Skip to main content
SpringerLink
Log in

Preconception care: An essential preventive strategy to improve children's and women's health

  • Original Article
  • Published:
Journal of Public Health Policy Aims and scope Submit manuscript

Abstract

Reproductive health has improved little in the last few decades. The Netherlands, particularly in large cities, has relatively high perinatal death rates compared with other European countries. Lack of improvement in reproductive outcomes despite improved quality of and better access to prenatal care strongly suggests that prenatal care alone is insufficient. We discuss how preconception care offers new strategies for improving reproductive health, how it usefully connects the life course of the affected individual and many health-care disciplines, and the benefits of combining a top-down policy structure and bottom-up organisation around caregivers. Given the likely benefits and cost savings calculated for the Netherlands, we conclude that failing to facilitate preconception care would reflect a breakdown of both professional and governmental responsibilities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Atrash, H., Johnson, K., Adams, M.M., Cordero, J. and Howse, J. (2006) Preconception care for improving perinatal outcomes: The time to act. Maternal and Child Health Journal 10 (5): 3–11.

    Article  Google Scholar 

  • Schutte, J.M. et al (2010) Rise in maternal mortality in the Netherlands. An International Journal of Obstetrics and Gynaecology 117 (4): 339–406.

    Article  Google Scholar 

  • Poeran, J., Denktaş, S., Birnie, E., Bonsel, G.J. and Steegers, E.A. (2010) Urban perinatal health inequalities. Journal Maternal Fetal Neonatal Medicine, September: 1–4.

  • de Graaf, J.P. et al (2008) Perinatal outcomes in the four largest cities and in deprived neighbourhoods in the Netherlands. Nederlands Tijdschrift voor de Geneeskunde 152 (50): 2734–2740.

    Google Scholar 

  • Korenbrot, C.C., Steinberg, A., Bender, C. and Newberry, S. (2002) Preconception care: A systematic review. Maternal and Child Health Journal 6 (2): 75–88.

    Article  Google Scholar 

  • Livingood, W.C., Brady, C., Pierce, K., Atrash, H., Hou, T. and Bryant, T. (2010) Impact of pre-conception health care: Evaluation of a social determinants focused intervention. Maternal and Child Health Journal 14 (3): 382–391.

    Article  Google Scholar 

  • de Weerd, S., Thomas, C.M.G., Cikot, R.J.L.M., Steegers-Theunissen, R.P.M., de Boo, T.M. and Steegers, E.A.P. (2002) Preconception counseling improves folate status of women planning pregnancy. Obstetrics and Gynaecology 99 (1): 45–50.

    Google Scholar 

  • Chamberlain, G. (1980) The pre-pregnancy clinic. British Medical Journal 281: 29–30.

    Article  Google Scholar 

  • Freda, M.C., Moos, M.K. and Curtis, M. (2006) The History of preconception Care: Evolving guidelines and standards. Maternal and Child Health Journal 10 (1): 43–52.

    Article  Google Scholar 

  • EURO-PERISTAT project, with SCPE EUROCAT, EURONEOSTAT. (2008) European Perinatal Health Report 1, http://www.europeristat.com, accessed 11 December 2010.

  • Health Council of the Netherlands. (2007) Preconception Care: A Good Beginning. Hague, the Netherlands: Health Council of the Netherlands.

  • Steegers, E.A. and Wildschut, H.I. (2005) Preparing for pregnancy: Preconception care. In: N. Macklon, (ed.) IVF in the Medically Complicated Patient: A Guide to Management. Oxford: Taylor & Francis, pp. 81–203.

    Google Scholar 

  • van der Pal-de Bruin, K.M. et al (2008) Pre-conception counselling in primary care: Prevalence of risk factors among couples contemplating pregnancy. Paediatric and Perinatal Epidemiology 22 (3): 280–287.

    Article  Google Scholar 

  • Jack, B.W., Atrash, H., Coonrod, D.V., Moos, M.K., O'Donnell, J. and Johnson, K. (2008) The clinical content of preconception care: An overview and preparation of this supplement. American Journal of Obstetrics and Gynecology 199 (6B): S266–S279.

    Article  Google Scholar 

  • Markus, A.R. (2008) Editor's Note. Women's health issues 18 (6): S1.

    Article  Google Scholar 

  • Centers for Disease Control. (2006) Recommendations to improving preconception health and health care – United States. Morbidity and Morality Weekly Report 55 (no. RR-06), pp. 1–23.

  • Mook-Kanamori, D.O., Steegers, E.A., Eilers, P.H., Raat, H., Hofman, A. and Jaddoe, V.W. (2010) Risk factors and outcomes associated with first trimester fetal growth restriction. Journal of the American Medical Association 303: 527–534.

    Article  Google Scholar 

  • Bukowski, R. et al (2007) Fetal growth in early pregnancy and risk of delivering low birth weight infant: Prospective cohort study. British Medical Journal 334 (7598): 836–841.

    Article  Google Scholar 

  • Dietz, P.M., England, L.J., Shapiro-Mendoza, C.K., Tong, V.T., Farr, S.L. and Callaghan, W.M. (2010) Infant morbidity and mortality attributable to prenatal smoking in the US. American Journal of Preventive Medicine 39 (1): 45–52.

    Article  Google Scholar 

  • Kerber, K.J., de Graft-Johnson, J.E., Bhutta, Z.A., Okong, P., Starrs, A. and Lawn, J.E. (2007) Continuum of care for maternal, newborn, and child health: From slogan to service delivery. Lancet 370 (9595): 1358–1369.

    Article  Google Scholar 

  • Szwajcer, E.M., Hiddink, G.J., Koelen, M.A. and van Woerkum, C.M.J. (2007) Nutrition awareness and pregnancy: Implications for the life course perspective. European Journal of Obstetrics & Gynecology and Reproductive Biology 135 (1): 58–64.

    Article  Google Scholar 

  • Weisman, C.S., Hillemeier, M.M., Downs, D.S., Chuang, C.H. and Dyer, A.M. (2010) Preconception predictors of weight gain during pregnancy: Prospective findings from the central pennsylvania women's health study. Women's Health Issues 20 (2): 126–132.

    Article  Google Scholar 

  • Frey, K.A., Navarro, S.M., Kotelchuck, M. and Lu, M.C. (2008) The clinical content of preconception care: Preconception care for men. American Journal of Obstetrics and Gynecology 199 (6): 389–395.

    Article  Google Scholar 

  • Sheldon, T. (2007) Netherlands considers introducing preconception care. British Medical Journal 335: 686–687.

    Article  Google Scholar 

  • Ministry of Health, Welfare and Sports. (2010) Letter number CZ/EKZ 3001556. (in Dutch) http://rosfriesland.nl/dynamic/file/Brief%20zwangerschap%20en%20geboorte.pdf, accessed 11 December 2010.

  • Ministry of Health, Welfare and Sports. (2010) Letter number CZ/EKZ 3040205. (in Dutch) http://rosfriesland.nl/dynamic/file/Brief%20zwangerschap%20en%20geboorte.pdf, accessed 18 February 2011.

  • Szwajcer, E.M., Hiddink, G.J., Maas, L., Koelen, M.A. and van Woerkum, C.M. (2008) Nutrition-related information-seeking behaviours of women trying to conceive and pregnant women: Evidence for the life course perspective. Family Practice 25 (1): i99–104.

    Article  Google Scholar 

  • de Weerd, S., Steegers, E.A., Heinen, M.M., van den Eertwegh, S., Vehof, R.M. and Steegers-Theunissen, R.P. (2003) Preconception nutritional intake and lifestyle factors: First results of an explorative study. European Journal of Obstetrics & Gynecology Reproductive Biology 111 (2): 167–172.

    Article  Google Scholar 

  • Weggemans, R.M., Schaafsma, G. and Kromhout, D. and Health Council of the Netherlands. (2009) Toward an optimal use of folic acid: An advisory report of the health council of the Netherlands. European Journal of Clinical Nutrition 63 (8): 1034–1036.

    Article  Google Scholar 

  • De Jong-van den Berg, L.T. (2008) Monitoring of the folic acid supplementation program in the Netherlands. Food Nutrition Bulletin 29 (2): S210–3.

    Article  Google Scholar 

  • Timmermans, S., Jaddoe, V.W., Mackenbach, J.P., Hofman, A., Steegers-Theunissen, R.P. and Steegers, E.A. (2008) Determinants of folic acid use in early pregnancy in a multi-ethnic urban population in the Netherlands: The generation r study. Preventive Medicine 47 (4): 427–432.

    Article  Google Scholar 

  • Achterbergh, R., Lakeman, P., Stemerding, D., Moors, E.H. and Cornel, M.C. (2007) Implementation of preconceptional carrier screening for cystic fibrosis and haemoglobinopathies: A sociotechnical analysis. Health Policy 83 (2–3): 277–286.

    Article  Google Scholar 

  • De Jong-Potjer, L., de Bock, G., Zaadstra, B., de Jong, O., Verloove-Vanhorick, S. and Springer, M. (2003) Women's interest in GP-initiated pre-conception counselling in the Netherlands. Family Practice 20 (2): 142–146.

    Article  Google Scholar 

  • KNOV. (2010) Evaluatie pilot preconceptiezorg 2006–2007, http://www.knov.nl/docs/uploads/Evaluatierapport_Pilot_Preconceptiezorg_definitief.pdf, accessed 17 December 2010.

  • GGD Amsterdam. (2006) Groeigids: Kinderwens, Amsterdam, the Netherlands: GGD.

  • Schrander-Stumpel, C. (1999) Preconception care: Challenge of the new millennium? American Journal of Medical Genetics 89 (2): 58–61.

    Article  Google Scholar 

  • http://www.preconceptiezorg.nl/verslag.php, accessed 17 December 2010.

  • Landkroon, A.P., de Weerd, S., van Vliet-Lachotzki, E. and Steegers, E.A. (2010) Validation of an Internet questionnaire for risk assessment in preconception care. Public Health Genomics 13 (2): 89–94.

    Article  Google Scholar 

  • de Weerd, S., van der Bij, A.K., Cikot, R.J., Braspenning, J.C., Braat, D.D. and Steegers, E.A. (2002) Preconception care: A screening tool for health assessment and risk detection. Preventive Medicine 34 (5): 505–511.

    Article  Google Scholar 

  • de Weerd, S., Polder, J., Cohen-Overbeek, T., Zimmermann, L. and Steegers, E. (2004) Preconception care: Preliminary estimates of costs and effects of smoking cessation and folic acid supplementation. Journal of Reproductive Medicine 49 (5): 338–344.

    Google Scholar 

  • Boulet, S.L., Parker, C. and Atrash, H. (2006) Preconception care in international settings. Maternal and Child Health Journal 10 (5): S29–S35.

    Article  Google Scholar 

  • Broussard, D.L., Sappenfield, W.B., Fussman, C., Kroelinger, C.D. and Grigorescu, V. (2010) Core state preconception health indicators: A voluntary, multi-state selection process. Maternal and Child Health Journal 15 (2): 158–68.

    Article  Google Scholar 

  • American College of Obstetricians and Gynecologists. (2005) The importance of preconception care in the continuum of women's health care. Committee Opinion no. 313. Obstetrics and Gynecology 106 (3): 665–6.

  • Freda, M.C., Moos, M.K. and Curtis, M. (2006) The History of Preconception Care. Evolving Guidelines and Standards Maternal and Child Health Journal 10: S43–S52.

    Article  Google Scholar 

  • Curtis, M., Abelman, S., Schulkin, J., Williams, J. and Fassett, E. (2006) Do we practice what we preach? A review of actual clinical practice with regards to preconception care guidelines. Maternal and Child Health Journal 10: 53–58.

    Article  Google Scholar 

  • Posner, S.F., Johnson, K., Parker, C., Atrash, H. and Biermann, J. (2006) The national summit on preconception care: A summary of concepts and recommendations. Maternal and Child Health Journal 10 (5): S197–205.

    Google Scholar 

  • Agrey, N., Crowe, K.M., Levitt, C., MacDonald, J., MacLean, D. and Polomeno, V. (2005) Preconception care. In: L. Hanvey, (ed.) Family-Centred Maternity and Newborn Care: National Guidelines. Ottawa, ON: Health Canada, Minister of Public Works and Government Services, pp. 3.1–3.29.

    Google Scholar 

  • Finer, L.B. and Henshaw, S.K. (2006) Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health 38 (2): 90–96.

    Article  Google Scholar 

  • Heavey, E. (2010) Don’t miss preconception care opportunities for adolescents. American Journal of Maternal and Child Nursing 35 (4): 213–219.

    Article  Google Scholar 

  • Health Council of the Netherlands. (2008) Towards an Optimal Use of Folic Acid. Hague, the Netherlands: Health Council of the Netherlands.

  • Van der Pal-de Bruin, K.M. et al (2000) The Dutch ‘folic acid campaign’. Have the Goals been Achieved? Peadiatrics and Perinatal Epidemiology 14: 111–117.

    Article  Google Scholar 

  • Mitchell, E. (2010) Opportunities for preconception health social marketing among women a US consumer perspective.Paper presented at the first European Congress on Preconception Health and Preconception Care 2010; Brussels, Belgium. Abstract book, pp. 82, http://www.preconception2010.one.be/fileadmin/user_upload/_temp_/Brochure_preconceptional_care.pdf, accessed 17 December 2010.

  • Mitchell, E., Levis, D. and Prue, C. (2010) Preconception health awareness, planning, and communication among a sample of US men and women. Maternal and Child Health Journal, 1–9 August.

  • Delvoye, P., Guillaume, C., Collard, S., Nardella, T., Hannecart, V. and Mauroy, M.C. (2009) Preconception health promotion: analysis of means and constraints. European Journal of Contraception and Reproductive Health Care 14 (4): 307–316.

    Article  Google Scholar 

  • de Weerd, S. and Steegers, E.A.P. (2002) The past and present practices and continuing controversies of preconception care. Community Genetics 5 (1): 50–60.

    Article  Google Scholar 

  • Ruhl, C. and Moran, B. (1998) The clinical content of preconception care: Preconception care for special populations. American Journal of Obstetrics and Gynecology 199 (6): 384–388.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Ethics and Philosophy of Medicine, Room AE 3–42, Erasmus University Medical Centre, Rotterdam, 3000, CA, The Netherlands

    Boukje van der Zee & Inez de Beaufort

  2. Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, 3000, CB, The Netherlands

    Sevilay Temel, Semiha Denktas & Eric Steegers

  3. Department of Health, Ethics & Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6200, MD, The Netherlands

    Guido de Wert

Authors
  1. Boukje van der Zee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Inez de Beaufort
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sevilay Temel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guido de Wert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Semiha Denktas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric Steegers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Boukje van der Zee.

Additional information

Given benefits and cost savings calculated for the Netherlands, the authors argue that governments should facilitate preconception care.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van der Zee, B., de Beaufort, I., Temel, S. et al. Preconception care: An essential preventive strategy to improve children's and women's health. J Public Health Pol 32, 367–379 (2011). https://doi.org/10.1057/jphp.2011.13

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/jphp.2011.13

Keywords

Search

Navigation