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Maternal and Child Health Journal

, Volume 18, Issue 6, pp 1512–1531 | Cite as

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

  • Geordan D. ShannonEmail author
  • Corinna Alberg
  • Luis Nacul
  • Nora Pashayan
Article

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.

Keywords

Preconception care Systematic review Programme Models Healthcare delivery 

Notes

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.

Supplementary material

10995_2013_1393_MOESM1_ESM.doc (66 kb)
Supplementary material 1 (DOC 66 kb)

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Geordan D. Shannon
    • 1
    • 2
    Email author
  • Corinna Alberg
    • 3
  • Luis Nacul
    • 3
  • Nora Pashayan
    • 1
    • 4
  1. 1.Department of Public Health and Primary Care, Institute of Public HealthUniversity of CambridgeCambridgeUK
  2. 2.Royal Brisbane and Women’s HospitalHerstonAustralia
  3. 3.PHG FoundationCambridgeUK
  4. 4.Department of Epidemiology and Public HealthUniversity College LondonLondonUK

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