www. jhgd.com.

br
ORIGINAL ARTICLE

Preconception Care to Improve Pregnancy Outcomes:

The Science
Hani Atrash1, Brian Jack2

Abstract
Open acess
Introduction: In the last decades, improvements in the care of
1
MD, MPH, Adjunct Professor,
pregnancy and child development have been observed worldwide.
Department of Epidemiology
However, pregnancy problems remain high in most countries. There
Emory University, Rollins School
of Public Health. was a concentration of care in the prenatal period as the primary
approach for improving pregnancy results. Currently, attention to the
MD, Professor and Vice Chair,
2 care of pregnant women, women who have recently given birth, and
Department of Family Medicine newborns are focused on the care of preconception to improve the
Boston University School of results of pregnancy and improve the outcomes of child growth and
Medicine / Boston Medical development.
Center.
Objective: Describe the evidence for preconception care (PCC)
Corresponding author
and information to the health care provider, as well as describe
[email protected]
instruments to present health care providers with PCC, its definition,
Article History its components, recommended interventions, and the scientific basis
Received: May 2020
Revised: May 2020 for recommendations.
Accepted: September 2020
Methods: There was a search for published and unpublished literature
related to scientific evidence for the effectiveness of PCC in improving
pregnancy results. The search was carried out based on Pubmed
and using data scraping techniques, in the material available on the
internet and disseminated by international organizations, such as the
World Health Organization and reports by government agencies.

Results: It is reported that the literature on the scientific basis for

PCC is fragmented, and most publications discuss evidence of one
or a few interventions, with the majority of reports considering PCC
for specific populations, such as women with chronic health problems
and couples with infertility. However, these publications do not offer
a realistic view of the proposed PCC interventions, with the scientific
evidence that supports them. The general aspects of the existing
literature and the recommended preconceived care interventions are
described, together with the quality of the scientific evidence and the
strength of the recommendations behind each of these interventions.

Conclusion: Many clinical interventions have been identified that

could be offered to women before conception to help avoid adverse
outcomes. Most of these interventions have scientific evidence to
support their role in improving pregnancy outcomes. Therefore, it is
recommended that clinical care providers incorporate evidence-based
prejudice services in their daily care of women of reproductive age, in
an effort to improve women’s health before and during pregnancy, as
well as improve pregnancy outcomes for women and their children.

Keywords: preconception care, preconception health, women’s

health, maternal health, infant health.

Suggested citation: Atrash H, Jack B. Preconception Care to Improve Pregnancy Outcomes: The Science. J Hum Growth Dev.
2020; 30(3):355-362. DOI: http:doi.org/10.7322/jhgd.v30.11064

J Hum Growth Dev. 2020; 30(3):355-362. DOI: http:doi.org/10.7322/jhgd.v30.11064 355

 www. jhgd.com.br

Authors summary

Why was this study done?

• The last few decades witnessed substantial improvements in maternal and infant pregnancy outcomes all over the world. However,
the levels of poor pregnancy outcomes in most countries continue to be very high. • Most countries have relied on improving access to
prenatal care to further improve pregnancy outcomes. • There is scientific evidence that improving the health of women before pregnancy
(preconception care) will improve maternal and infant pregnancy outcomes. • Over 80 interventions have been recommended to be
included in a preconception care package. • We summarized the evidence for the effectiveness of preconception care to make the
information available to health care providers.

What did the researchers do and find?

• We reviewed published and un-published literature related to the scientific evidence for the effectiveness of preconception care in
improving pregnancy outcomes. • We searched PubMed for published articles. • We searched the internet for unpublished reports
prepared by international organizations such as the World Health Organization and reports from governmental agencies. • Many
clinical interventions have been identified which could be offered to women prior to conception to help avoid adverse outcomes. • Most
of these interventions have scientific evidence to support their role in improving pregnancy outcomes.

What do these findings mean?

• There is scientific evidence that preconception care improves maternal and infant pregnancy outcomes. • It is recommended that
clinical care providers incorporate evidence-based preconception services into their daily care of women of reproductive age.

INTRODUCTION
Improving pregnancy outcomes and reducing The United States has also succeeded in reducing
maternal and infant mortality and morbidity has been a infant mortality rates from 12.6 deaths per 1,000 live
major priority for countries around the world, led by the births in 1980 to 5.9 in 20156. However, despite these
World Health Organization (WHO). During the last 40 improvements, the maternal and infant mortality rates,
years, efforts to improve pregnancy outcome have mainly and the rates of complications of pregnancy and adverse
focused on the care and health of women during pregnancy pregnancy outcomes, including congenital anomalies, low
and at the time of delivery by increasing prenatal care birthweight and preterm delivery, continue to be higher
(PNC) coverage and ensuring deliveries by skilled birth than desired: the proportion of babies born low birthweight
attendants. Many countries succeeded in improving PNC and the proportion of babies born preterm continue to be
coverage. According to the WHO, in 83 countries, 75% high (8.1% and 9.9% respectively), and maternal mortality
of pregnant women had at least 4 PNC visits in 20121. and morbidity rates are increasing6. In fact, in 2012, 35
However, despite these improvements, the maternal and of the 38 “Very High Human Development Countries”
infant mortality rates, and the number of both pregnancy reported preterm delivery rates that were lower than that
complications and adverse pregnancy outcomes, including of the USA, and 29 developed countries reported lower
congenital anomalies, low birthweight and preterm infant mortality rates than the US6,7. In 2015, the WHO
delivery, continue to be higher than desired. Globally, the reported that 53 countries had lower maternal mortality
WHO reported that maternal mortality continues to be rates than the USA2.
unacceptably high: it was estimated that in 2017, about Over the past few years, and because of the slow
295,000 women died during and following pregnancy and progress in improving pregnancy outcomes, there has
childbirth2. The WHO also reported that although globally been a great emphasis on preconception care (PCC) as
the infant mortality rate has decreased from an estimated an alternative and additional approach to counter the
rate of 65 deaths per 1000 live births in 1990 to 29 deaths persistent adverse pregnancy outcomes around the world.
per 1000 live births in 2017, still every year, 4.1 million The goal of PCC is to promote the health of women of
babies die during the first year of their life3. In 2006, the reproductive age before conception and thereby improve
March of Dimes reported that “every year an estimated maternal and infant pregnancy outcomes. Today, there is
7.9 million children – 6% of total births worldwide - are ample scientific evidence that in many cases, improving a
born with a serious birth defect of genetic or partially woman’s health before pregnancy (preconception health
genetic origin. Additional hundreds of thousands more are and health care) will improve pregnancy outcomes for
born with serious birth defects of post-conception origin, both mothers and infants. However, despite the scientific
including maternal exposure to environmental agents evidence and the broad interest in PCC, there has been
(teratogens) such as alcohol, rubella, syphilis and iodine only modest progress in implementing these concepts
deficiency that can harm a developing fetus”4. into clinical practice and developing research studies
The focus on PNC reflects an emphasis on to advance practice and PCC has proven to be difficult
observing and monitoring a woman’s health during to implement into clinical practice. Most women and
pregnancy and intervening when and if needed (health physicians realize the importance of optimizing their
promotion, risk assessment and intervention). However, health before pregnancy, however, time constraints and
improving the coverage, content, and use of PNC was a the wide range of activities that constitute preconception
necessary, but not sufficient step in improving pregnancy care are primary barriers to widespread implementation8.
outcomes. For example, in the United States, in 2016,
93.8% of pregnant women initiated PNC before the third HISTORY
trimester (77.1% initiated care during the first trimester PCC is not a new concept –it has been believed for
and 16.7% initiated care during the second trimester)5. ages that the health of a woman before she gets pregnant

J Hum Growth Dev. 2020; 30(3):355-362. DOI: http:doi.org/10.7322/jhgd.v30.11064 356

 www. jhgd.com.br
as well as her behavioral and her environmental exposures be acted on before conception or early in pregnancy to
have an impact on the outcome of her pregnancy for her have maximal impact. Thus, it is more than a single visit
and for her infant. In fact, references to the importance and less than all well-woman care. It includes care before
of a mother’s health in improving pregnancy outcomes a first pregnancy or between pregnancies (commonly
are found in documents hundreds of years old. In 1825, known as interconception care)”13.
William Potts Dewees in the first pediatric textbook in the Scientists convened by WHO in February 2012
United States stated that “physical treatment of children defined PCC as “the provision of biomedical, behavioral
should begin as far as may be practicable, with the earliest and social health interventions to women and couples
formation of the embryo; it will, therefore, necessarily before conception occurs. It aims at improving their
involve the conduct of the mother, even before her marriage, health status and reducing behaviors and individual and
as well as during her pregnancy”9. In recent years, PCC environmental factors that contribute to poor maternal
was first described by Chamberlain in1980 as a specialty and child health outcomes. Its ultimate aim is to improve
service for women who had a previous poor reproductive maternal and child health, in both the short and long
outcome10. It was then described in the United States by term”18.
the United States Public Health Service in the landmark The published literature lists a very wide range of
publication “Preventing Low Birth Weight”11. The concept interventions that are proposed to be included in PCC. Some
was adopted by the United States Public Health Service’s of these interventions are based on scientific evidence and
Expert Panel on the Content of Prenatal Care, who defined have existing clinical practice guidelines whereas others
its components and emphasized that it is most effectively are based on common sense and current standard practice.
delivered as part of primary care services12. It is clear from the above definitions that PCC is not
More recently, in 2004, the United States Centers limited to clinical care but addresses all factors that may
for Disease Control and Prevention (CDC) convened contribute to the outcomes of pregnancy: family history,
experts who developed and published “Recommendations medical conditions, exposures to teratogens including
to Improve Preconception Health and Health Care”13. prescription medications, environmental exposures, and
Following the publication of the recommendations, state risky behaviors such as smoking and drinking.
and local health departments within the United States Participants at the WHO meeting defined the
initiated programs to implement the Recommendations. components of PCC to include 13 conditions as follows:
Many countries such as Canada, Belgium and the nutritional conditions, tobacco use, genetic conditions,
Netherlands have also started to implement PCC environmental health, infertility/ subfertility, interpersonal
programs14-16. In February 2012, the WHO convened violence, too early/unwanted and rapid successive
a meeting of researchers and partner organizations pregnancies, sexually transmitted infections, HIV, mental
“to achieve a global consensus on the place of PCC health, psychoactive substance use, vaccine preventable
as part of an overall strategy to prevent maternal and diseases, and female genital mutilation18.
childhood mortality and morbidity”. Deliberations and
conclusions from the meeting are summarized in a WHO DOES PRECONCEPTION CARE WORK?
Policy Brief titled “Preconception Care: Maximizing Over the past 50 years, there have been many
the Gains for Maternal and Child Health” and a report publications advocating the use of PCC. Most discussed
titled “Meeting to Develop a Global Consensus on evidence for one or a few interventions and most discussed
Preconception Care to Reduce Maternal and Childhood PCC for specific populations such as women with chronic
Mortality and Morbidity”17-18. These reports include an health conditions and couples with infertility. The most
in-depth discussion of the rationale behind PCC as well comprehensive discussion of the evidence in support of
as definitions, components of PCC, delivery mechanisms, PCC came from the CDC published in a supplement of the
and proposed action steps for countries. The report American Journal of Obstetrics and Gynecology19.
concludes that PCC has a positive impact on maternal In June 2006, CDC established five PCC
and child health outcomes. The report also provides a implementation workgroups (clinical, public health,
foundation for implementing a package of promotive, consumer, policy and finance, and research and surveillance)
preventive and curative health interventions shown to have to discuss opportunities and to develop strategies for
been effective in improving maternal and child health. implementing PCC. The clinical workgroup worked
The report recommends that a wide range of sectors and together for over 2 years to define the clinical components
stakeholders needs to be engaged to ensure universal of PCC, summarize the existing evidence for inclusion of
access to PCC and guides non-health sectors, foundations each component in clinical activities, and define the health
and civil society organizations to collaborate with, and promotion package to be delivered as part of PCC.
support, public health policy-makers to maximize gains To identify PCC recommended interventions and
for maternal and child health through PCC18. better understand the scientific evidence in support of these
interventions, the 29 members of the clinical workgroup
DEFINITION along with 30 expert consultants reviewed over 700 papers
The group of scientists convened by CDC in and used specific criteria to make their assessment. The
2004 defined PCC as “interventions that aim to identify workgroup reviewed in depth topics currently proposed
and modify biomedical, behavioral, and social risks to a to be included in PCC. Topics were selected based on the
woman’s health or pregnancy outcome through prevention effect of PCC on the health of the mother and/or infant, its
and management, emphasizing those factors which must prevalence, and detectability, as follows20:

J Hum Growth Dev. 2020; 30(3):355-362. DOI: http:doi.org/10.7322/jhgd.v30.11064 357

 www. jhgd.com.br
• There is a good chance that the health of the for or against the inclusion of the condition in a
mother or the infant will be improved if the PCC evaluation, but recommendation to include or
condition is identified and addressed before exclude may be made on other grounds.
pregnancy; (D) There is fair evidence to support the
• The burden of suffering and prevalence of the recommendation that the condition be excluded in
condition are sufficient to justify screening and a PCC evaluation.
treatment; (E) There is good evidence to support the
• The condition is detectable in clinical care, in recommendation that the condition be excluded in
either primary or specialty settings; a PCC evaluation.
• If screening is employed, the screening methods
available to detect the condition are sufficiently Results of this activity were published in a special
predictive to justify screening; or supplement of the American Journal of Obstetrics and
• Clinical practice guidelines already exist Gynecology19 and summarized in an article titled “The
suggesting that preconception interventions be Clinical Content of Preconception Care: An Overview”20.
implemented. The clinical workgroup concluded that for 30 of the
conditions reviewed there was good evidence to support
The group concluded that there were 83 the recommendation that the condition be specifically
components that were recommended to be included in a considered in a PCC evaluation. These conditions
PCC package. The group then researched these topics to include: having a reproductive life plan / family planning,
determine the quality of the scientific evidence in support nutritional adequacy, folate supplements, immunization
of including these topics in a PCC package and the strength status, Sexually Transmitted Infections (STIs), Hepatitis
of recommendation based on that evidence. For each B, Rubella, HIV, Chlamydia, diabetes, hypothyroidism,
topic the workgroup assigned a score for the strength of Phenylketonuria, seizure disorders, hypertension,
the evidence supporting its inclusion in PCC and assigned rheumatoid arthritis, tobacco use, alcohol use, excess
a strength of the recommendation, using criteria adapted vitamin A, vitamin D deficiency, calcium intake, BMI
from those used in the report by the US Preventive Services ≤18.5 kg/m2, BMI ≥25 kg/m2, household exposures,
Task Force Guide to Clinical Preventive Services19-22. The teratogenic medications, over-the-counter medication,
following criteria were used to determine the quality of dietary supplements, preterm birth/Low birthweight
the evidence20: infant, cesarean section, history of miscarriage, and cancer
survivors20.
(I-a) Evidence was obtained from at least 1 properly The number of interventions recommended to be
conducted randomized controlled trial that was included in a PCC package by various groups, countries
done before pregnancy. and programs is much larger than the 30 listed above. In
(I-b) Evidence was obtained from at least 1 general, recommended PCC interventions may be grouped
properly conducted randomized controlled trial into three main categories: Assessment (including family
that was done not necessarily before pregnancy. and personal history and medical assessment), Counseling
(II-1) Evidence was obtained from well-designed and Education, and Prevention and Management. Based
controlled trials without randomization. on our review of the literature, we have summarized the
(II-2) Evidence was obtained from well-designed recommended interventions for each category along with
cohort or case-control analytic studies, preferably the quality of evidence and the strength of recommendation
from 1 center or research group. for each intervention.
(II-3) Evidence was obtained from multiple-time
series with or without the intervention. Dramatic 1. Assessment: assessment aims to identify
results in uncontrolled experiments could also be potential risks to the mother and baby and to rule out any
regarded as this type of evidence. potential complications of pregnancy. Providers should
(III) Opinions were gathered from respected review the woman’s family history, past obstetrical and
authorities, based on clinical experience, gynecological history, past medical and drug history,
descriptive studies and case reports, or reports of chronic illnesses, psychosocial history, behaviors,
expert committees and exposures to potential teratogens. All women in
need of PCC should also undergo a thorough physical
The following criteria were used to determine the examination and have specific laboratory tests done to
strength of the recommendation20: identify potential risks to their pregnancy outcomes. If
(A) There is good evidence to support the risk factors are identified during these assessments, the
recommendation that the condition be considered risks should be managed, or patients should be referred
specifically in a PCC evaluation. to specialized services if needed. Table 1 describes
(B) There is fair evidence to support the some of the interventions recommended to be included
recommendation that the condition be considered under the assessment category along with the quality of
specifically in a PCC evaluation. evidence and strength of recommendations described in
(C) There is insufficient evidence to recommend the literature14-16,18,19,22.

J Hum Growth Dev. 2020; 30(3):355-362. DOI: http:doi.org/10.7322/jhgd.v30.11064 358

 www. jhgd.com.br
Table 1: Components of Preconception Care: Assessment
Component Intervention Quality of Strength of
Evidence Recommendation
Personal history/demography: age, education,
III As and Bs
occupation, consanguinity
Family history: diabetes, hypertension, congenital
anomalies, other chronic diseases including disability, II-3 B
mental disorders
Personal medical, surgical and obstetrics/gynecology
history: seizure disorders, diabetes, hypertension,
mental disorders, vaccination status (tetanus,
History I-a As
diphtheria, rubella), hepatitis C, STIs, thyroid,
history of poor perinatal outcomes, history of genetic
conditions
Behavior: smoking, medical prescription, self-
medication (over the counter), folic acid intake, I-a As
contraception, unprotected sex
Domestic violence III C
Environmental exposures: second-hand smoking,
III As, Bs, and Cs
insecticides, pesticides, cleaning products
Physical exercise II-2 C

Physical examination: general exam, body mass III

index, vital signs These
A
Mental health status: depression interventions
These
were not
Complete blood count interventions were
assessed;
Screening and testing if indicated: sickle cell disease not assessed;
a score was
and beta thalassemia, other genetic conditions a score was
assigned
Medical assigned based on
ABO blood grouping and Rhesus based on
Assessment relevance
relevance

Blood sugar: fasting sugar and HbA1c (if available) if

I A
there is family history of diabetes
Other screenings if indicated: hepatitis B/C,
HIV, Sexually Transmitted Infections, bleeding/
Variable As, Bs, Cs
clotting disorders, periodontal disease, pap smear,
mammogram, etc
2. Counseling and Education: There is have the opportunity to receive treatment or sit with
evidence that counseling and education during the a specialist to receive counselling on the best course
preconception period results in changes in risk behaviors of action. Table 2 describes some of the interventions
leading to improved maternal and neonatal outcomes. included under the health promotion category along with
Based on history and medical assessment, if a health the quality of evidence and strength of recommendations
condition or a risk is identified, women and couples will described in the literature14-16,18,19,22.

Table 2: Components of Preconception Care: Counseling and Education

Intervention Strength of
Quality of Evidence
Recommendation
Counselling on healthy lifestyles Various Various
Counselling on healthy reproductive life planning III A
Counselling on the importance of early entry into prenatal
Not Assessed A
care
Counselling on Folic acid intake I-a A
Counselling on healthy diet II-a A

J Hum Growth Dev. 2020; 30(3):355-362. DOI: http:doi.org/10.7322/jhgd.v30.11064 359

 www. jhgd.com.br
Continuation - Table 2: Components of Preconception Care: Counseling and Education
Intervention Strength of
Quality of Evidence
Recommendation
Counselling and education on avoiding tobacco II-a A
Counselling and education on avoiding alcohol and harmful
III A
substances
Counselling and education about avoiding medications II-2 (prescription)
contraindicated in pregnancy and III (over the A
counter)
Counselling on risks of congenital anomalies Not assessed A
Infertility counselling Not assessed A
Counselling on STI/HIV III (STI)
A
I-b (HIV)

3. Prevention and management: many preconception period. Managing chronic conditions

women of childbearing age suffer from various chronic during pregnancy is not feasible and often by the time
conditions and are exposed to (or consume) substances a woman presents for prenatal care, all the fetal organs
that can have an adverse effect on pregnancy outcomes, had been formed and it is too late to prevent maternal
leading to pregnancy loss, infant death, birth defects, or and fetal complications related to these conditions.
other complications for mothers and infants. Conditions In addition to having chronic diseases, a substantial
like asthma, overweight or obesity, cardiac disease, proportion of women who become pregnant engage in
hypertension, diabetes, thyroid disorder, dental caries high-risk behaviors that contribute to adverse pregnancy
and other oral diseases have been found to be associated outcomes. These behaviors must be addressed during a
with complications for mothers and infants. It is essential PCC encounter14-16,18,19,22.
that these conditions be identified and addressed in the
Table 3: Components of Preconception Care: Prevention and Management
Component Intervention Quality of Evidence Strength of
Recommendation
Folic acid supplements I-a A
Family planning services III A
Safe sex Not Assessed A
Iron supplements if indicated I-b A
Vaccination against rubella (MMR)
II-3 A
(if indicated)
Prevention
Vaccination against tetanus and
III B
diphtheria (if indicated)
Vaccination against hepatitis B
III A
(if indicated)
Vaccination against influenza III C
HPV vaccine II-2 A

Diabetes Mellitus I A
Obesity II-2 B
Thyroid Disease II-1 A
Phenylketonuria II-1 A
Seizure disorder II-2 A
Management Hypertension II-2 A
Rheumatoid Arthritis III A
Cancer III A
Alcohol use III A
Tobacco II-a A
Illicit drugs III C

J Hum Growth Dev. 2020; 30(3):355-362. DOI: http:doi.org/10.7322/jhgd.v30.11064 360

 www. jhgd.com.br
CONCLUSION pregnancy outcomes. Clinical care providers play a
Effective preconception care is delivered very important role in providing these interventions
through a wide range of clinical and community during the preconception period. Therefore, it is
settings and cuts across many sectors, including recommended that clinical care providers incorporate
health, education and social. Many clinical evidence-based preconception services into their
interventions have been identified which could be daily care of women of reproductive age in an effort
offered to women prior to conception to help avoid to further improve the health of women before and
adverse outcomes. Most of these interventions have during pregnancy as well as to improve the outcomes
scientific evidence to support their role in improving of pregnancy for women and their children.
REFERENCES

1. World Health Organization (WHO). Global Health Observatory data repository. Antenatal care coverage
data by country [internet] 2020. [cited 2020 Jun 09] Available from: https://apps.who.int/gho/data/node.
main.ANTENATALCARECOVERAGE4?lang=en
2. UNFPA, World Health Organization, UNICEF, World Bank Group, the United Nations Population Division.
Trends in maternal mortality: 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and
the United Nations Population Division [internet] 2019. [cited 2020 Jun 09] Available from: https://www.
who.int/news-room/fact-sheets/detail/maternal-mortality
3. World Health Organization (WHO). Global Health Observatory data repository. Probability of dying per
1000 live births data by country [internet] 2020. [cited 2020 Jun 09] Available from: https://apps.who.int/
gho/data/view.main.182
4. Christianson A, Howson CP, Modell B. March of Dimes Global Report on Birth Defects. The hidden toll of
dying and disabled children. White Plains, New York: White Plains, 2006.
5. Osterman MJK, Martin JA. Timing and Adequacy of Prenatal Care in the United States, 2016. Natl Vital
Stat Rep. 2018;67(3):1-14.
6. National Center for Health Statistics (US). Health, United States, 2016: With Chartbook on Long-term
Trends in Health. Hyattsville. 2017
7. Chang HH, Larson J, Blencowe H, Spong CY, Howson CP, Cairns-Smith S, et al.
Preventing preterm births: analysis of trends and potential reductions with interventions in
39 countries with very high human development index. Lancet. 2013;381(9862):223-34.
DOI: http://doi.org/10.1016/S0140-6736(12)61856-X
8. Goossens J, De Roose M, Hecke AV, Goemaes R, Verhaeghe S, Beeckman D. Barriers and facilitators
to the provision of preconception care by healthcare providers: A systematic review. Int J Nurse Stud.
2018;87:113-30. DOI: http://doi.org/10.1016/j.ijnurstu.2018.06.009
9. Dewees WP. A Treatise on the physical and medical treatment of children (Classic Reprint). Forgotten
Books, 2017.
10. Chamberlain G. The prepregnancy clinic. Br Med J 1981;281(6232):29-30.
11. Committee to Study the Prevention of Low Birth Weight, Institute of Medicine. Preventing low birthweight.
Washington: National Academy Press, 1985.
12. National Institutes of Health. Caring for our future: the content of prenatal care. A report of the Public
Health Service Expert Panel on the Content of Prenatal Care. Washington: National Institutes of
Health,1989.
13. Johnson K, Posner SF, Bierman J, Cordero JF, Atrash HK, Parker CS, et al. Recommendations
to Improve Preconception Health and Health Care - United States. A Report of the CDC/ATSDR
Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Reconn Rep.
2006;55(RR-6):1-23.
14. Public Health Agency of Canada. Family-Centered Maternity and Newborn Care: National Guidelines. In:
Chapter 2 - Preconception care [internet] 2020. [cited 2020 Jun 09] Available from: https://www.canada.
ca/en/public-health/services/maternity-newborn-care-guidelines.html
15. Sheldon T. Netherlands considers introducing preconception care. BMJ. 2007;335(7622):686-7.
DOI: http://doi.org/10.1136/bmj.39353.518067.DB
16. Ebrahim SH, Lo SST, Zhuo J, Han JY, Delvoye P, Han JY, Zhu L. Models of Preconception
Care Implementation in Selected Countries. Matern Child Health J. 200610(Suppl 1):37-42.
DOI: http://doi.org/10.1007/s10995-006-0096-9
17. World Health Organization (WHO). Preconception care: Maximizing the gains for maternal and child
health [internet] 2013 [cited 2020 Jun 09] Available from: https://www.who.int/maternal_child_adolescent/
documents/preconception_care_policy_brief.pdf

J Hum Growth Dev. 2020; 30(3):355-362. DOI: http:doi.org/10.7322/jhgd.v30.11064 361

 www. jhgd.com.br
18. World Health Organization (WHO). Meeting to Develop a Global Consensus on Preconception Care to
Reduce Maternal and Childhood Mortality and Morbidity. Geneva: WHO, 2013.
19. Jack BW, Atrash H, Coonrod DV, Moos MK, O’Donnell J, Johnson K. The Clinical Content of
Preconception Care: An Overview and Preparation of This Supplement. Am J Obstetr Ginecol.
2008;199(6 Suppl 2): S266-79. DOI: http://doi.org/10.1016/j.ajog.2008.07.067
20. Jack B, Atrash HK. Preconception Health and Health Care: The Clinical Content of Preconception Care.
Am J Obstetr Ginecol. 2008;199(6 Suppl B):S257-396.
21. Thomas P. Guide to Clinical Preventive Services: Report of the US Preventive Services Task Force.
JAMA. 1996;276(11):923-4. DOI: http://doi.org/10.1001/jama.1996.03540110077039
22. South Australian Perinatal Practice Guidelines. Preconception Advice [internet 2015. [cited 2020 Jun
09] Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/1f11de804eed8cb5afbeaf6a7
ac0d6e4/Preconception+Advice_Sept2015.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-
1f11de804eed8cb5afbeaf6a7ac0d6e4-n5jkcsW

Resumo
Introdução: As Nas últimas décadas, foram observadas melhorias no cuidado à gravidez e no
desenvolvimento infantil em todo o mundo. No entanto, os problemas de gravidez continuam
altos na maioria dos países. Houve uma concentração de cuidados no período pré-natal como a
principal abordagem para melhorar os resultados da gravidez. Atualmente, a atenção aos cuidados
de mulheres grávidas, mulheres que deram à luz recentemente e recém-nascidos está focada no
cuidado de preconcepção para melhorar os resultados da gravidez e os resultados do crescimento e
desenvolvimento infantil.
Objetivo: Descrever as evidências para os cuidado preconcepção (PCC) e informações para o
profissional da saúde, bem como descrever instrumentos para apresentar aos profissionais de saúde
o PCC, sua definição, seus componentes, intervenções recomendadas e a base científica para
recomendações.
Método: Houve uma pesquisa de literatura publicada relacionada a evidências científicas para
a eficácia do PCC na melhoria dos resultados da gravidez. A pesquisa foi realizada com base no
Pubmed e utilizando técnicas de raspagem de dados, no material disponível na internet e divulgado
por organizações internacionais, como a Organização Mundial da Saúde e relatórios de órgãos
governamentais.
Resultados: Relata-se que a literatura sobre a base científica do PCC é fragmentada e a maioria
das publicações discute evidências de uma ou poucas intervenções, com a maioria dos relatórios
considerando o PCC para populações específicas, como mulheres com problemas crônicos de
saúde e casais com infertilidade. No entanto, essas publicações não oferecem uma visão realista das
intervenções propostas do PCC, com as evidências científicas que as apoiam. Os aspectos gerais da
literatura existente e as intervenções preconcebidas recomendadas são descritas, juntamente com
a qualidade das evidências científicas e a força das recomendações por trás de cada uma dessas
intervenções.
Conclusão: Muitas intervenções clínicas foram identificadas que poderiam ser oferecidas às mulheres
antes da concepção para ajudar a evitar resultados adversos. A maioria dessas intervenções possui
evidências científicas para apoiar seu papel na melhoria dos resultados da gravidez. Portanto,
recomenda-se que os prestadores de cuidados clínicos incorporem serviços de preconcepção baseados
em evidências em seus cuidados diários a mulheres em idade reprodutiva, em um esforço para
melhorar a saúde das mulheres antes e depois da gravidez. durante a gravidez, bem como melhorar os
resultados da gravidez para mulheres e filhos.

Palavras-chave: cuidados preconcepção, saúde preconcepção, saúde da mulher, saúde materna,

saúde infantil.

©
The authors (2020), this article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​
creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided
you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate
if changes were made. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​
1.​0/​) applies to the data made available in this article, unless otherwise stated.

J Hum Growth Dev. 2020; 30(3):355-362. DOI: http:doi.org/10.7322/jhgd.v30.11064 362