Amie Steel, Edwina Dorney, Jacqueline Boyle
Most people know that smoking and drinking alcohol during pregnancy is not ideal.
But very few know just how important it is for both parents to maintain healthy behaviours, not only during pregnancy, but in the weeks or months beforehand.
The health of both parents before pregnancy is instrumental in determining pregnancy outcomes and the health of the child.
While supported by science, this key health message is not widely known in the community. Many are unaware of the importance of health behaviours and healthcare in the lead up to pregnancy – known as ‘the preconception period’.
Healthy weight, physical activity, smoking, alcohol, exposures in the home and workplace can all impact maternal health and the health of the developing fetus, the neonate and even into childhood.
There is also increasing evidence of the impact of men’s preconception health behaviours – such as smoking and alcohol, medications, and weight – on the health of their child.
Yet recommended preconception health behaviours are only reported in between 40% and 80% of women with planned pregnancies, and one in four pregnancies in Australia are unplanned.
Women with more pregnancies are even less likely to plan pregnancy or adopt healthy preconception behaviours, and many male partners are unaware that their behaviours before pregnancy matter.
This is an important topic for all people, regardless of gender, pregnancy experience or pregnancy intention.
So why do so few people know about preconception health?
The answer is multi-faceted and includes a lack of publicly available information, health professional’s knowledge, time in health consultations and ability to educate people one-on-one.
The website ‘YourFertility’ offers freely available, accessible, evidence-based, comprehensive preconception health information and is hosted by the Victorian Assisted Reproductive Treatment Authority (VARTA).
Recent changes to government funding resulted in the defunding of YourFertility and while this website is still live, the ability to maintain and update the information is now non-existent.
This change leaves the Australian community without its one source of publicly available preconception health information.
Given most individuals search for health information online, including in pregnancy (and many do not visit a health professional to discuss the information they’ve found), the loss of a government-funded, evidence-based website for preconception health is a major concern.
Even those who seek preconception advice from a health professional can experience challenges.
A recent study used a simulated online Google search to determine the types of health services an individual seeking preconception care in Australia might find.
A diverse range of health professionals were identified through this search, including specialist doctors, nurses, psychologists or counsellors, and naturopaths.
The high rate of specialist doctor ‘hits’ is somewhat understandable given the close links between reproductive conditions such as endometriosis and polycystic ovary syndrome, fertility treatments and preconception.
However, it can be costly to access specialists in the community and for those without difficulties conceiving, such care may not be required.
The high rate of naturopathic clinics found in the search uncovers additional challenges.
While Australian research shows that women attempting to conceive are more likely to consult a naturopath, these health professionals lack the scope required to undertake some critical preconception care activities (e.g. genetic screening, vaccination) while also experiencing barriers to effectively integrate with biomedical health care teams.
Interestingly, general practitioners (GPs) were notably under-represented in search results. GPs, however, are ideally positioned to provide preconception care.
While some components of preconception care may require referral to a specialised allied health professional (e.g. dietician), or targeted behaviour change intervention (e.g. tobacco cessation program), the broader scope of preconception care clearly aligns with the remit of general practice.
Some GP-identified barriers to their provision of comprehensive preconception care include gaps in knowledge and time constraints in consultations, partly due to the absence of any dedicated Medicare item for preconception care.
While both midwives and primary care nurses have also been flagged as having a role in preconception care, they are under-utilised and were under-represented in the simulated internet search results.
For health professionals who do provide preconception care, high-quality evidence-based guidelines to support practice are lacking.
While both the Royal Australian College of General Practitioners and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists have guidelines for preconception health, an international review has concluded that these guidelines are of ‘moderate’ quality.
There are not yet any other Australian guidelines for health professionals on this critical aspect of clinical care.
Despite these challenges, Australia has an opportunity to make a difference to preconception health and care nationally, as is outlined in both the National Women’s Health Strategy and National Men’s Health Strategy.
Numerous initiatives have been developed around the world for preconception health, which Australia can adopt and adapt to meet our needs.
In the US, OneKeyQuestion® has been developed to screen for pregnancy intention and alert the clinician and their patient to the need for preconception care.
UK researchers have worked with charity ‘Tommy’s’ to develop online preconception health resources.
The Netherlands has worked closely with midwives to leverage their knowledge, skills, and capacity to deliver outreach preconception care interventions in the community.
Preconception health and care have wide-reaching impacts on parents and their children, and the power to determine the health of future generations – making it one of the most critical areas of preventive health.
As the National Women’s and Men’s Health Strategies are implemented, we have an ideal opportunity to institute real change – and make sure every contact with the health system counts towards better preconception health.
Amie Steel is Associate Professor of Public Health at the University of Technology Sydney. Edwina Dorney is a PhD Candidate at The University of Sydney and a Public Health Physician. Jacqueline Boyle is an Associate Professor of Public Health, obstetrician and gynaecologist.
Image: Canva / Build Up Studio