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The impact of preconception counselling on maternal and fetal outcomes in women with chronic medical conditions: A systematic review

Published:November 23, 2022DOI:https://doi.org/10.1016/j.ejim.2022.11.003

      Highlights

      • A paucity of data exists describing pregnancy outcomes for women receiving preconception counselling.
      • Improved outcomes are described in the studies that we identified.
      • This supports the routine inclusion of PCC for women with chronic medical conditions.
      • Further studies are required to broaden the evidence base.

      Abstract

      Background

      Beyond diabetes mellitus little data reports outcomes of women with chronic medical conditions who have received pre-conception counselling (PCC). This study aimed to perform a systematic review of the literature to evaluate evidence regarding the impact of PCC on maternal and fetal outcomes in women with chronic medical conditions aside from diabetes mellitus.

      Methods

      A systematic review was conducted in accordance with PRISMA. PubMed, Cochrane, Ovid Medline and Web of Science were searched. Two reviewers screened abstracts and full texts. Inclusion criteria included studies relating to chronic medical disorders of interest published between database inception and 21st May 2022, reporting outcomes relating to disease activity and perinatal outcomes.

      Results

      The search yielded 11,814 results of which six met criteria for inclusion. Two papers describe the demographics of women more likely to receive PCC which included younger age, shorter disease duration, nulliparity, IVF pregnancy and higher education/job security. Two reported the effects of PCC on women's behaviour with improvements demonstrated in correct medication adherence, folic acid intake and smoking cessation. Five studies reported outcomes related to disease activity; those receiving PCC were more likely to have quiescent disease during pregnancy. Improvements in pregnancy outcomes were described including reduced rates of small for gestational age, low birth weight, preterm birth, congenital abnormality and obstetric complications.

      Discussion

      A paucity of data exists relating to pregnancy outcomes in women with chronic medical conditions receiving PCC. Reported outcomes are favorable, supporting the routine inclusion of PCC in preparation for pregnancy in such patients.

      Graphical abstract

      Keywords

      Abbreviations:

      AED (Antiepileptic Drug), APGAR (Appearance, Pulse, Grimace, Activity, and Respiration), APS (Antiphospholipid Syndrome), COVID-19 (Coronavirus-19), CVD (Cardiovascular Disease), HCP (Healthcare Professional), IBD (Inflammatory Bowel Disease), IVF (In Vitro Fertilisation), MeSH (Medical Sibject Headings), NTD (Neural Tube Defect), PCC (Preconception Counselling), PRISMA (Preferred Reporting System for Systematic Reviews and Meta-Analysis), RA (Rheumatoid Arthritis), ROBIS (Risk Of Bias In Systematic review), SLE (Systemic Lupus Erythematous), SUDEP (Sudden or Unexpected Death in Epilepsy)
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