Maternal Health Leaders Propose Research Agenda for Preconception Care

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By: Sarah Blake, MHTF consultant

The concept of preconception care has emerged in recent years as a potentially vital tool for not only improving adolescent girls’ and women’s chances of having healthy pregnancies and newborns, but of supporting their reproductive health status over time.  It holds special promise for women and couples who have particular health needs, such as HIV-positive women. As a recent guest blog post by Dr. Jean Anderson, Johns Hopkins School of MedicineJhpiego, Kelly Curran,JhpiegoMCHIP, and Laura Fitzgerald, JhpiegoMCHIP pointed out, extending preconception care  and family planning services to HIV-positive women can be a powerful tool for ensuring that they are able to prevent unintended pregnancies, promote  healthy birth-spacing, prevent maternal to child transmission of HIV, and reduce the risk of transmission from infected partners to uninfected partners.

In spite of this promise, preconception care remains a loosely defined field, with no set period of time or services. What is more, there is neither guidance on what elements of preconception care should take priority in research or practice. For this reason, a group of maternal, newborn and child health experts gathered recently to develop a research agenda on preconception care. The result, “Setting Research Priorities for Preconception Care in Low- and Middle-Income Countries: Aiming to Reduce Maternal and Child Mortality and Morbidity” was published this week in PLOS Medicine.  In it, the authors offer a set of 12 priority research questions meant to guide effective interventions.  In defining priorities, the group placed a high importance on feasibility of interventions, likely effects of interventions on health outcomes, and potential for advancing health equity in low- and middle-income countries (LMIC).  They also suggest that the timeline for preconception care be standardized, with services offered at least one year prior to a possible pregnancy.

From the article:

The research questions that received the highest scores therefore highlighted the need to develop strategies to increase coverage of basic interventions such as improving nutrition; reproductive planning for adolescents; contraception; prevention, detection and treatment of chronic conditions that affect maternal health; immunization, diagnosis, and treatment of infectious diseases; and reducing harmful environmental smoke exposures. The highest priorities also advocated for a systems-based approach to increase preconception care services in LMICs including integration with other programs; task-shifting to CHWs; improving supply chains for preconception care commodities; partnerships with media and information technology; maximizing demand for and uptake of preconception interventions, especially by adolescents.

The authors go on to conclude:

It is imperative that preconception care is seen as an earlier opportunity, not just for family planning or to reduce maternal and neonatal mortality, but also to improve long-term outcomes for adolescent girls, women, and children. Adolescent health and reproductive health must increasingly be considered as crucial stages in the continuum of care. Health research investment and policy should be pursued in a more balanced way, promoting increased access and delivery of an essential package of preconception interventions.

Along with the article on research priorities, PLOS Medicine also published “Preconception Care in Low- and Middle-Income Countries: New Opportunities and a New Metric” this week. In it, the authors further make the case for incorporating preconception care into the existing continuum of reproductive, maternal, newborn and child health measures, and emphasize the particular importance of enabling adolescent girls and young women to delay pregnancy until they are ready, as well as promoting girls’ education as essential to ensuring that preconception care is effective. Building from the notion that preconception care should both have a goal of reducing unwanted pregnancy and securing safe pregnancies, they identify age-adjusted maternal mortality rates as a useful metric for judging the quality of preconception care. Where the agenda-setting piece argues that preconception care should be incorporated into the existing continuum of care for maternal, newborn and child health, this piece looks beyond health services to place this care in a broader context of opportunities and barriers to health that young women and, in particular, adolescent girls face.

For more on  recent efforts to advance preconception care,  visit the World Health Organization’s report:  “Meeting to Develop a Global Consensus on Preconception Care to Reduce Maternal and Childhood Mortality and Morbidity.”