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Meta-Analysis
. 2014 Sep 26;11 Suppl 3(Suppl 3):S5.
doi: 10.1186/1742-4755-11-S3-S5. Epub 2014 Sep 26.

Preconception care: screening and management of chronic disease and promoting psychological health

Zohra S Lassi, Ayesha M Imam, Sohni V Dean, Zulfiqar A Bhutta
Meta-Analysis

Preconception care: screening and management of chronic disease and promoting psychological health

Zohra S Lassi et al. Reprod Health. .

Abstract

Introduction: A large proportion of women around the world suffer from chronic diseases including mental health diseases. In the United States alone, over 12% of women of reproductive age suffer from a chronic medical condition, especially diabetes and hypertension. Chronic diseases significantly increase the odds for poor maternal and newborn outcomes in pregnant women.

Methods: A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for preventing and managing chronic diseases and promoting psychological health on maternal, newborn and child health outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.

Results: Maternal prepregnancy diabetic care is a significant intervention that reduces the occurrence of congenital malformations by 70% (95% Confidence Interval (CI): 59-78%) and perinatal mortality by 69% (95% CI: 47-81%). Furthermore, preconception management of epilepsy and phenylketonuria are essential and can optimize maternal, fetal and neonatal outcomes if given before conception. Ideally changes in antiepileptic drug therapy should be made at least 6 months before planned conception. Interventions specifically targeting women of reproductive age suffering from a psychiatric condition show that group-counseling and interventions leading to empowerment of women have reported non-significant reduction in depression (economic skill building: Mean Difference (MD) -7.53; 95% CI: -17.24, 2.18; counseling: MD-2.92; 95% CI: -13.17, 7.33).

Conclusion: While prevention and management of the chronic diseases like diabetes and hypertension, through counseling, and other dietary and pharmacological intervention, is important, delivering solutions to prevent and respond to women's psychological health problems are urgently needed to combat this leading cause of morbidity.

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Figures

Figure 1
Figure 1
Search flow diagram
Figure 2
Figure 2
congenital malformations in preconception care versus non preconception care: evidence from observational study
Figure 3
Figure 3
Perinatal mortality in preconception care versus non preconception care evidence from observational study
Figure 4
Figure 4
Periconception use of anti-thyroid medications and Birth defects evidence from observational study
Figure 5
Figure 5
Preconception disease activity and disease flares during pregnancy evidence from observational study
Figure 6
Figure 6
Preconception disease activity and perinatal mortality evidence from observational study
Figure 7
Figure 7
Pregnancy outcomes of Pre/Periconception use of oral contraceptives evidence from observational study
Figure 8
Figure 8
Morbidities associated with depression in adolescents: evidence from observational study
Figure 9
Figure 9
IPV and risk of unintended pregnancies (in women who have undergone IPV in the last 1 year: evidence from observational study
Figure 10
Figure 10
IPV and risk depression (in women who have undergone IPV in the last 1 year: evidence from observational study
See this image and copyright information in PMC

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