Preconception Care - Who cares? : Perspectives from prospective parents and healthcare providers

Despite major advances in clinical research and medical technology, the prevalence of adverse maternal and neonatal pregnancy outcomes has only moderately decreased over the past decades. Evidence on the role of unhealthy lifestyles before and during pregnancy on fetal growth and placental development is accumulating. Early timing is considered a crucial factor for the effectiveness of intervention strategies and therefore, the organization of obstetric care should increasingly focus on the preconception period to prevent adverse outcomes. This thesis concentrates on preconception care (PCC) as a mean to capacitate prospective parents to improve unhealthy lifestyles prior to pregnancy. The three key elements of PCC are risk prevention, health promotion and interventions. This thesis outlines a rationale, framework and pilot study for a tailored PCC care approach in a local primary care setting, based on the perspectives of prospective parents as well as healthcare providers. Five studies (chapter 2-6) were undertaken to support the development of this locally tailored PCC approach, which was subsequently implemented in a pilot study (chapter 7). The objectives of the research presented in this thesis were: (1) to investigate associations between modifiable lifestyle factors and the risk of adverse pregnancy outcomes and, subsequently, to determine to which extent PCC contributes to the improvement of preconception lifestyles; (2) to explore how women prepare themselves for pregnancy and to explore their considerations whether or not to use PCC; (3) to assess perceptions, needs and preferences of prospective parents and healthcare providers towards the delivery of PCC; and (4) to study the effect of a local promotional campaign on preconceptional lifestyle changes and the use of PCC