EFPC Conference 9-10 September
2013, Istanbul
Workshop Preconception Care
Denhard de Smit, PhD, Health Care researcher/Epidemiologist
Managing director Research and Projects, MediClara Projects BV,
Abcoude NL
Arzu Uzuner, MD PhD, Associate Professor of Family Medicine
Marmara University Hospital Pendik Training and Research
Hospital, Istanbul TR
1. Introduction
Introduction
Today’s programme
1.
2.
3.
5.
Introduction
01-05
a.
b.
WG
WG
Agenda
Today’s participants
Preconception care: headlines
06-15
a.
b.
c.
DS
DS
DS
The health issues of interest
Involvement of PC, PH and specialist care
Policy development: examples and events
Primary care involvement in preconception care
16-55
a. Objectives for primary care
b. Opportunities and requirements
c. Role of EFPC-network
16-30
31-45
46-55
Summary and closing
56-60
Introduction
Today’s participants
Who is who?
Name, country
Profession, current position and
experience
Main reason to attend this workshop?
2. Preconception care: headlines
Preconception care: headlines
General definition (1)
“Preconception care is defined in this
advisory report as the entire raft of
measures to promote the health of the
mother-to-be and her child. If they are to
be effective, these measures should
preferably be undertaken prior to
conception. Preconception care is
therefore multidisciplinary, encompassing
lifestyle (including food, drink, tobacco
and other recreational drugs), working
conditions, illness, medication and genetic
factors.”
Health Council of the Netherlands. Preconception care: a good beginning.
The Hague: Health Council of the Netherlands, 2007; publication no.
2007/19.
Preconception care:
An headlines
overwiew
General definition (2)
Modified CDC definition by consensus:
“A set of interventions and/or programme
that aim to identify and enable informed
decision-making to modify biomedical,
behavioural, and (psycho) social risks to
parental health and the health of their
future child, through counselling, prevention
and management, emphasizing those
factors that must be acted on before
conception or early in pregnancy to have
maximal impact and/or choice.”
Dutch consensus meeting on Preconception Care. January/April 2012. The
Netherlands. [To be published].
Preconception care: headlines
a. The health issues of interest
Preconception care:
An headlines
overwiew
The health issues … (1)
From the Dutch health council report
Food, alcohol, tobacco and other
recreational drugs
• Folic Acid suppletion (general population 0,4 mg;
increased risk 4,0 mg)
• Vitamin D suppletion (if needed)
• Vitamin A (prevent too high intake)
• Alcohol (fertility, FAS)
• Tobacco (fertility, birth weight)
Working conditions
• Chemical agents (pesticides, solvents, …)
• Stress
Preconception care:
An headlines
overwiew
The health issues … (2)
Illness and medication
• Infectious diseases (Vaccination, treatment and
prevention)
• Chronic diseases ilke diabetes, epilepsy, depression
(optimization of medication)
• Teratogenic drugs (pregnancy prevention)
• Obesity, anorexia and maternal/paternal age
Genetic factors
• Extend range of options in the case of unfavourable
genetic background
– Known increased risks (genetic diagnosis/counselling done
previously)
– Indications from family history
– Carrier screening (cystic fibrosis, hemoglobinopathies)
Preconception care:
An headlines
overwiew
The health issues … (3)
Additional issues that can/should be
dealt with in the preconception period
Personal preparation for pregnancy?
• Prenatal screening options (Down screening, 20-wk
ultrasound)
Medical preparation for pregnancy
• Obstetric history
• Increased risks from pre-existing disease
Timely uptake of prenatal care
Preconception care: headlines
b. Involvement of PC, PH and
specialist care
Preconception care:
An headlines
overwiew
The involvement of primary care,
public health and specialist care
“Preconception care has various, complementary
forms. Some are aimed at individual parents-tobe, while others may, for example, collectively
target all women of child-bearing age”.
and
“ … the various components of the programme …
should not be provided as separate elements but
as an integrated healthcare concept.”
Preconception care:
An headlines
overwiew
The involvement of … (1)
Care sectors
•
•
•
•
•
Folic acid  PH
Genetic risk assessment  PC, SC
“Lifestyle”  PH, PC, SC
Preconception consultation  PC, SC
Promotion of preconception consultation
 PH, PC
An overwiew
The involvement of … (2)
Primary care workers
• GP’s: (promotion of) preconception
consultation and follow-up as appropriate
• Midwives, nurses: preconception
consultation and follow-up as appropriate
• Pharmacists: FA-education, medication
surveillance, promotion of preconception
consultation
An overwiew
The involvement of … (3)
An overwiew
Prevalences of risks/disorders
NTD’s
• Affected pregnancies: ~1 in 1000
• In Europe ~4.500 cases/year
• 70% TOP
Cystic fibrosis
• Cases: 1 in 3600 newborns
• Couples at risk: 1 in 900
Medication use first trimester
• 40 in 100 >= 1 prescription
Developments: ….
a. Developments: implementation and
events
Developments:
An overwiew
….
Developments: implementation
and events
Existing implementation in Hungary
Programme development 1984-1994
Current implementation by specialized nurses
Developments in The Netherlands
Ministry of Health reply to Health Council report (2007)
Coordination of resources for public information (RIVM)
Major role for midwives in preconception consultation?
GP- Standard available (2011)
Implementation in Italy
Active implementation e.g. in Veneto region (2010)
Developments:
An overwiew
….
Developments …(2)
Scientific events
European congresses on Preconception Health and
Prevention of Birth defects (Budapest, 2008; Brussels,
2010; Rotterdam, 2012; Budapest, 2014)
Preparing for Life Initiative
International initiative group 2010
Alignment with WHO objectives and strategies
Global ambitions
Developments: ….
PfL Mission
The overall objective of Preparing for Life is to initiate
an international awareness and prevention program
to reduce common known risks of adverse health
effects for the parents-to-be, the fetus or neonate by
addressing women and men at child-bearing age, in
both developed and developing countries. This
objective follows the 4th and 5th UN- millennium
development goal to "reduce child mortality by
two/thirds'' and “reduce the maternal mortality ratio
by two three quarters”.
www.preparingforlife.net
Primary care involvement
3. Primary care involvement in
preconception care in Europe
Primary care involvement
a. Objectives for primary care
Primary care involvement
b. Opportunities and requirements
Primary care involvement
c. Role of EFPC-network
The End
Thank you for your participation!
arzuuzuner@gmail.com
djedesmit@mediclara.nl