Editor's Blog

Pre-conception care and considerations for women and men

I have recently been in contact with an amazing woman in the United States who, five years ago, initiated a campaign called the One Key Question - OKQ. OKQ encourages primary care-givers routinely to ask women of childbearing age, ‘Would you like to become pregnant in the next year?’ The aim of the initiative is for health and social care professionals to open up an opportunity to support women in their reproductive decisions, prevent unintended pregnancies and prepare for healthy ones.

It has been known for some time that unplanned pregnancies tend to have less favourable outcomes than planned ones. Babies may be smaller, less healthy, and the relationships between them and their most important caregiver(s) may be less nurturing. A study published this year from University College in London (Hall et al., 2017) concludes that, ‘there seems to be an increased risk of adverse pregnancy outcome in unintended pregnancies’.

So a major aspect – perhaps the most important aspect of pre-conception care - needs to be supporting women to consider whether this is the right time for them to become pregnant or whether pregnancy needs to be avoided for the time being. In an era when planned parenthood is possible for most women in affluent countries, there is a responsibility on the part of everyone to ensure that every baby is indeed a much wanted one.

The OKQ focuses on women’s reproductive plans. However, as the old saying goes, ‘it takes two to tango’. What about men’s reproductive decisions? Another paper that I came across recently explored preconception health messages across 52 websites. The sites offered advice, mainly to women, about smoking and alcohol use, and taking folic acid before conception. The authors of the paper noted that, ‘messages used biomedical language and rarely mentioned other important health topics such as social support and violence’ (Thompson et al., 2017), important areas of consideration for any woman thinking about pregnancy or who might accidentally become pregnant.

The American Institute of Medicine has stated that ‘of all the substances of abuse, alcohol produces by far the most serious neurobiological effects on the fetus’ (1996).Two thirds of the websites examined in the study mentioned above focused on preconception care for women only. Yet research into the impact on the brain development of unborn babies is revealing that men’s use of alcohol affects sperm quality and may therefore be a factor in the current surge in learning difficulties associated with alcohol use prior to and during pregnancy.

Government policy and professionals’ attention is currently much focused on ‘the critical 1001 days’ from conception to two years – and rightly so. But there is also a critical period prior to the 1001 days. Preconception education and support, and preconception reflection, are equally, if not more vital if we are to ensure that every baby is wanted, and stands the best possible chance of leading a healthy, happy and useful life.



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