One key question is gaining traction around the world, and that is asking women “Would you like to become pregnant in the next year?”
With pre-conception care an often overlooked preventive care strategy, it is hoped this simple and neat question will help GPs begin a discussion on health behaviours that will help women improve their fertility and pregnancy outcomes, says Family Planning NSW medical director Dr Deborah Bateson.
“We know that many pregnancies are unplanned, and some women may be missing out on valuable information to help them out with their preconception health,” Dr Bateson told The Medical Republic.
Writing in the MJA, Dr Bateson and her colleague highlighted nine key areas for women hoping to become pregnant to focus on. These were: folate and iodine supplementation, nutrition and weight management, oral health, smoking, alcohol and illicit drug use, contraceptive use following pregnancy, chronic diseases, vaccinations and serological testing.
Nevertheless, it was also important to recognise that not everyone wanted to have children, might be in same-sex relationships or might not be sexually active. So GPs needed to ensure the question didn’t come loaded with any assumptions, she said.
To broach it sensitively, Dr Bateson said she tried to normalise the question by saying something such as: “I ask this of all women I see.”
For those who were not seeking to become pregnant in the near future, the question opened the door to discuss contraceptive options.
The MJA authors recognises that most pre-conception care happened in primary care, where doctors were time-poor, they but hoped such a simple question could encourage opportunistic and routine screening.
This was especially important given the lack of knowledge many women and men had about the importance of preconception health in the wellbeing of a child.
Dr Bateson and her colleague said that while pre-conception care would benefit any woman contemplating pregnancy, it was particularly important for women with medical conditions such as diabetes and obesity.
Weight was the single most important modifiable risk factor in terms of poor pregnancy outcomes, linked to premature birth, stillbirth, congenital abnormalities and later metabolic disease.
This was especially concerning in light of the growing rates of obesity among Australians.
While bringing weight into the healthy range was important, Dr Bateson stressed that most pre-conception advice came from a relatively poor evidence base, other than folate supplementation.
“The possible benefit of pre-conception weight reduction on pregnancy outcomes is largely based on population-based cohort studies rather than clinical trials,” the authors wrote.
MJA 2018; online 5 November