Preconception health is an important determinant of maternal, paternal, and infant outcomes. Knowledge is commonly used to evaluate the effectiveness of interventions to promote preconception health. Our objective was to examine how preconception health knowledge has been measured in the existing literature and to identify measurement gaps, biases, and logistical challenges.
Data Source:
MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Database of Systematic Reviews, and gray literature were searched from database inception to January 2018.
Study Inclusion and Exclusion Criteria:
Studies were included if they measured preconception or interconception health knowledge and included reproductive-aged women and/or men.
Data Extraction:
Two independent reviewers completed data extraction and quality appraisal using standardized instruments.
Data Synthesis:
Due to measurement heterogeneity, a narrative synthesis was performed.
Results:
The review included 34 studies from 14 countries with data collected in 2000 to 2017. Most studies used cross-sectional (n = 24) or prepost designs (n = 7). Studies primarily sampled women (n = 25), and methodological quality was rated largely as weak (n = 18) or moderate (n = 14). Preconception health knowledge tools focused on fertility, folic acid, and alcohol, with few questions pertaining to men’s health, mental health, or the interconception period. Only 19 (56%) studies reported psychometric properties of their knowledge tools.
Conclusions:
This systematic review revealed the need for a valid and reliable knowledge tool that reflects a holistic conceptualization of preconception health.
Ontario Public Health Association. Shift—Enhancing the Health of Ontarians: A Call to Action for Preconception Health Promotion and Care. Toronto, Canada: Ontario Public Health Association; 2014.
2.
Centre for Effective Practice. Preconception Health Care Tool. Toronto, Canada: Centre for Effective Practice; 2015.
3.
RobbinsCLZapataLBFarrSL. Core state preconception health indicators—pregnancy risk assessment monitoring system and behavioral risk factor surveillance system, 2009. MMWR Surveill Summ. 2014;63(3):1–62.
4.
World Health Organization. Pre-Conception Care: Maximizing the Gains for Maternal and Child Health. Geneva, Switzerland: World Health Organization Headquarters; 2013.
5.
AllenVMArmsonBAWilsonRD. Teratogenicity associated with pre-existing and gestational diabetes. JOGC. 2007;29(11):927–934.
6.
HermanWHJanzNKBeckerMPCharron-ProchownikD. Diabetes and pregnancy: preconception care, pregnancy outcomes, resource utilization and costs. Obstet Gynecol Surv. 1999;54(8):489–491.
7.
KassebaumNJBertozzi-VillaACoggeshallMS. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9947):980–1004.
8.
FinerLBZolnaMR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception. 2011;84(5):478–485.
9.
BrownHKMuellerMMillC. Preconception health interventions delivered in public health and community settings: a systematic review. CJPH. 2017;108(4): E388–E397.
10.
BanduraA. Health promotion by social cognitive means. Health Educ Behav. 2004;31(2):143–164.
11.
CaneJO’ConnorDMichieS. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7(1):37.
12.
DysonJLawtonRJacksonCCheaterF. Does the use of a theoretical approach tell us more about hand hygiene behaviour? The barriers and levers to hand hygiene. J Infect Prev. 2011;12(1):17–24.
13.
Chapman-NovakofskiKKarduckJ. Improvement in knowledge, social cognitive theory variables, and movement through stages of change after a community-based diabetes education program. J Acad Nutr Diet. 2005;105:1613–1616.
14.
O’LearyAGoodhartFJemmottLSBoccher-LattimoreD. Predictors of safer sex on the college campus: a social cognitive theory analysis. J Am Coll Health. 1992;40(6):254–263.
15.
St JamesPJYoungerMDHamiltonBDWaisbrenSE. Unplanned pregnancies in young women with diabetes. An analysis of psychosocial factors. Diabetes Care. 1993;16(12):1572–1578.
16.
JanzNKHermanWHBeckerMP. Diabetes and pregnancy: factors associated with seeking pre-conception care. Diabetes Care. 1995;18(2):157–165.
17.
Charron-ProchownikDSereikaSMBeckerD. Reproductive health beliefs and behaviors in teens with diabetes: application of the expanded health belief model. Pediatr Diabetes. 2001;2(1):30–39.
18.
AjzenIJoyceNSheikhSCoteNG. Knowledge and the prediction of behavior: the role of information accuracy in the theory of planned behavior. Basic Appl Soc Psych. 2011;33(2):101–117.
19.
DiClementeRJForrestKAMicklerS. College students’ knowledge and attitudes about AIDS and changes in HIV-preventive behaviors. AIDS Educ Prev. 1990;2(3):201–212.
20.
FisherWAFisherJDHarmanJ. The information-motivation-behavioral skills model: a general social psychological approach to understanding and promoting health behavior. In: SulsJWallstonKA, eds. Social Psychological Foundations of Health and Illness. Malden, MA: Blackwell Publishing; 2003:82–106.
21.
FlayBR. Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. Prev Med. 1986;15(5):451–474.
22.
BarkerMDumbrowskiSUColbournT. Intervention strategies to improve nutrition and health behaviours before conception. Lancet. 2018;391(10132):1853–1864.
23.
MoherDLiberatiATetzlaffJAltmanDG; Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Plos Med. 2009;6(7):e1000097.
24.
Canadian Agency for Drugs and Technologies in Health. Grey Matters: A Practical Tool for Searching Health-Related Grey Literature [Internet]. Ottawa, Canada: CADTH; 2015.
25.
Armijo-OlivoSStilesCRHagenNABiondoPDCummingsGG. Assessment of study quality for systematic reviews: a comparison of the Cochrane collaboration risk of bias tool and the effective public health practice project quality assessment tool: methodological research. J Eval Clin Pract. 2012;18(1):12–18.
26.
Falah-HassaniKShiriRVigodSDennisCL. Prevalence of postpartum depression among immigrant women: a systematic review and meta-analysis. J Psychiatr Res. 2015;70:67–82.
27.
AgricolaEPandolfiEGonfiantiniMV. Women participating in a web-based preconception study have a high prevalence of risk factors for adverse pregnancy outcomes. BMC Pregnancy Childbirth. 2014;14(1):169.
28.
Al-AkourNSou’UbRMohammadKZayedF. Awareness of preconception care among women and men: a study from Jordan. J Obstet Gynaecol. 2015;35(3):246–250.
29.
AyalewYMulatADileMSimegnA. Women’s knowledge and associated factors in preconception care in Adet, west Gojjam, northwest Ethiopia: a community based cross sectional study. Reprod Health. 2017;14(1):15.
30.
Best Start Resource Center. Preconception Health: Awareness and Behaviours in Ontario. Toronto, Canada: Best Start Resource Center; 2009.
31.
CharafeddineLEl RafeiRAziziS. Improving awareness of preconception health among adolescents: experience of a school-based intervention in Lebanon. BMC Public Health. 2014;14(1):774.
32.
CoonrodDVBruceNCMalcolmTDDrachmanDFreyKA. Knowledge and attitudes regarding preconception care in a predominantly low-income Mexican American population. Am J Obstet Gynecol. 2009;200(6):686.e1–686.e7.
33.
CorbettE. Preconception Health and Wellness: Knowledge and Attitudes of Undergraduate Women. Fort Collins, Colorado: Colorado State University; 2011.
34.
CrusenberryKJ. An Online Study of Undergraduates’ Knowledge, Awareness, and Attitudes of Preconception Care. Knoxville, Tennessee: The University of Tennessee; 2016.
35.
DelgadoCE. Undergraduate student awareness of issues related to preconception health and pregnancy. Matern Child Health J. 2008;12(6):774–782.
36.
DelgadoC. Pregnancy 101: a call for reproductive and prenatal health education in college. Matern Child Health J. 2013;17(2):240–247.
37.
DunlopALLogueKMThorneCBadalHJ. Change in women’s knowledge of general and personal preconception health risks following targeted brief counseling in publicly funded primary care settings. Am J Health Promot. 2013;27(suppl 3):S50–S57.
38.
ElsingaJde Jong-PotjerLCvan der Pal-de BruinKMle CessieSAssendelftWJJBuitendijkSE. The effect of preconception counselling on lifestyle and other behaviour before and during pregnancy. Womens Health Issues. 2008;18(6): S117–S125.
39.
EspositoGAmbrosioRNapolitanoFDi GiuseppeG. Women’s knowledge, attitudes and behavior about maternal risk factors in pregnancy. PloS One. 2015;10(12):e0145873.
40.
FreyKAFilesJA. Preconception healthcare: what women know and believe. Matern Child Health J. 2006;10(1):73–77.
41.
FreyKAEngleRNobleB. Preconception healthcare: what do men know and believe?JMH. 2012;9(1):25–35.
42.
GautamPDhakalR. Knowledge on preconception care among reproductive age women. Saudi J Med Pharm Sci. 2016;2(1):6.
43.
GodinKMAltonGDGangodawilageHP. Knowledge change associated with participation in prenatal education programs in Ontario: a cohort study. CJPH. 2015;106(6):e401–e407.
44.
HarelickLViolaDTaharaD. Preconception health of low socioeconomic status women: assessing knowledge and behaviors. Womens Health Issues. 2011;21(4):272–276.
45.
HussainiKSHammEMeansT. Using community-based participatory mixed methods research to understand preconception health in African American communities of Arizona. Matern Child Health J. 2013;17(10):1862–1871.
46.
KasimRDramanNKadirAAMuhamadR. Knowledge, attitudes and practice of preconception care among women attending maternal health clinic in Kelantan. Educ in Med J. 2016;8(4):57–68.
47.
KrishnanGG. Effect of structured teaching program on knowledge and attitude regarding preconception care among adolescent girls. IJAR. 2016;2(4):435–439.
48.
LundsbergLSPalLGariepyAMXuXChuMCIlluzziJL. Knowledge, attitudes, and practices regarding conception and fertility: a population-based survey among reproductive-age United States women. Fertil Steril. 2014;101(3):767–774.
49.
MitchellEWLevisDMPrueCE. Preconception health: awareness, planning, and communication among a sample of US men and women. Matern Child Health J. 2012;16(1):31–39.
50.
NepaliGSapkotaSD. Knowledge and practice regarding preconception care among antenatal mothers. Int J Percept Public Health. 2017;1(4):224–227.
51.
OlowokereAKomolafeAOwofadejuC. Awareness, knowledge and uptake of preconception care among women in Ife central local government area of Osun State, Nigeria. J Community Med Primary Health Care. 2015;27(2):83–92.
52.
PandolfiEGonfiantiniMVGesualdoF. A cohort study of a tailored web intervention for preconception care. BMC Med Inform Decis Mak. 2014;14(1):33.
53.
PatabendigeMGoonewardeneI. Preconception care received by women attending antenatal clinics at a teaching hospital in southern Sri Lanka. SLJOG. 2013;35(1):3–9.
54.
PaulsenAM. Preconception Health Knowledge Among Undergraduate Women. Mankato, Minnesota: Minnesota State University; 2017.
55.
SternJLarssonMKristianssonPTydénT. Introducing reproductive life plan-based information in contraceptive counselling: an RCT. Hum Reprod. 2013;28(9):2450–2461.
56.
VauseTDJonesLEvansMWilkieVLeaderA. Pre-conception health awareness in infertility patients. JOGC. 2009;31(8):717–720.
57.
WadeGHHerrmanJMcBeth-SnyderL. A preconception care program for women in a college setting. MCN Am J Matern Child Nurs. 2012;37(3):164–170.
58.
WallaceMHurwitzB. Preconception care: who needs it, who wants it, and how should it be provided?Br J Gen Pract. 1998;48(427):963–966.
59.
WanyonyiMVictorD. Maternal knowledge on preconception health care topics at Moi teaching and referral hospital in Eldoret, Uasin Gishu County, Kenya. IJAR. 2017;5(5):2176–2185.
60.
WickremasingheVPrageethPPulleperumaDPushpakumaraK. Preconceptional care of women at booking visit at de Soysa Maternity hospital and castle street hospital for women. Ceylon Med J. 2003;48(3):77–79.
61.
HeyesTLongSMathersN. Preconception care: practice and beliefs of primary care workers. Fam Pract. 2004;21(1):22–27.
62.
RosnahS. Pre-pregnancy care among the Indian ethnic group in Semenyih, Selangor. J Community Health. 2010;16(2):29.
FreyKANavarroSMKotelchuckMLuMC. The clinical content of preconception care: preconception care for men. Am J Obstet Gynecol. 2008;199(6):S389–S395.
65.
MoosM. From concept to practice: reflections on the preconception health agenda. J Womens Health. 2010;19(3):561–567.
66.
RossLESteeleLSEpsteinR. Service use and gaps in services for lesbian and bisexual women during donor insemination, pregnancy, and the postpartum period. JOGC. 2006;28(6):505–511.
67.
BoyerKKOlsonJRCalantoneRJJacksonEC. Print versus electronic surveys: a comparison of two data collection methodologies. J Oper Manage. 2002;20(4):357–373.
68.
ThriemerKLeyBAmeSM. Replacing paper data collection forms with electronic data entry in the field: findings from a study of community-acquired bloodstream infections in Pemba, Zanzibar. BMC Res Notes. 2012;5(1):113.
69.
CobanogluCMoreoPJWardeB. A comparison of mail, fax and web-based survey methods. Int J Market Res. 2001;43(4):1–15.
70.
Guerra-ReyesLChristieVMPrabhakarAHarrisALSiekKA. Postpartum health information seeking using mobile phones: experiences of low-income mothers. Matern Child Health J. 2016;20(1):13–21.
71.
WittWPWiskLEChengERHamptonJMHagenEW. Preconception mental health predicts pregnancy complications and adverse birth outcomes: a national population-based study. Matern Child Health J. 2012;16(7):1525–1541.
SarkarN. The impact of intimate partner violence on women’s reproductive health and pregnancy outcome. J Obstet Gynaecol. 2008;28(3):266–271.
74.
Conde-AgudeloARosas-BermúdezAKafury-GoetaAC. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA. 2006;295(15):1809–1823.
75.
VillamorECnattingiusS. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet. 2006;368(9542):1164–1170.
DunlopALJackBFreyK. National recommendations for preconception care: the essential role of the family physician. J Am Board Fam Med. 2007;20(1):81–84.
78.
ChuangCHHwangSWMcCall-HosenfeldJSRosenwasserLHillemeierMMWeismanCS. Primary care physicians’ perceptions of barriers to preventive reproductive health care in rural communities. Persp Sex Reprod Health. 2012;44(2):78–83.
79.
DelissaintD. Exploring the Factors Associated with Preconception Health Behaviors Among Women of Childbearing Age: A Naturalistic Inquiry. College Station, Texas: Texas A & M University; 2011.
80.
TuomainenHCross-BardellLBhodayMQureshiNKaiJ. Opportunities and challenges for enhancing preconception health in primary care: qualitative study with women from ethnically diverse communities. BMJ Open. 2013;3(7):e002977.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
