconception care (PCC) is defined as “a set of interventions that aim to identify and modify medical, behavioral and social risks to a woman's health or pregnancy outcome through prevention and management” (Johnson et al., 2006). PCC provides a window of opportunity to timely alter or eliminate these risks by focusing on the period prior to conception (Johnson et al., 2006, Lu, 2007). Over the past decades the prevalence of adverse pregnancy outcomes, such as preterm birth, congenital birth defects, maternal complications and mortality rates, has decreased only moderately (Atrash et al., 2006). Antenatal care is often initiated too late, as the booking visit generally takes place near the end of the first trimester (Temel et al., 2013, Feijen-de Jong et al., 2015). Preventive actions are needed to address risk factors during the first gestational weeks, which are critical for fetal growth and development (Atrash et al., 2006, Johnson et al., 2006, Moos, 2006).

Several studies have shown that almost all women who are planning a pregnancy have at least one risk factor that could adversely affect pregnancy outcomes (Jack et al., 1998, van der Pal-de Bruin et al., 2008). These risk factors include lifestyle that can be altered, such as smoking, alcohol consumption, nutritional intake and folic acid supplementation (Atrash et al., 2006). However, few women planning a pregnancy appear to comply with preconception health recommendations and health behaviors are generally not changed before conception (de Weerd et al., 2003, Inskip et al., 2009, Chuang et al., 2011, Lum et al., 2011). Although PCC has demonstrated to improve health behaviors and decrease risk factors, not many couples are aware of the possibility of PCC and uptake rates remain low between 27% and 39% (Frey and Files, 2006, Elsinga et al., 2008, Mazza and Chapman, 2010, Hammiche et al., 2011, Williams et al., 2012, Oza-Frank et al., 2014, Stephenson et al., 2014).

Recent studies show that despite several policy initiatives to improve the delivery of PCC among providers, there is still no comprehensive PCC program or routine offer to all couples with a potential desire to conceive in the Netherlands (M'hamdi et al., 2016, Poels et al., 2017, van Voorst et al., 2016). Previous research also showed that women perceive several barriers for the use of PCC, among which lack of awareness, perceived sufficient knowledge and the wish for secrecy (Hosli et al., 2008, Mazza and Chapman, 2010, van der Zee et al., 2013, Poels et al., 2016). Yet, little is known about (other) ways in which women acquire their knowledge regarding preconception health and risk factors. Thus, it is important to gain insight in women's information seeking behavior and experiences while preparing for pregnancy, in order to improve PCC use. In a survey conducted by Frey and Files, women were asked about their preferences regarding preconception health, with only a minority stating that they would seek information from sources different than healthcare providers (Frey and Files, 2006). By contrast, a study from the UK found that although less than 30% of women visited a healthcare provider for advice, they commonly searched for preconception information elsewhere (Stephenson et al., 2014). Yet, it remains unclear whether women succeed to reduce preconception risk factors based on information they acquired themselves. The aim of this study was to assess whether actively preparing for pregnancy through information seeking or PCC consultation is associated with lifestyle changes during the preconception period.