Improving Preconception Care
There is now a lot of evidence that the health of the mother and father around the time that their baby is conceived can affect the outcome of the pregnancy, such as miscarriage and low birth weight. It can also have longer term effects on the child’s health and development, even increasing their risk of chronic diseases such as diabetes and high blood pressure later in life. Improving women’s and men’s health before pregnancy is also important for their own future health. Digital interventions are a promising avenue for intervention which we are actively exploring.
We provided advice to Tommy's charity who have developed preconception advice for women (developing preconception advice for women.)
Professor Stephenson is providing advice to the charity Tommy's who are developing preconception advice for women.
For the general public, preparing for parenthood before a pregnancy is often considered a private matter rather than a time for optimising health. In fact, the health and nutrition of both men and women before conception are important not only for pregnancy outcomes but also for the lifelong health of their children and even the next generation.
Our Lancet Series (2018) on preconception health showed that 90% of women of reproductive age in the UK were not well prepared, in health terms, for pregnancy. Among UK healthcare providers, preconception health is seldom seen as ‘core business’ despite a wealth of evidence pinpointing this as a special window of opportunity for intervention to reduce risk of chronic disease across generations.
Our vision for preconception health is one where the notion of preparing for healthy pregnancy is normalised, where environmental conditions are conducive and effective interventions available to support women and men towards healthy pregnancies.
A further Lancet paper (2019) provides a national framework for delivery and evaluation of interventions at both population and individual level to improve preconception health.
To articulate our vision and advance the national framework, we have established a UK Preconception Partnership, co-chaired by Professor Judith Stephenson and Professor Mary Barker from the University of Southampton, .
With women and men of reproductive age, we also co-designed a resource ‘Thinking of having a baby? that presents the key steps before conception for a healthy pregnancy and baby.
You can find it here.
Dr Jennifer Hall, on behalf of the UK Preconception Partnership and working with Prof Stephenson, Dr Geraldine Barrett at UCL and Dr Danielle Schoenaker at University of Southampton, has been awarded a grant from Public Health England to explore the evidence for different models of community based preconception care. This will include a literature review, stakeholder engagement and user participation, the latter of which will be conducted in collaboartion with Tommy’s.
Previous Projects
Systematic review of the effect of lifestyle factors on early pregnancy outcomes
Dr Jennifer Hall and Dr Bola Grace supported Eline Oostingh, a PhD student at Erasmus University, Rotterdam, The Netherlands, with a systematic review of the effect of lifestyle factors on early pregnancy outcomes, which has been published in the journal Reproductive Biomedicine Online https://www.rbmojournal.com/article/S1472-6483(18)30519-4/fulltext
Start at the beginning
We have explored various ways of providing women with individually tailored information before they become pregnant.
Pre-pregnancy weight loss in women with obesity: a pilot study of an intensive weight management programme.
Maternal obesity, affecting over 1 in 5 of all women in antenatal care in the UK, increases the risk of many adverse outcomes in pregnancy and childbirth. In collaboration with weight loss experts at UCL, Prof. Stephenson and Dr Paul Hardiman examined the acceptability of an intensive weight management programme to women with obesity (BMI over 34) attending a clinic to have their contraceptive device removed so that they could become pregnant. Nearly two-thirds of women agreed to engage in an intensive weight management programme including lasting 24 weeks and nearly half of the women who started the programme completed it and achieved significant weight loss, with BMI dropping from 37.4 to 31.5 kg/m2.
Start at the beginning
We conducted a pilot randomised controlled trial in primary care to determine the feasibility of a nutrition and lifestyle digital intervention, Smarter Pregnancy, to improve preconception nutrition in women planning a pregnancy. The aim of Smarter Pregnancy is to help women reduce their preconception risk by improving nutrition and lifestyle before they become pregnant.
The main objective was to compare risk scores from self-reported data on dietary and lifestyle factors between women randomised to receive preconception care health information via a web-based intervention with follow up every six weeks and coaching and women randomised to receive coaching and advice every 12 weeks. At 6 months participants were invited to an interview about their thoughts, opinions and experiences of using Smarter Pregnancy.
We recruited over 300 women aged 18-45 presenting at Community Health Visiting Teams and planning a pregnancy. In-depth interviews were undertaken with a 15 women and 8 Health Visitors.
Overall users enjoyed using Smarter Pregnancy and found the coaching and advice encouraging in improving behaviours, particularly increasing the fruit and vegetables in their diet. They were positive towards having support in this pre-pregnancy period and recognised the importance of being healthy prior to conception. Health visitors also shared that there is a need for training for them in preconception health and care in order to provide better advice for women planning a pregnancy. They also expressed that they were well placed to provide preconception care to their clients.
Health buddies
We collaborated with Prof. Harden of the University of East London on a pilot study of locally recruited ‘health buddies’ to support women who are planning to become pregnant.
Pre-pregnancy care in England
The overall aim of the study was to provide evidence about pre-pregnancy health and care for women and men in England in order to inform future policy and practice. This research was funded by the Department of Health, Policy Research Programme.
We used critical appraisal and review techniques, and both quantitative and qualitative methods for empirical data collection and analysis. We reviewed over 4000 papers and 100 guidelines, analysed data from two large cohort studies, surveyed over 1000 antenatal women and over 500 of their partners, including the London Measure of Unplanned Pregnancy, and conducted 40 interviews with health professionals and women.
We found that, awareness of preconception health and care among the public and health professionals is generally low – particularly in men and even among women attending an assisted conception service. There are very few studies about how best to deliver effective preconception interventions in clinical practice. Engagement between women and health professionals about preconception health and care is often lacking, responsibility for providing preconception care is confused and delivery patchy, leading to multiple missed opportunities to improve maternal and child health.
Project - Fertility awarness for Family building
Women and men deserve greater understanding of their reproductive health and global health policies have highlighted the importance of optimising women’s health and knowledge for contraception as part of pregnancy-prevention and for pregnancy-planning as part of preconception care. This research project used mixed-methods to evaluate knowledge and awareness of fertility and reproductive health; socioeconomic factors influencing family building decisions and improvement opportunities. Overall, survey results showed poor knowledge of topics relating to fertility and reproductive health among men, women and Healthcare professionals. Qualitative interviews showed that school education did not adequately cover topics related to family building and respondents were distrustful of many sources. Several interconnecting socioeconomic and personal factors influence family building decisions. These were used to identify five main groups of individuals (No Desire, Stoppers, Betweeners, Planners and Conceivers), for whom fertility awareness information would need to be tailored differently to suit different intentions in order to help individuals achieve their desired family building intentions. Findings from this research have been presented in dozens of national and international conferences. Publications can be viewed here.
PhD Project - Exploring how to best support men through their fertility journey
There is currently little support for men planning and preparing for pregnancy, even if they are deemed to be reproductively challenged. Online and digital interventions are commonly cited as the method of choice for information and guidance by both men and women whilst they navigate their fertility journey. This project aims to investigate men’s information seeking journey’s to better understand how to better support them through their fertility journey. This project has already identified a process of how men find a new normal when using online forums to share with one another, see Figure 1, and publication "I feel like only half a man": Online Forums as a Resource for Finding a "New Normal" for Men Experiencing Fertility Issues.
This project uses mainly qualitative methods to understands men’s experiences and feelings whilst experiencing fertility difficulties.
Phd on Prevention of Neural tube defects in Ethnic Communities in the UK
Jordana Peake completed her PhD, supervised by Prof Jill Shawe and Andrew Copp looking at knowledge and peri-conceptional use of folic acid for the prevention of neural tube defects (e.g. spina bifida) in ethnic communities in the UK.
Abstract:
Neural tube defects (NTD) are severe congenital abnormalities, caused by failed closure of the embryonic neural tube, that affect approximately 1 in 1,000 pregnancies worldwide. There is a paucity of epidemiological and qualitative research on NTDs within different ethnic communities in the UK.
This PhD was a mixed methods study conducted to explore NTD prevalence, pregnancy outcomes and attitudes towards prevention in different ethnic communities. For the quantitative study, congenital anomaly data supplemented with Department of Health termination data were used to explore the NTD prevalence and pregnancy decisions by maternal ethnicity. Semi-structured interviews, combined with grounded theory methodology, explored women’s pre-pregnancy knowledge, attitudes and health behaviours with regard to folic acid supplementation, and subsequent pregnancy decisions.
After adjustment for maternal deprivation and age, NTD prevalence was found to be nearly twice as high in Indian mothers and almost three times as high in Bangladeshi mothers, as in mothers of White ethnicity. The excess was particularly marked in Indian mothers for non-isolated NTDs. Through qualitative interviews, women detailed how more information on why folic acid should be taken needs to be given and that health professionals, such as GPs, are the preferred information source. It was also indicated that health professionals who rarely see children with spina bifida are less likely to give a balanced view of the condition, in relation to a decision on possible pregnancy termination.
An ethnic discrepancy in prevalence being more marked for non-isolated NTDs is indicative of the involvement of genetic factors. Increasing folic acid use among all population groups is essential and targeting a culturally sensitive education campaign at health professionals is a crucial first stage in increasing supplementation among South Asian mothers. It is also of critical importance that those counselling mothers when spina bifida is detected, are fully informed of the conditionthemselves.