Abstract
Objectives: To perform a systematic review of published research trials of preconception care services to determine what evidence for effectiveness of care at improving the course of pregnancy or its outcomes has accumulated since the last major review in 1990. Methods: The review was conducted adapting the systematic methods developed by the Cochrane Collaboration to collect evidence from published clinical research literature with as little bias as possible. The review included literature published after January 1990, and posted on MEDLINE by July 1999. Results: Although more than 40 preconception risk conditions were searched and 470 articles were abstracted, only four problem areas and 19 research trials met the review criteria. New evidence of effectiveness was found for screening women who are seeking family planning for risk conditions; having sexually active women of reproductive age take dietary folate supplements; and providing women affected by certain metabolic conditions (diabetes and hyperphenylalanemia) with nutrition services. Conclusions: To help improve pregnancy outcomes MCH professionals need to promote the concept of readiness for pregnancy and help see that women are as healthy and appropriately nourished as possible before they become pregnant.
Similar content being viewed by others
REFERENCES
Haas J, Berman S, Goldberg AB, Lee LW, Cook EF. Prenatal hospitalization and compliance with guidelines for prenatal care. Am J Public Health 1996;86:815–9.
Misra D, Cassady C, Rothert K, Poole V. Women's reproductive health and their overall well-being. In: Grason H, Hutchins J, Silver G, editors. Charting a course for the future of women's and perinatal health. Rockville, MD: Maternal and Child Health Bureau, 1999:57–80.
U.S. Department of Health and Human Services. Caring for our future: Content of prenatal care. Washington, DC: Government Printing Office, 1989.
Alexander GR. Preterm birth: Etiology, mechanisms and prevention. Prenat Neonat Med 1998;3:3–9.
Cefalo RC, Moos MK. Preconceptional health care: Apractical guide. St. Louis, MO: Mosby, 1995.
Institute of Medicine. Best intentions: Unintended pregnancy and the well-being of children and families. Washington, DC: National Academy Press, 1995.
Ventura SJ, Martin JA, Curtin SC, Mathews TJ. Births: Final data for 1997. Natl Vital Stat Rep 1999;47(18):1–96.
Wyn R, Brown ER, Yu H. Women's use of preventive health services. In: Falik MM, Collins KS, editors. Women's health: The commonwealth fund survey. Baltimore: Johns Hopkins University Press, 1996:49–75.
U.S. Department of Health and Human Services. Healthy people 2000: National health promotion and disease prevention objectives. Washington, DC: U.S. Government Printing Office, 1991.
American College of Obstetricians and Gynecologists. Preconceptional care. ACOG Tech Bull 1995;(205):1–6.
Mills JL, Rhoads JL, Simpson JL, Cunningham GC, Conley MR, Lassman MR, Walden ME, Depp OR, Hoffman HJ. The absence of a relation between the periconceptional use of vitamins and neural tube defects. N Eng J Med 1989;321:430–5.
Milunsky A, Jick H, Jick SS, Bruell CL, MacLaughlin DS, Rothman KJ, Willett W. Multivitamin/folic acid supplementation in early pregnancy reduces the prevalence of neural tube defects. JAMA 1989;262:2847–52.
Mulinare J, Cordero JF, Erickson JD, Berry RJ. Periconceptional use of multivitamins and the occurrence of neural tube defects. JAMA 1988;260:3141–5.
American College of Obstetricians and Gynecologists. Nutrition in pregnancy. ACOG Tech Bull 1993;(179):1–2.
U.S. Department of Health and Human Services, Preventive Services Task Force. Guide to clinical preventive services, 2nd ed. Baltimore, MD: Williams and Wilkins, 1996.
American College of Obstetricians and Gynecologists. Guidelines for women's health care. Washington, DC: American College of Obstetricians and Gynecologists, 1996.
Jack BW, Culpepper L. Preconception care. In: Merkatz IR, Thompson JE, editors. New perspectives in prenatal care. New York: Elsevier, 1990:61–88.
Harrison EA. Preconception and postconception care of women with medical illness. In: Merkatz IR, Thompson JE, editors. New perspectives in prenatal care. New York: Elsevier, 1990;89–107.
Klein L, Stewart F. Preconception care. In: Hatcher RA, Trussell J, Stewart F, Cates W, Stewart GK, Guest F, Kowal D, editors. Contraceptive technology, 17th ed. New York: Ardent Media, 1997:623–33.
Bero L, Rennie D. Cochrane collaboration. JAMA 1995;274: 1935–8.
Jack BW, Culpepper L, Babcock J, Kogan MD, Weismiller D. Addressing preconception risks identified at the time of a negative pregnancy test. J Fam Pract 1998;47:33–8.
Moos MK, Bangdiwala SI, Meibohm AR, Cefalo RC. Impact of a preconceptional health promotion program on intendedness of pregnancy. Am J Perinatol 1996;13:103–8.
Medical Research Council (MRC) Vitamin Study Research Group. Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. Lancet 1991;338:131–7.
Czeizel AE, Dudas I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med 1992;327:1832–5.
Werler MM, Shapiro S, Mitchell AA. Periconceptional folic acid exposure and risk of reccurrent neural tube defects. JAMA 1993;269:1257–61.
Shaw GM, Schaffer D, Velie EM, Morland K, Harris JA. Periconceptional vitamin use, dietary folate, and the occurrence of neural tube defects. Epidemiology 1995;6:219–26.
Czeizel AE, Taoth M, Rockenbauer M. Population-based case control study of folic acid supplementation during pregnancy. Teratology 1996;53:345–51.
Czeizel AE. Controlled studies of multivitamin supplementation on pregnancy outcomes. Ann N Y Acad Sci 1993;678:266–75.
Li DK, Daling JR, Mueller BA, Hickok DE, Fantel AG, Weiss NS. Periconceptional multivitamin use in relation to the risk of congenital urinary tract anomalies. Epidemiology 1995;6:212–8.
Shaw GM, Wasserman CR, Murray JC, Lammer EJ. Infant TGF-alpha genotype, orofacial clefts, and maternal periconceptional multivitamin use. Cleft palate Craniofac J 1998;35:366–70.
Scanlon KS, Ferencz C, Loffredo CA, Wilson PD, Correa-Villasenor A, Khoury MJ, Willett WC. Preconceptional folate intake and malformations of the cardiac outflow tract. Baltimore-Washington Infant Study Group. Epidemiology 1998;9:95–8.
Shaw GM, Schaffer D, Velie EM, Morland K, Harris JA. Periconceptional vitamin use, dietary folate, and the occurrence of neural tube defects. Epidemiology 1995;6:219–26.
Steel JM, Johnstone FD, Hepburn DA, Smith AF. Can prepregnancy care of diabetic women reduce the risk of abnormal babies? BMJ 1990;301:1070–4.
Kitzmiller JL, Gavin LA, Gin GD, Jovanovic-Peterson L, Main EK, Zigrang WD. Preconception care of diabetes. Glycemic control prevents congenital anomalies. JAMA 1991;265:731–6.
Rosenn B, Miodovnik M, Combs CA, Khoury J, Siddiqi TA. Pre-conception management of insulin-dependent diabetes: Improvement of pregnancy outcome. Obstet Gynecol 1991;77:846–9.
Diabetes Control and Complications Trial. Pregnancy outcomes in the Diabetes Control and Complications Trial. Am J Obstet Gynecol 1996;174:1343–53.
Garcia-Patterson A, Corcoy R, Rigla M, Caballero A, Adelantado JM, Altirriba O, de Leiva A. Does preconceptional counselling in diabetic women influence perinatal outcome? Ann Ist Super Sanita 1997;33:333–6.
Willhoite MB, Bennert HW Jr, Palomaki GE, Zaremba MM, Herman WH, Williams JR, Spear NH. The impact of preconception counseling on pregnancy outcomes: Experience of the Maine Diabetes in Pregnancy Program. Diabetes Care 1993;16:450–5.
Herman WH, Prior DE, Yassine MD, Weder AB. Nephropathy in NIDDM is associated with cellular markers for hypertension. Diabetes Care 1993;16:815–8.
Koch R, Hanley W, Levy H, Matalon R, Rouse B, Dela Cruz F, Azen C, Gross, Friedman E. A preliminary report of the collaborative study of maternal phenylketonuria in the United States and Canada. J Inherit Metab Dis 1990;13:641–50.
Smith I, Glossop J, Beasley M. Fetal damage due to maternal phenylketonuria: Effects of dietary treatment and maternal phenylalanine concentrations around the time of conception (an interim report from the UK Phenylketonuria Register). J Inherit Metab Dis 1990;13:651–7.
Brenton DP, Lilburn M. Maternal phenylketonuria. A study from the United Kingdom. Eur J Pediatr 1996;155 (Suppl 1):S177–80.
Cipcic-Schmidt S, Trefz FK, Feunders B, Seidlitz G, Ullrich K. German Maternal Phenylketonuria Study. Eur J Pediatr 1996;155(Suppl 1):S173–S6.
Li DK, Daling JR, Mueller BA, Hickok DE, Fantel AG, Weiss NS. Periconceptional multivitamin use in relation to the risk of congenital urinary tract anomalies. Epidemiology 1995;6:212–8.
Herman WH, Janz NK, Becker MP, Charron-Prochownik D. Diabetes and pregnancy. Preconception care, pregnancy outcomes, resource utilization and costs. J Reprod Med 1999;44:33–8.
Brenton DP, Lilburn M. Maternal phenylketonuria. A study from the United Kingdom. Eur J Pediatr 1996;155(Suppl 1):S177–S80.
Morrison EH. Periconception care. Primary Care 2000;27:1–12.
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. Morbidity Mortality Weekly Rev 1992;4:1–7.
Berry RJ, Li Z, Erickson JD, Li S, Moore CA, Wang H, Mulinare J, Zhao P, Wong LY, Gindler J, Hong SX, Correa A. N Eng J Med 2000;342:1135–6.
American Academy of Pediatrics, Committee on Genetics. Folic acid for the prevention of neural tube defects. Pediatrics 1999;104:325–7.
American College of Obstetricians and Gynecologists. Planning your pregnancy and birth. Washington, DC: American College of Obstetricians and Gynecologists, 2000.
Czeizel AE. Primary prevention of neural tube defects and some other major congenital abnormalities: Recommendations for the appropriate use of folic acid during pregnancy. Paediatr Drugs 2000;2:437–9.
Shaw GM, Croen LA, Todoroff K, Tolarova MM. Periconceptional intake of vitamin supplements and risk of multiple congenital anomalies. Am J Med Genet 2000;93:188–93.
Loffredo LC, Souza JM, Freitas JA, Mossey PA. Oral clefts and vitamin supplementation. Cleft Palate Craniofac J 2001;38:76–83.
Elkin AC, Higham J. Folic acid supplements are more effective than increased dietary folate intake in elevating serum folate levels. Brit J Obstet Gynecol 2000;107:285–9.
American College of Obstetricians and Gynecologists. Diabetes and pregnancy. ACOG Tech Bull 1994;(200):1–2.
Janz NK, Herman WH, Becker MP, Charron-Prochownik D, Shayna VL, Lesnick TG, Jacober SJ, Fachnie JD, Kruger DF, Sanfield JA. Diabetes and pregnancy. Factors associated with seeking pre-conception care. Diabetes Care 1995;18:157–65.
American Diabetes Association. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1999;22:S5–S16.
Holing EV. Preconception care of women with diabetes: The unrevealed obstacles. J Matern Fetal Med 2000;9:10–3.
Dunne FP, Brydon P, Smith T, Essex M, Nicholson H, Dunn J. Preconception diabetes care in insulin-dependent diabetes mellitus. Q J Med 1999;92:175–6.
Holing EV, Beyer CS, Brown ZA, Connell FA. Why don't women with diabetes plan their pregnancies? Diabetes Care 1998;21:889–95.
Casele HL, Laifer SA. Factors influencing preconception control of glycemia in diabetic women. Arch Intern Med 1998;158:1321–4.
Waisbren SE, Hamilton BD, St James PJ, Shiloh S, Levy HL. Psychosocial factors in maternal phenylketonuria: Women's adherence to medical recommendations. Am J Public Health 1995;85:1636–41.
Waitzman NJ, Scheffler RM, Romano PS. Cost of birth defects: Estimates of the value of prevention. New York: University Press of America, 1996.
Elixhauser A, Weschler JM, Kitzmiller JL, Marks JS, Bennert HW Jr, Coustan DR, Gabbe SG, Herman WH, Kaufmann RC, Ogata ES. Cost-benefit analysis of preconception care for women with established diabetes mellitus. Diabetes Care 1993;16:1146–57.
Dievler A, Grason HA, Guyer B. MCH functions framework: A guide to the role of government in maternal and child health in the 21st century. Maternal Child Health J 1997;1:1–13.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Korenbrot, C.C., Steinberg, A., Bender, C. et al. Preconception Care: A Systematic Review. Matern Child Health J 6, 75–88 (2002). https://doi.org/10.1023/A:1015460106832
Issue Date:
DOI: https://doi.org/10.1023/A:1015460106832