Preconception education interventions provide information about the risks and benefits of behaviors that affect a woman’s health before, during, and after pregnancy; improving certain health behaviors prior to pregnancy reduces risks to mothers’ and infants’ health. Preconception education interventions cover a variety of topics related to those behaviors, such as nutrition, exercise and weight management, birth control methods, STI prevention, controlling chronic disease, reducing alcohol consumption, quitting smoking and other tobacco use, or improving mental health. Interventions can be delivered in clinical or community settings, and may be presented by medical providers, public health professionals, lay people, or others with relevant education and training (e.g., community health workers). Ongoing well-woman care, as well as education for men partnered with women of child bearing age, often compliment these interventions.
Expected Beneficial Outcomes (Rated)
Increased healthy behaviors
Other Potential Beneficial Outcomes
Increased preconception planning
Improved health-related knowledge
Improved birth outcomes
Evidence of Effectiveness
There is some evidence that preconception education interventions increase healthy behaviors among participating women1, 2. Additional evidence is needed to confirm effects on behaviors and birth outcomes, and determine which types of health behaviors and conditions these interventions address most effectively.
Preconception interventions that address multiple risk factors appear to alter targeted behaviors1. For example, participants in the Central Pennsylvania Women’s Health Study’s Strong Women program reported increases in their intent to eat healthier and be physically active, as well as increased physical activity, consumption of folic acid, and self-efficacy following the program’s 6 bi-weekly education sessions3. An intensive intervention covering both alcohol consumption and contraception appeared to reduce binge drinking among risky drinkers2. Interventions targeting smoking may also reduce smoking pre-pregnancy1.
Preconception nutrition interventions appear to increase consumption of folic acid. A study of nutrition lessons for non-pregnant low income women, for example, appeared to increase their intake of dietary folate1. Various other individual programs, usually involving both education and supplement provision1, and collective interventions (e.g., public education campaigns and fortification of food products) have been shown to increase consumption of folic acid and reduce the risk of birth defects1, 4.
Risk assessment followed by individualized counseling as needed appears to increase participant’s knowledge of healthy behaviors. In five urban primary care clinics, for example, risk assessment and brief counseling for low income black and Hispanic women appeared to increase knowledge of the importance of folic acid, the need to treat and control chronic health conditions, and the importance of preconception medication review with a provider5. In a greater Atlanta area-based study, black women attending WIC clinic nutrition classes who received brief counseling based on their risk assessment results reported that counseling was both acceptable and important6.
Integrating preconception and interconception care into diabetic women’s ongoing usual care may reduce congenital malformation, preterm delivery, and perinatal infant mortality7, however, additional evidence is needed to confirm effects8, 9.
Impact on Disparities
Several states have developed preconception health campaigns that incorporate education as one component, including Every Woman California, Deleware Thrives, Every Woman North Caroline, Arizona’s Power Me A2Z, and Utah’s Power Your life, Power Your Health10, 11, 12, 13, 14.
Many university and non-profit organizations also provide preconception education interventions. The University of Oklahoma’s Healthy Women, Healthy Futures program, for example, provides education, care coordination, and other support services for non-pregnant women living in poverty15. PASOs, a program serving the Latino community in South Carolina, includes a culturally appropriate preconception health education workshop as part of its wider preconception health efforts16.
The Show Your Love national campaign encourages healthy behaviors for all women17.
AMCHP-Innovation station - Association of Maternal & Child Health Programs (AMCHP). Innovation station: Sharing best practices in MCH.
Before and Beyond - Preconception Health and Healthcare Initiative. Before, Between & Beyond Pregnancy. Chapel Hill: The University of North Carolina at Chapel Hill.
CDC-Preconception health education materials - Centers for Disease Control and Prevention (CDC). Before Pregnancy. Preconception health and health care: health education materials for women and men.
CDC-Humphrey 2012 - Humphrey JR, Floyd RL. Preconception health and health care environmental scan. Atlanta: Centers for Disease Control and Prevention (CDC); 2012.
EWCA - Every Woman California (EWCA). Educational resources for public health professionals & providers. Preconception Health Council of California.
Show Your Love - Show your love. Preconception Health and Health Care Initiative.
NBDPN-Prevention - National Birth Defects Prevention Network (NBDPN). National Birth Defects Prevention Month.
* Journal subscription may be required for access.
1 Temel 2014 - Temel S, van Voorst SF, Jack BW, Denkta S, Steegers EAP. Evidence-based preconceptional lifestyle interventions. Epidemiologic Reviews. 2014;36(1):19-30.
2 Cochrane-Whitworth 2009* - Whitworth M, Dowswell T. Routine pre-pregnancy health promotion for improving pregnancy outcomes. Cochrane Database of Systematic Reviews. 2009;(4):CD007536.
3 Hillemeier 2008 - Hillemeier MM, Symons Downs D, Feinberg ME, et al. Improving women's preconceptional health: Findings from a randomized trial of the strong healthy women intervention in the central Pennsylvania women's health study. Women's Health Issues. 2008;18(6 Suppl 1):87-96.
4 CG-Birth defects - The Guide to Community Preventive Services (The Community Guide). Birth defects.
5 Dunlop 2013b* - Dunlop AL, Logue KM, Thorne C, Badal HJ. Change in women’s knowledge of general and personal preconception health risks following targeted brief counseling in publicly funded primary care settings. American Journal of Health Promotion. 2013;27(3 Suppl 1):50-7.
6 Dunlop 2013a* - Dunlop AL, Dretler AW, Badal HJ, Logue KM. Acceptability and potential impact of brief preconception health risk assessment and counseling in the WIC setting. American Journal of Health Promotion. 2013;27(3 Suppl 1):58-65.
7 Wahabi 2010* - Wahabi HA, Alzeidan RA, Bawazeer GA, Alansari LA, Esmaeil SA. Preconception care for diabetic women for improving maternal and fetal outcomes: A systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2010;10:63.
8 Cochrane-Tieu 2013* - Tieu J, Bain E, Middleton P, Crowther C. Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes. Cochrane Database of Systematic Reviews. 2013;(6):CD010211.
9 Cochrane-Tieu 2010* - Tieu J, Middleton P, Crowther CA. Preconception care for diabetic women for improving maternal and infant health. Cochrane Database of Systematic Reviews. 2010;(12):CD007776.
10 Every Woman California - Every woman California. Preconception Health Council of California.
11 Delaware Thrives - Delaware thrives: Healthy women. Delaware Health and Social Services Division of Public Health and Delaware Healthy Mother & Infant Consortium.
12 Every Woman North Carolina - Every Woman North Carolina. March of Dimes North Carolina Preconception Health Campaign.
13 Power Me A2Z - Power me a2z. Arizona Department of Health Services.
14 UDOH-Power Your Life - Utah Department of Health (UDOH). Power Your Life, Power Your Health.
15 OU-HWHF - The University of Oklahoma College of Nursing. Healthy Women, Healthy Futures.
16 Torres 2013a* - Torres ME, Smithwick-Leone J, Willms L, et al. Developing a culturally appropriate preconception health promotion strategy for newly immigrated Latinos through a community-based program in South Carolina. American Journal of Health Promotion. 2013;27(3):S7-S9.
17 Show Your Love - Show your love. Preconception Health and Health Care Initiative.
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