Knowledge Synthesis: Preconception Health

Despite the importance of optimal preconception health for the health of the pregnancy and the baby, there is a lack of evidence-based guidelines for PCC and primary care providers are not routinely asking about pregnancy intention citing lack of knowledge as a barrier. The One Key Question (OKQ) concept is a novel approach to initiating conversations about pregnancy intention in primary care and providing those who plan pregnancy with PCC. This is particularly important for women with NCD who have significant unmet PCC needs. Contrary to primary care professionals’ beliefs, our research shows that asking people of reproductive age about their pregnancy intentions is acceptable to them. 

A systematic review identified international guidelines on preconception care (PCC), assessed their quality using the AGREE II tool, and assessed the level of evidence for their recommendations. Eleven guidelines were identified, ten of which were classified as moderate quality and only one as very high quality. The levels of evidence for recommendations ranged from the lowest possible level of evidence (III) to the highest (I-a). It was concluded that high-quality guidelines on PCC are lacking and that few recommendations are supported by high-quality evidence [1].

A Delphi technique was used to rank priorities for PCC and establish values to guide future work in PCC in Australia. Multidisciplinary experts in PCC or social care (n=23), completed the Delphi technique. Ten priority areas were identified, with health behaviours, medical history, weight, and reproductive health ranked most highly. Underpinning values included engagement with stakeholders, a life course view of preconception health, an integrated multi-sectorial approach and a need for large scale collaboration to implement interventions that deliver impact across health care, social care, policy and population health [2].

A pregnancy desire question is an entry point to offer compassionate, non-judgmental, patient-centred, evidence-based, contraceptive care for those who do not want to become pregnant, and comprehensive preconception/interconception care for those who do. This paper describes the development, implementation, evaluation, and international adaptation of the One Key Question® (OKQ®). This pregnancy desire screening question identifies the reproductive health information and services women need to be healthy, to avoid unplanned pregnancy, and to increase their chances of a successful pregnancy, if and when they want to be pregnant [3].

While nurses in primary care are in a unique place to ask about pregnancy intention (e.g. using OKQ) and provide PCC to those who plan pregnancy, a survey of 152 nurses working in primary care in Australia showed that only 13% do so routinely. Respondents identified at least many barrier to delivery of PCC, with lack of time and knowledge being the most common [4].

Based on evidence that nurses in primary care perceive lack of knowledge as a barrier for providing PCC, the efficacy and acceptability of a free online learning module to assist nurses and midwives in primary health care to promote preconception health in their practice was evaluated through a repeat online survey administered before and after completion of the learning module. 121 nurses completed both surveys. There were statistically significant improvements in the knowledge scores and in the proportion of participants who reported feeling confident in their knowledge about preconception health. Almost all (95%) were satisfied with the duration and content of the learning module [5]. 

A systematic review and narrative synthesis of the pregnancy planning health information and service needs of women with chronic non-communicable diseases (NCD) revealed that they have significant unmet needs. To improve pregnancy outcomes for women living with NCDs, health care providers need to ask women of reproductive age proactively and routinely about their pregnancy intentions (e.g. using OKQ) and provide them with personalised advice on how to avoid unplanned pregnancy and be in optimal health when they wish to conceive [6].  

A population-based survey of >700 people of reproductive age found that routinely asking people about their pregnancy intentions (e.g. using OKQ) and advising those who are planning pregnancy about what they can do to ensure optimal preconception health would be acceptable to most people and may improve reproductive outcomes [7].  

1. Dorney E, Boyle JA, Walker R, Hammarberg K, Musgrave L, Schoenaker D, et al. A Systematic Review of Clinical Guidelines for Preconception Care. Semin Reprod Med. 2022.
2. Boyle JA, Black K, Dorney E, Amor DJ, Brown L, Callander E, et al. Setting Preconception Care Priorities in Australia Using a Delphi Technique. Semin Reprod Med. 2022. 
3. Stranger Hunter M, Hammarberg K, Sher J. Ask women what they want: Integrating pregnancy desire screening into routine primary care. International Journal of Birth and Parent Education. 2022;10(1):19-28.
4. Dorney E, Millard J, Hammarberg K, Griffin K, Gordon A, McGeechan K, et al. Australian primary health care nurses’ knowledge, practice and attitudes relating to preconception care: learnings for service implementation. Australian Journal of Primary Health. 2022;28(1):63-8.
5. Hammarberg K, Stocker R. Evaluation of an online learning module to improve nurses’ and midwives’ capacity to promote preconception health in primary healthcare settings. Australian Journal of Primary Health. 2021;27(6):462-6. 
6. Hammarberg K, Stocker R, Romero L, Fisher J. Pregnancy planning health information and service needs of women with chronic non-communicable conditions: a systematic review and narrative synthesis. BMC Pregnancy Childbirth. 2022;22(1):236.
7. Hammarberg K, Hassard J, de Silva R, Johnson L. Acceptability of screening for pregnancy intention in general practice: a population survey of people of reproductive age. BMC Fam Pract. 2020;21(1):40.