Pre- and periconception care Exploration of the relevance of EFPC involvement in the disclosure and exchange of expertise regarding pre- and preconception

Pre- and periconception care

Exploration of the relevance of EFPC involvement in the disclosure and exchange of expertise regarding pre- and preconception care in respect of the implementation and delivery of this care in primary care settings in European

countries

Denhard de Smit, PhD, Health Care researcher/EpidemiologistManaging director Research and Projects, MediClara Projects BV, Abcoude NL

Today’s programme

Starting up

a. Who is who?b. Expertise and vision of participants

Pre- and periconception care: an overview

a. The health issues of interestb. Involvement of PC, PH and specialist care c. Policy development: examples and events

I- Starting up

a. Who is who?

As a person

As a professional

Main reason to attend this workshop?

Starting upStarting up

b. Expertise and vision from you and your country

General status of policy making

Political and societal focus points

Scope of implementation

Awareness and feelings of urgency

Starting upStarting up

II- Pre- and periconception care: an overview

The health issues of interest

“Preconception care is defined in this advisory report as the entire raft of measures to promote the health of the mother-to-be and her child. If they are to be effective, these measures should preferably be undertaken prior to conception. Preconception care is therefore multidisciplinary, encompassing lifestyle (including food, drink, tobacco and other recreational drugs), working conditions, illness, medication and genetic factors.”

Health Council of the Netherlands. Preconception care: a good beginning. The Hague: Health Council of the Netherlands, 2007; publication no. 2007/19.

An overwiewAn overwiew

The health issues … (2)

From the Dutch health council report

Food, drink, tobacco and other recreational drugs• Folic Acid prevention (general population 0,4 mg; increased risk 4,0 mg)• Vitamin D suppletion (if needed)• Vitamin A (prevent too high intake)• Alcohol (fertility, FAS)• Tobacco (fertility, birth weight)

Working conditions• Chemical agents (pesticides, solvents, …)• Stress



Illness and medication• Infectious diseases (Vaccination, treatment and prevention)• Chronic diseases ilke diabetes, epilepsy (optimization of medication)• Teratogenic drugs (pregnancy prevention)• Obesity, anorexia and maternal/paternal age

Genetic factors• Extend range of options in the case of unfavourable genetic background

– Known increased risks (genetic diagnosis/counselling done previously)– Indications from family history – Carrier screening (cystic fibrosis, hemoglobinopathies)



Additional issues that can/should be dealt with in the preconception period

Personal preparation for pregnancy?• Prenatal screening options (triple test, 20-wk ultrasound)

Medical preparation for pregnancy• Obstetric history• Increased risks from pre-existing disease

Timely uptake of prenatal care


The involvement of primary care, public health and specialist care

“Preconception care has various, complementary forms. Some are aimed at individual parents-to-be, while others may, for example, collectively target all women of child-bearing age”.

and

“ … the various components of the programme … should not be provided as separate elements but as an integrated healthcare concept.”


The involvement of … (2)

Care sectors

• Folic acid ph• Genetic risk assessment pc, sc• “Lifestyle” ph, pc, sc • Preconception consultation pc, sc• Promotion of preconception consultation ph, pc


The involvement of … (3)

Primary care workers

• GP’s: (promotion of) preconception consutlation and follow-up as appropriate

• Midwives, nurses: preconception consultation and follow-up as appropriate

• Pharmacists: FA-education, medication surveillance, promotion of preconception consultation


Policy development: examples and events

Existing implementation in HungaryProgramme development 1984-1994Current implementation by specialized nurses

Policy development in The NetherlandsMinistry of Health reply to Health Council reportCoordination of resources for public information (RIVM)Preconception consultation fee in basic insurance?Major role for midwives in preconception consultation?Very pro-active involvement of patient organisations (VSOP, Erfocentrum)

Policy development in Walloon provinces in BelgiumCoordinated by Office de la Naissance et de l’Enfance (ONE)Current status?


Policy development: … (2)

Recent eventsFirst CEE Summit on Preconception Health and Prevention of Birth defects (Budapest, August 2008)

National conference on preconception care (Utrecht, September 2009)

Extended neonatal screening in NL since 1-1-2007 Preconception care?

EU policyRare diseases COM (2008) 679…??


The End

Thank you for your participation!

[email protected]

www.mediclara.nl

Recommendations and closingRecommendations and closing

Documents

Pre- and periconception care Exploration of the relevance of EFPC involvement in the disclosure and exchange of expertise regarding pre- and preconception