Published On:Tuesday, August 31, 2010

* Women between the age of 18 and 35 are at the prime of their reproductive years. Whilst many women may face reproductive challenges such as infertility, most will become pregnant at some point, once sexually active. The outcome of pregnancy is determined long before the point of conception. Therefore the health of women in this age range is a priority concern for health care providers in the Maternal and Child Health Services of the Bahamas. In this article, Gina Dean SNO, and Coordinator of the Maternal and Child Health Programme share on the importance of Preconception Health in the population.)

What is Preconception Health (PCH)?

Preconception health refers to the health of women of reproductive (or childbearing) age when they are in a non-pregnant state. This includes adolescents and women, before they become pregnant for the first time, as well as women who are between pregnancies.

Why is there a need to focus on PCH?

We need to focus on PCH because of the strong and important link between the health status of a woman before she becomes pregnant, and her health status and that of her baby, during pregnancy, during childbirth and during the (postpartum) period just after she had her baby. The better a woman's health is before she becomes pregnant, the healthier she and her baby are likely to be after she gives birth.

What is PCH care and what is the main goal of PCH care?

Preconception health care is the educational, promotional and preventive health services provided to women before conception (that is, before becoming pregnant). The main goal is to improve a woman's health before conception (before a first or subsequent pregnancy). The objective of PCH care is to identify factors (diseases, infection, 'risky' health behaviours) associated with negative pregnancy outcomes (deformity, miscarriages, low birth weight etc) so that they can be modified through clinical interventions (treatment) and behavioural changes.

Who are the target groups for the promotion of PCH?

The target group for PCH is all women of reproductive age. That is, females from menarche to menopause, who are capable of having children, even if they do not intend to get pregnant (11 - 50 years). Although females are our primary focus, PCH services also target males; recognising that men are partners and key contributors in reproduction.

What are some of the risk factors for poor pregnancy outcomes among women and infants?

Risk factors for poor pregnancy outcomes include:

* Medical conditions such as diabetes, hypertension, obesity, sickle cell disease (partners who are both carriers of the sickle cell trait should seek counseling before conception), sexually transmitted infections, vitamin and mineral deficiencies (folic acid deficiency is especially important), periodontal disease

* Poor pregnancy history such as repeated premature labour and spontaneous abortions, previous miscarriages, death of baby soon after birth or before the age of two and previous low birth weight infants.

* Lifestyle behaviours such as smoking/illicit drugs, over use of alcohol, and poor nutritional intake

* Psychosocial risks such as abusive relationships (physical, sexual or mental), and poor housing conditions

* Environmental exposures such as exposure to passive tobacco smoke, chemicals, lead, and radiation

* Social, economic and physical risks associated with adolescent pregnancy

* Age related factors such as the increased risk of chromosomal problems for older women. Advancing age also increases risk of hypertension and diabetes in pregnancy.

What can women do to improve their PCH?

* Take a proactive approach to your reproductive health. Have a plan; decide whether you want to have children, when you want to have children, and whether you are physically, mentally and economically prepared for children. Make the necessary changes in your life that is needed based on your answers to these questions so that your reproductive health will go in the direction you would like.

* Be aware of your health status and the risk factors that might be present or contribute to poor pregnancy outcomes and make the necessary changes early.

* Begin or continue to have regular preventive health visits with your doctor

* Have a pre-pregnancy check-up once deciding to get pregnant.

What should women expect during a PCH visit?

Preventive visits should be a part of your routine yearly check-up or primary care visit. This visit should include disease screening, and should seek to address the majority of your personal health care needs as well as address any existing health problems. It will also include risk assessment, reproductive history tracking, medication being taken, nutritional pattern, monitoring of folic acid intake, weight management, substance use, vaccinations, family planning methods, and all social and mental health concerns, including support networks, domestic violence and housing. These are all important to a healthy reproductive life.

Where can women go to access PCH services?

PCH services can be accessed wherever individuals receive their primary health care services. This includes all community health clinics on New Providence and the Family Islands, as well as private primary health centres. Most health care facilities do not generally include the term pre-pregnancy or preconception health in their list of services but all of the components of PCH are available at most of these facilities. Ask for the service at your next visit.

* For more information on preconception care and other topics on women and family health contact the Maternal and Child Health Secretariat of the Department of Public Health at telephone numbers 502-4883 or 502-4778.