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Preconception education interventions

Health Factors: Access to Care
Decision Makers: Educators Healthcare Professionals & Advocates Nonprofit Leaders Public Health Professionals & Advocates
Evidence Rating: Some Evidence
Population Reach: 20-49% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Preconception education interventions provide information about the risks and benefits of behaviors that affect a woman’s health before, during, and after pregnancy; improving certain health behaviors prior to pregnancy reduces risks to mothers’ and infants’ health. Preconception education interventions cover a variety of topics related to those behaviors, such as nutrition, exercise and weight management, birth control methods, STI prevention, controlling chronic disease, reducing alcohol consumption, quitting smoking and other tobacco use, or improving mental health. Interventions can be delivered in clinical or community settings, and may be presented by medical providers, public health professionals, lay people, or others with relevant education and training (e.g., community health workers). Ongoing well-woman care, as well as education for men partnered with women of child bearing age, often compliment these interventions.

Expected Beneficial Outcomes

Increased healthy behaviors
Increased preconception planning
Improved health-related knowledge
Improved birth outcomes

Evidence of Effectiveness

There is some evidence that preconception education interventions increase healthy behaviors among participating women (Temel 2014, Cochrane-Whitworth 2009). Additional evidence is needed to confirm effects on behaviors and birth outcomes, and determine which types of health behaviors and conditions these interventions address most effectively.

Preconception interventions that address multiple risk factors appear to alter targeted behaviors (Temel 2014). For example, participants in the Central Pennsylvania Women’s Health Study’s Strong Women program reported increases in their intent to eat healthier and be physically active, as well as increased physical activity, consumption of folic acid, and self-efficacy following the program’s 6 bi-weekly education sessions (Hillemeier 2008). An intensive intervention covering both alcohol consumption and contraception appeared to reduce binge drinking among risky drinkers (Cochrane-Whitworth 2009). Interventions targeting smoking may also reduce smoking pre-pregnancy (Temel 2014).

Preconception nutrition interventions appear to increase consumption of folic acid. A study of nutrition lessons for non-pregnant low income women, for example, appeared to increase their intake of dietary folate (Temel 2014). Various other individual programs, usually involving both education and supplement provision (Temel 2014), and collective interventions (e.g., public education campaigns and fortification of food products) have been shown to increase consumption of folic acid and reduce the risk of birth defects (Temel 2014, CG-Birth defects).

Risk assessment followed by individualized counseling as needed appears to increase participant’s knowledge of healthy behaviors. In five urban primary care clinics, for example, risk assessment and brief counseling for low income black and Hispanic women appeared to increase knowledge of the importance of folic acid, the need to treat and control chronic health conditions, and the importance of preconception medication review with a provider (Dunlop 2013b). In a greater Atlanta area-based study, black women attending WIC clinic nutrition classes who received brief counseling based on their risk assessment results reported that counseling was both acceptable and important (Dunlop 2013a).

Integrating preconception and interconception care into diabetic women’s ongoing usual care may reduce congenital malformation, preterm delivery, and perinatal infant mortality (Wahabi 2010), however, additional evidence is needed to confirm effects (Cochrane-Tieu 2013Cochrane-Tieu 2010).

Implementation

United States

Several states have developed preconception health campaigns that incorporate education as one component, including Every Woman California, Delaware Thrives, Every Woman North Carolina, Arizona’s Power Me A2Z, and Utah’s Power Your Life, Power Your Health.

Many university and non-profit organizations also provide preconception education interventions. The University of Oklahoma’s Healthy Women, Healthy Futures program, for example, provides education, care coordination, and other support services for non-pregnant women living in poverty (OU-HWHF). PASOs, a program serving the Latino community in South Carolina, includes a culturally appropriate preconception health education workshop as part of its wider preconception health efforts (Torres 2013a).

The Show Your Love national campaign encourages healthy behaviors for all women (Show Your Love). 

Implementation Resources

AMCHP-Innovation station - Association of Maternal & Child Health Programs (AMCHP). Innovation station: Sharing best practices in MCH. Accessed on December 22, 2015
Before and Beyond - Preconception Health and Healthcare Initiative. Before, Between & Beyond Pregnancy. Chapel Hill: The University of North Carolina at Chapel Hill. Accessed on December 28, 2015
CDC-Humphrey 2012 - Humphrey JR, Floyd RL. Preconception health and health care environmental scan. Atlanta: Centers for Disease Control and Prevention (CDC); 2012. Accessed on December 22, 2015
CDC-Preconception health education materials - Preconception health and health care: health education materials for women and men. Centers for Disease Control and Prevention (CDC). Accessed on January 11, 2016
EWCA - Every Woman California (EWCA). Educational resources for public health professionals & providers. Preconception Health Council of California. Accessed on January 14, 2016
Show Your Love - Show your love. Preconception Health and Health Care Initiative. Accessed on January 11, 2016

Citations - Evidence

CG-Birth defects - The Guide to Community Preventive Services (The Community Guide). Birth defects. Accessed on December 19, 2016
Cochrane-Tieu 2010* - Tieu J, Middleton P, Crowther CA. Preconception care for diabetic women for improving maternal and infant health. Cochrane Database of Systematic Reviews. 2010;(12):CD007776. Accessed on January 12, 2016
Cochrane-Tieu 2013* - Tieu J, Bain E, Middleton P, Crowther C. Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes. Cochrane Database of Systematic Reviews. 2013;(6):CD010211. Accessed on January 20, 2016
Cochrane-Whitworth 2009* - Whitworth M, Dowswell T. Routine pre-pregnancy health promotion for improving pregnancy outcomes. Cochrane Database of Systematic Reviews. 2009;(4):CD007536. Accessed on December 30, 2015
Dunlop 2013a* - Dunlop AL, Dretler AW, Badal HJ, Logue KM. Acceptability and potential impact of brief preconception health risk assessment and counseling in the WIC setting. American Journal of Health Promotion. 2013;27(3 Suppl 1):58-65. Accessed on December 15, 2015
Dunlop 2013b* - Dunlop AL, Logue KM, Thorne C, Badal HJ. Change in women’s knowledge of general and personal preconception health risks following targeted brief counseling in publicly funded primary care settings. American Journal of Health Promotion. 2013;27(3 Suppl 1):50-7. Accessed on January 14, 2016
Hillemeier 2008 - Hillemeier MM, Symons Downs D, Feinberg ME, et al. Improving women's preconceptional health: Findings from a randomized trial of the strong healthy women intervention in the central Pennsylvania women's health study. Women's Health Issues. 2008;18(6 Suppl 1):87-96. Accessed on January 14, 2016
Temel 2014 - Temel S, van Voorst SF, Jack BW, Denkta S, Steegers EAP. Evidence-based preconceptional lifestyle interventions. Epidemiologic Reviews. 2014;36(1):19-30. Accessed on December 22, 2015
Wahabi 2010* - Wahabi HA, Alzeidan RA, Bawazeer GA, Alansari LA, Esmaeil SA. Preconception care for diabetic women for improving maternal and fetal outcomes: A systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2010;10:63. Accessed on January 20, 2016

Citations - Implementation

Delaware Thrives - Delaware thrives: Healthy women. Delaware Health and Social Services Division of Public Health and Delaware Healthy Mother & Infant Consortium. Accessed on January 11, 2016
Every Woman California - Every woman California. Preconception Health Council of California. Accessed on January 11, 2016
Every Woman North Carolina - Every Woman North Carolina. March of Dimes North Carolina Preconception Health Campaign. Accessed on January 11, 2016
OU-HWHF - The University of Oklahoma College of Nursing. Healthy Women, Healthy Futures. Accessed on January 11, 2016
Power Me A2Z - Power me a2z. Arizona Department of Health Services. Accessed on January 11, 2016
Power Your Life, Power Your Health - Power your life, power your health. Utah Department of Health. Accessed on January 11, 2016
Show Your Love - Show your love. Preconception Health and Health Care Initiative. Accessed on January 11, 2016
Torres 2013a* - Torres ME, Smithwick-Leone J, Willms L, et al. Developing a culturally appropriate preconception health promotion strategy for newly immigrated Latinos through a community-based program in South Carolina. American Journal of Health Promotion. 2013;27(3):S7-S9. Accessed on February 4, 2016

Page Last Updated

January 12, 2016

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