Dia 1

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Pre- and periconception care
Exploration of the relevance of EFPC involvement
in the disclosure and exchange of expertise
regarding pre- and preconception care in respect
of the implementation and delivery of this care
in primary care settings in European
countries Denhard de Smit, PhD, Health Care
researcher/Epidemiologist Managing director
Research and Projects, MediClara Projects BV,
Abcoude NL
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Todays programme
Starting up
Who is who? Expertise and vision of participants
Pre- and periconception care an overview
The health issues of interest Involvement of PC, PH and specialist care Policy development examples and events
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• I- Starting up

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a. Who is who?
Starting up

• As a person
• As a professional
• Main reason to attend this workshop?

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b. Expertise and vision from you and your country
Starting up

• General status of policy making
• Political and societal focus points
• Scope of implementation
• Awareness and feelings of urgency

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• II- Pre- and periconception care an overview

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The health issues of interest
An overwiew

• Preconception care is defined in this advisory
  report as the entire raft of measures to promote
  the health of the mother-to-be and her child. If
  they are to be effective, these measures should
  preferably be undertaken prior to conception.
  Preconception care is therefore
  multidisciplinary, encompassing lifestyle
  (including food, drink, tobacco and other
  recreational drugs), working conditions, illness,
  medication and genetic factors.
• Health Council of the Netherlands. Preconception
  care a good beginning. The Hague Health Council
  of the Netherlands, 2007 publication no. 2007/19.

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The health issues (2)
An overwiew

• From the Dutch health council report
• Food, drink, tobacco and other recreational drugs
• Folic Acid prevention (general population 0,4 mg
  increased risk 4,0 mg)
• Vitamin D suppletion (if needed)
• Vitamin A (prevent too high intake)
• Alcohol (fertility, FAS)
• Tobacco (fertility, birth weight)
• Working conditions
• Chemical agents (pesticides, solvents, )
• Stress

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The health issues (3)
An overwiew

• Illness and medication
• Infectious diseases (Vaccination, treatment and
  prevention)
• Chronic diseases ilke diabetes, epilepsy
  (optimization of medication)
• Teratogenic drugs (pregnancy prevention)
• Obesity, anorexia and maternal/paternal age
• Genetic factors
• Extend range of options in the case of
  unfavourable genetic background
• Known increased risks (genetic diagnosis/counselli
  ng done previously)
• Indications from family history
• Carrier screening (cystic fibrosis,
  hemoglobinopathies)

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The health issues (4)
An overwiew

• Additional issues that can/should be dealt with
  in the preconception period
• Personal preparation for pregnancy?
• Prenatal screening options (triple test, 20-wk
  ultrasound)
• Medical preparation for pregnancy
• Obstetric history
• Increased risks from pre-existing disease
• Timely uptake of prenatal care

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The involvement of primary care, public health
and specialist care
An overwiew

• Preconception care has various, complementary
  forms. Some are aimed at individual
  parents-to-be, while others may, for example,
  collectively target all women of child-bearing
  age.
• and
• the various components of the programme
  should not be provided as separate elements but
  as an integrated healthcare concept.

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The involvement of (2)
An overwiew

• Care sectors
• Folic acid ? ph
• Genetic risk assessment ? pc, sc
• Lifestyle ? ph, pc, sc
• Preconception consultation ? pc, sc
• Promotion of preconception consultation ? ph, pc

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The involvement of (3)
An overwiew

• Primary care workers
• GPs (promotion of) preconception consutlation
  and follow-up as appropriate
• Midwives, nurses preconception consultation and
  follow-up as appropriate
• Pharmacists FA-education, medication
  surveillance, promotion of preconception
  consultation

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Policy development examples and events
An overwiew

• Existing implementation in Hungary
• Programme development 1984-1994
• Current implementation by specialized nurses
• Policy development in The Netherlands
• Ministry of Health reply to Health Council
  report
• Coordination of resources for public information
  (RIVM)
• Preconception consultation fee in basic
  insurance?
• Major role for midwives in preconception
  consultation?
• Very pro-active involvement of patient
  organisations (VSOP, Erfocentrum)
• Policy development in Walloon provinces in
  Belgium
• Coordinated by Office de la Naissance et de
  lEnfance (ONE)
• Current status?

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Policy development (2)
An overwiew

• Recent events
• First CEE Summit on Preconception Health and
  Prevention of Birth defects (Budapest, August
  2008)
• National conference on preconception care
  (Utrecht, September 2009)
• Extended neonatal screening in NL since 1-1-2007
  ? Preconception care?
• EU policy
• Rare diseases COM (2008) 679
• ??

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The End
Recommendations and closing

• Thank you for your participation!
• djedesmit_at_mediclara.nl
• www.mediclara.nl