Interconception Health: Improving Equitable Access to Pregnancy Planning

Abstract

Challenges remain with the implementation of preconception care, as many women do not plan their pregnancies and clinicians do not initiate preconception consultations. However, the interconception period may present a more opportune time to address health issues that impact on pregnancy outcomes and may influence future conceptions. It is also an important time to focus on pregnancy complications that may influence a person's health trajectory. This review discusses the evidence pointing to a need for greater attention on interconception health and focuses on five areas of care that may be particularly important in affecting equitable access to good care before a subsequent pregnancy: interpregnancy intervals, contraception, weight, nutrition, and gestational diabetes follow-up. Several programs internationally have developed models of care for interconception health and this review presents one such model developed in the United States that explicitly seeks to reach vulnerable populations of women who may otherwise not receive preconception care.

Keywords

preconception care - postnatal care - reproductive health - pregnancy outcomes

Publikationsverlauf

Artikel online veröffentlicht:
28. Juli 2022

• References

• 1 World Health Organization. Maternal mortality Geneva: World Health Organization; 2019. [cited 03/09/2021. Accessed February 25, 2022 at: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
• 2 Hug L, Alexander M, You D, Alkema L. UN Inter-agency Group for Child Mortality Estimation. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health 2019; 7 (06) e710-e720
• 3 Flenady VJ, Middleton P, Wallace EM. et al. Stillbirth in Australia 1: the road to now: two decades of stillbirth research and advocacy in Australia. Women Birth 2020; 33 (06) 506-513
• 4 Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System Atlanta Georgia: U.S. Department of Health & Human Services. 2021 Accessed February 25, 2022 at: https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm
• 5 Humphrey MD. Maternal mortality trends in Australia. Med J Aust 2016; 205 (08) 344-346
• 6 Bhatia M, Dwivedi LK, Banerjee K, Bansal A, Ranjan M, Dixit P. Pro-poor policies and improvements in maternal health outcomes in India. BMC Pregnancy Childbirth 2021; 21 (01) 389
• 7 Bearak J, Popinchalk A, Ganatra B. et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990-2019. Lancet Glob Health 2020; 8 (09) e1152-e1161
• 8 World Health Organization. Born Too Soon: The Global Action Report on Preterm Birth. Geneva: World Health Organization; 2012
• 9 Rich-Edwards JW. Reproductive health as a sentinel of chronic disease in women. Womens Health (Lond) 2009; 5 (02) 101-105
• 10 Rich-Edwards JW, Fraser A, Lawlor DA, Catov JM. Pregnancy characteristics and women's future cardiovascular health: an underused opportunity to improve women's health?. Epidemiol Rev 2014; 36 (01) 57-70
• 11 Girum T, Wasie A. Correlates of maternal mortality in developing countries: an ecological study in 82 countries. Matern Health Neonatol Perinatol 2017; 3 (01) 19
• 12 Kawakita T, Franco S, Ghofranian A, Thomas A, Landy HJ. Association between long interpregnancy intervals and cesarean delivery due to arrest disorders. Am J Obstet Gynecol MFM 2020; 2 (03) 100103
• 13 Conde-Agudelo A, Rosas-Bermúdez A, Kafury-Goeta AC. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA 2006; 295 (15) 1809-1823
• 14 Hanley GE, Hutcheon JA, Kinniburgh BA, Lee L. Interpregnancy interval and adverse pregnancy outcomes: an analysis of successive pregnancies. Obstet Gynecol 2017; 129 (03) 408-415
• 15 Bujold E, Gauthier RJ. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months. Obstet Gynecol 2010; 115 (05) 1003-1006
• 16 Getahun D, Strickland D, Ananth CV. et al. Recurrence of preterm premature rupture of membranes in relation to interval between pregnancies. Am J Obstet Gynecol 2010; 202 (06) 570.e1-570.e6
• 17 Razzaque A, Da Vanzo J, Rahman M. et al. Pregnancy spacing and maternal morbidity in Matlab, Bangladesh. Int J Gynaecol Obstet 2005; 89 (Suppl. 01) S41-S49
• 18 Smith GC, Pell JP, Dobbie R. Interpregnancy interval and risk of preterm birth and neonatal death: retrospective cohort study. BMJ 2003; 327 (7410): 313
• 19 Cheslack-Postava K, Liu K, Bearman PS. Closely spaced pregnancies are associated with increased odds of autism in California sibling births. Pediatrics 2011; 127 (02) 246-253
• 20 Zerbo O, Yoshida C, Gunderson EP, Dorward K, Croen LA. Interpregnancy interval and risk of autism spectrum disorders. Pediatrics 2015; 136 (04) 651-657
• 21 Pereira G, Francis RW, Gissler M. et al. Optimal interpregnancy interval in autism spectrum disorder: a multi-national study of a modifiable risk factor. Autism Res 2021; 14 (11) 2432-2443
• 22 Hutcheon JA, Nelson HD, Stidd R, Moskosky S, Ahrens KA. Short interpregnancy intervals and adverse maternal outcomes in high-resource settings: an updated systematic review. Paediatr Perinat Epidemiol 2019; 33 (01) O48-O59
• 23 Ahrens KA, Nelson H, Stidd RL, Moskosky S, Hutcheon JA. Short interpregnancy intervals and adverse perinatal outcomes in high-resource settings: an updated systematic review. Paediatr Perinat Epidemiol 2019; 33 (01) O25-O47
• 24 Tessema GA, Marinovich ML, Håberg SE. et al. Interpregnancy intervals and adverse birth outcomes in high-income countries: an international cohort study. PLoS One 2021; 16 (07) e0255000
• 25 Swaminathan A, Fell DB, Regan A, Walker M, Corsi DJ. Association between interpregnancy interval and subsequent stillbirth in 58 low-income and middle-income countries: a retrospective analysis using Demographic and Health Surveys. Lancet Glob Health 2020; 8 (01) e113-e122
• 26 Hutcheon JA, Moskosky S, Ananth CV. et al. Good practices for the design, analysis, and interpretation of observational studies on birth spacing and perinatal health outcomes. Paediatr Perinat Epidemiol 2019; 33 (01) O15-O24
• 27 World Health Organization.. Report of a WHO Technical Consultation on Birth Spacing. Geneva, Switzerland, June 13–15, 2005. Geneva: WHO; 2007
• 28 Bahk J, Yun S-C, Kim YM, Khang Y-H. Impact of unintended pregnancy on maternal mental health: a causal analysis using follow up data of the Panel Study on Korean Children (PSKC). BMC Pregnancy Childbirth 2015; 15 (01) 85
• 29 Hall JA, Barrett G, Copas A, Phiri T, Malata A, Stephenson J. Reassessing pregnancy intention and its relation to maternal, perinatal and neonatal outcomes in a low-income setting: a cohort study. PLoS One 2018; 13 (10) e0205487
• 30 Le HH, Connolly MP, Bahamondes L, Cecatti JG, Yu J, Hu HX. The burden of unintended pregnancies in Brazil: a social and public health system cost analysis. Int J Womens Health 2014; 6: 663-670
• 31 Aleni M, Mbalinda SN, Muhindo R. Birth intervals and associated factors among women attending young child clinic in Yumbe Hospital, Uganda. Int J Reprod Med 2020; 2020: 1326596
• 32 Mamo H, Dagnaw A, Sharew NT, Brhane K, Kotiso KS. Prevalence of short interpregnancy interval and its associated factors among pregnant women in Debre Berhan town, Ethiopia. PLoS One 2021; 16 (08) e0255613
• 33 de Jonge HCC, Azad K, Seward N. et al. Determinants and consequences of short birth interval in rural Bangladesh: a cross-sectional study. BMC Pregnancy Childbirth 2014; 14 (01) 427
• 34 Pimentel J, Ansari U, Omer K. et al. Factors associated with short birth interval in low- and middle-income countries: a systematic review. BMC Pregnancy Childbirth 2020; 20 (01) 156
• 35 Centers for Disease Control and Prevention. Short Interpregnancy Intervals in 2014: Differences by Maternal Demographic Characteristics Atlanta, Georgia: CDC. 2016 [02/11/2021]. Accessed February 25, 2022 at: https://www.cdc.gov/nchs/products/databriefs/db240.htm
• 36 Yang JM, Cheney K, Taylor R, Black K. Interpregnancy intervals and women's knowledge of the ideal timing between birth and conception. BMJ Sex Reprod Health 2019 bmjsrh-2018-200277
• 37 Health TFoSaR. UK medical eligibility criteria for contraceptive use 2019. 02/11/2021. Accessed February 25, 2022 at: www.fsrh.org/ukmec
• 38 Jackson E, Glasier A. Return of ovulation and menses in postpartum nonlactating women: a systematic review. Obstet Gynecol 2011; 117 (03) 657-662
• 39 Australian Institute of Health and Welfare. 2010 Australian National Infant Feeding Survey: Indicator Results. Canberra: AIHW; 2011
• 40 White K, Teal SB, Potter JE. Contraception after delivery and short interpregnancy intervals among women in the United States. Obstet Gynecol 2015; 125 (06) 1471-1477
• 41 Rowe H, Holton S, Kirkman M. et al. Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey. Aust N Z J Public Health 2016; 40 (02) 104-109
• 42 Brito MB, Ferriani RA, Quintana SM, Yazlle ME, Silva de Sá MF, Vieira CS. Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study. Contraception 2009; 80 (06) 519-526
• 43 American College of Obstetricians and Gynecologists. Committee Opinion Number 736 Optimizing postpartum care. 2018 May 2018. Accessed February 25, 2022 at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care
• 44 National IUD Clinical Research Group. Observations on the clinical efficacies and side effects of six different timings of IUD insertions. Zhonghua Fu Chan Ke Za Zhi 1987; 22: 350-353
• 45 Lopez LM, Bernholc A, Hubacher D, Stuart G, Van Vliet H. Immediate postpartum insertion of intrauterine device for contraception. Cochrane Database Syst Rev 2015; (06) CD003036
• 46 McIntyre HD, Gibbons KS, Flenady VJ, Callaway LK. Overweight and obesity in Australian mothers: epidemic or endemic?. Med J Aust 2012; 196 (03) 184-188
• 47 Yang Z, Phung H, Freebairn L, Sexton R, Raulli A, Kelly P. Contribution of maternal overweight and obesity to the occurrence of adverse pregnancy outcomes. Aust N Z J Obstet Gynaecol 2019; 59 (03) 367-374
• 48 Godfrey KM, Reynolds RM, Prescott SL. et al. Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endocrinol 2017; 5 (01) 53-64
• 49 Aune D, Saugstad OD, Henriksen T, Tonstad S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 2014; 311 (15) 1536-1546
• 50 Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med 2016; 50 (06) 761-779
• 51 Gaillard R. Maternal obesity during pregnancy and cardiovascular development and disease in the offspring. Eur J Epidemiol 2015; 30 (11) 1141-1152
• 52 Mannan M, Doi SA, Mamun AA. Association between weight gain during pregnancy and postpartum weight retention and obesity: a bias-adjusted meta-analysis. Nutr Rev 2013; 71 (06) 343-352
• 53 Schummers L, Hutcheon JA, Bodnar LM, Lieberman E, Himes KP. Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling. Obstet Gynecol 2015; 125 (01) 133-143
• 54 Cnattingius S, Villamor E. Weight change between successive pregnancies and risks of stillbirth and infant mortality: a nationwide cohort study. Lancet 2016; 387 (10018): 558-565
• 55 Teulings NEWD, Masconi KL, Ozanne SE, Aiken CE, Wood AM. Effect of interpregnancy weight change on perinatal outcomes: systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19 (01) 386
• 56 Dean SV, Lassi ZS, Imam AM, Bhutta ZA. Preconception care: nutritional risks and interventions. Reprod Health 2014; 11 (03, Suppl 3): S3
• 57 World Health Organization. Iron Supplementation in Postpartum Women. Geneva: WHO; 2016
• 58 Kominiarek MA, Rajan P. Nutrition recommendations in pregnancy and lactation. Med Clin North Am 2016; 100 (06) 1199-1215
• 59 Centers for Disease Control and Prevention. Iodine. Atlanta, Georgia: U.S. Department of Health & Human Services; 2021. . Accessed February 25, 2022 at: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/iodine.html
• 60 Oliveira-Menegozzo JM, Bergamaschi DP, Middleton P, East CE. Vitamin A supplementation for postpartum women. Cochrane Database Syst Rev 2010; (10) CD005944
• 61 Liu M, Chen J, Liu J. et al. Socioeconomic inequality in periconceptional folic acid supplementation in China: a census of 0.9 million women in their first trimester of pregnancy. BMC Pregnancy Childbirth 2017; 17 (01) 422
• 62 Kinnunen TI, Sletner L, Sommer C, Post MC, Jenum AK. Ethnic differences in folic acid supplement use in a population-based cohort of pregnant women in Norway. BMC Pregnancy Childbirth 2017; 17 (01) 143
• 63 Petersen JM, Yazdy MM, Getz KD, Anderka MT, Werler MM. National Birth Defects Prevention Study. Short interpregnancy intervals and risks for birth defects: support for the nutritional depletion hypothesis. Am J Clin Nutr 2021; 113 (06) 1688-1699
• 64 Beharier O, Shoham-Vardi I, Pariente G. et al. Gestational diabetes mellitus is a significant risk factor for long-term maternal renal disease. J Clin Endocrinol Metab 2015; 100 (04) 1412-1416
• 65 Appiah D, Schreiner PJ, Gunderson EP. et al. Association of gestational diabetes mellitus with left ventricular structure and function: the CARDIA study. Diabetes Care 2016; 39 (03) 400-407
• 66 Buchanan TA, Xiang AH, Page KA. Gestational diabetes mellitus: risks and management during and after pregnancy. Nat Rev Endocrinol 2012; 8 (11) 639-649
• 67 Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373 (9677): 1773-1779
• 68 Dennison RA, Chen ES, Green ME. et al. The absolute and relative risk of type 2 diabetes after gestational diabetes: a systematic review and meta-analysis of 129 studies. Diabetes Res Clin Pract 2021; 171: 108625
• 69 Sorbye LM, Cnattingius S, Skjaerven R. et al. Interpregnancy weight change and recurrence of gestational diabetes mellitus: a population-based cohort study. BJOG 2020; 127 (13) 1608-1616
• 70 O'Reilly SL, Dunbar JA, Versace V. et al; MAGDA Study Group. Mothers after gestational diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program. PLoS Med 2016; 13 (07) e1002092
• 71 Dennison RA, Fox RA, Ward RJ, Griffin SJ, Usher-Smith JA. Women's views on screening for Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for increasing uptake. Diabet Med 2020; 37 (01) 29-43
• 72 Nielsen KK, Kapur A, Damm P, de Courten M, Bygbjerg IC. From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy Childbirth 2014; 14: 41
• 73 Eggleston EM, LeCates RF, Zhang F, Wharam JF, Ross-Degnan D, Oken E. Variation in postpartum glycemic screening in women with a history of gestational diabetes mellitus. Obstet Gynecol 2016; 128 (01) 159-167
• 74 Tovar A, Chasan-Taber L, Eggleston E, Oken E. Postpartum screening for diabetes among women with a history of gestational diabetes mellitus. Prev Chronic Dis 2011; 8 (06) A124
• 75 National Diabetes Services Scheme. National Gestational Diabetes Register Canberra: NFDD; 2021
• 76 Joseph KS, Liston RM, Dodds L, Dahlgren L, Allen AC. Socioeconomic status and perinatal outcomes in a setting with universal access to essential health care services. CMAJ 2007; 177 (06) 583-590
• 77 Zilidis C, Hadjichristodoulou C. Economic crisis impact and social determinants of perinatal outcomes and infant mortality in Greece. Int J Environ Res Public Health 2020; 17 (18) E6606
• 78 Kim MK, Lee SM, Bae S-H. et al. Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system. Int J Equity Health 2018; 17 (01) 2
• 79 Jardine J, Walker K, Gurol-Urganci I. et al; National Maternity and Perinatal Audit Project Team. Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study. Lancet 2021; 398 (10314): 1905-1912
• 80 Lorch SA, Enlow E. The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes. Pediatr Res 2016; 79 (1-2): 141-147
• 81 Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P. Consortium for the European Review of Social Determinants of Health and the Health Divide. WHO European review of social determinants of health and the health divide. Lancet 2012; 380 (9846): 1011-1029
• 82 Sijpkens MK, Steegers EA, Rosman AN. Facilitators and barriers for successful implementation of interconception care in preventive child health care services in the Netherlands. Matern Child Health J 2016; 20 (Suppl. 01) 117-124
• 83 Frayne D, Hughes P, Lugo B. et al. Interconception care for mothers at well child visits after implementation of the IMPLICIT model. Matern Child Health J 2021; 25 (08) 1193-1199
• 84 Srinivasan S, Schlar L, Rosener SE. et al. Delivering interconception care during well-child visits: an IMPLICIT Network Study. J Am Board Fam Med 2018; 31 (02) 201-210
• 85 Sijpkens MK, Lagendijk J, van Minde MRC. et al. Integrating interconception care in preventive child health care services: the Healthy Pregnancy 4 All program. PLoS One 2019; 14 (11) e0224427
• 86 Kallem S, Matone M, Boyd RC, Guevara JP. Mothers' mental health care use after screening for postpartum depression at well-child visits. Acad Pediatr 2019; 19 (06) 652-658
• 87 Rosener SE, Barr WB, Frayne DJ, Barash JH, Gross ME, Bennett IM. Interconception care for mothers during well-child visits with family physicians: an IMPLICIT Network Study. Ann Fam Med 2016; 14 (04) 350-355
• 88 March of Dimes. Implicit Interconception Toolkit Arlington Virginia: March of Dimes. 2021 . Accessed February 25, 2022 at: https://www.marchofdimes.org/professionals/implicit-interconception-care-toolkit.aspx
• 89 Schummers L, Hutcheon JA, Hernandez-Diaz S. et al. Association of short interpregnancy interval with pregnancy outcomes according to maternal age. JAMA Intern Med 2018; 178 (12) 1661-1670
• 90 Ogunwole SM, Chen X, Mitta S. et al. Interconception care for primary care providers: consensus recommendations on preconception and postpartum management of reproductive-age patients with medical comorbidities. Mayo Clin Proc Innov Qual Outcomes 2021; 5 (05) 872-890