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Preconception Healthcare Delivery at a Population Level: Construction of Public Health Models of Preconception Care

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Abstract

A key challenge of preconception healthcare is identifying how it can best be delivered at a population level. To review current strategies of preconception healthcare, explore methods of preconception healthcare delivery, and develop public health models which reflect different preconception healthcare pathways. Preconception care strategies, programmes and evaluations were identified through a review of Medline and Embase databases. Search terms included: preconception, pre-pregnancy, intervention, primary care, healthcare, model, delivery, program, prevention, trial, effectiveness, congenital disorders OR abnormalities, evaluation, assessment, impact. Inclusion criteria for review articles were: (1) English, (2) human subjects, (3) women of childbearing age, (4) 1980–current data, (5) all countries, (6) both high risk and universal approaches, (7) guidelines or recommendations, (8) opinion articles, (9) experimental studies. Exclusion criteria were: (1) non-human subjects, (2) non-English, (3) outside of the specified timeframe, (4) articles on male healthcare. The results of the literature review were synthesised into public health models of care: (1) primary care; (2) hospital-based and inter-conception care; (3) specific preconception care clinics; and, (4) community outreach. Fifteen evaluations of preconception care were identified. Community programmes demonstrated a significant impact on substance use, folic acid supplementation, diabetes optimization, and hyperphenylalaninemia. An ideal preconception visits entail risk screening, education, and intervention if indicated. Subsequently, four public health models were developed synthesizing preconception-care delivery at a population level. Heterogeneity of risk factors, health systems and strategies of care reflect the lack of consensus about the best way to deliver preconception care. The proposed models aim to reflect differing aspects of preconception healthcare delivery.

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Acknowledgments

The authors would like to acknowledge the support and resources of the PHG Foundation.

Conflict of interest

We declare that we have no other conflicts of interest.

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Authors and Affiliations

  1. Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, University Forvie Site, Robinson Way, Cambridge, CB2 2SR, UK

    Geordan D. Shannon & Nora Pashayan

  2. Royal Brisbane and Women’s Hospital, Herston, QLD, 4029, Australia

    Geordan D. Shannon

  3. PHG Foundation, 2 Worts Causeway, Cambridge, Cambridgeshire, CB1 8RN, UK

    Corinna Alberg & Luis Nacul

  4. Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK

    Nora Pashayan

Authors
  1. Geordan D. Shannon
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  2. Corinna Alberg
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Correspondence to Geordan D. Shannon.

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Shannon, G.D., Alberg, C., Nacul, L. et al. Preconception Healthcare Delivery at a Population Level: Construction of Public Health Models of Preconception Care. Matern Child Health J 18, 1512–1531 (2014). https://doi.org/10.1007/s10995-013-1393-8

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  • DOI: https://doi.org/10.1007/s10995-013-1393-8

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