Provision of Preconception Care by Midwives, Nurses and Doctors at Ndola Teaching Hospital in Ndola District, Zambia

Background: The goal of preconception care is to improve the outcome of a mother’s pregnancy and childbirth. Nevertheless, in most developing nations;Zambia included, there are still issues with implementation of preconception care. Therefore, the aim of this study was to establish the provision of preconception care by midwives, nurses and doctors at Ndola Teaching Hospital in Zambia. Methods: A concurrent embedded mixed methodology utilising a descriptive explorative study design, where 107 respondents were randomly selected using the lottery technique for quantitative part and two focused group discussions for qualitative part of the study was used. A self-administered questionnaire was used to collect quantitative data and a focus group discussion guide was used for the focus group discussions. Statistical Package of Social Sciences version 26 with significance set at 0.05 and at 95% confidence level and thematic analysis were used for data analysis. Results: 75% of the respondents in this study were not providing preconception care and only 25% of respondents were providing preconception care;however, this was provided randomly because there were no guidelines to follow. Among the respondents, 81.3% had medium knowledge, 70.1% had good practices and 92.5% had positive attitudes towards preconception care. Further analysis showed that the association between preconception care and knowledge, practices and attitudes was not statistically significant (p = values 0.336;0.344;1.000 respectively). Multivariate logistic regression revealed that participants with high knowledge were five times more likely to provide preconception care (OR = 5.00, CI = 0.42 - 59.7, P = 0.203). Generally, all the participants acknowledged that preconception care was an important package that could prevent maternal and child morbidities and mortalities. Conclusions: The study revealed that most of the respondents were not providing preconception care. Provision of preconception was done by a small fraction of the respondents and it was done in an unorderly manner due to lack of set standards and guidelines. Despite medium levels of knowledge and generally good practices and positive attitudes towards preconception care, its random provision indicates a need for established standards to enhance maternal and child health outcomes.

Paternal physical exercise modulates global DNA methylation status in the hippocampus of male rat offspring

It is widely known that maternal physical exercise is able to induce beneficial improvements in offspring cognition; however, the effects of paternal exercise have not been explored in detail. The present study was designed to evaluate the impact of paternal physical exercise on memory and learning, neuroplasticity and DNA methylation levels in the hippocampus of male offspring. Adult male Wistar rats were divided into two groups: sedentary or exercised fathers. The paternal preconception exercise protocol consisted of treadmill running, 20 minutes daily, 5 consecutive days per week for 22 days, while the mothers were not trained. After mating, paternal sperm was collected for global DNA methylation analysis. At postnatal day 53, the offspring were euthanized, and the hippocampus was dissected to measure cell survival by 5-bromo-2′-deoxiuridine and to determine the expression of synaptophysin, reelin, brain-derived neurotrophic factor and global DNA methylation levels. To measure spatial memory and learning changes in offspring, the Morris water maze paradigm was used. There was an improvement in spatial learning, as well as a significant decrease in hippocampal global DNA methylation levels in the offspring from exercised fathers compared with those from sedentary ones; however, no changes were observed in neuroplasticity biomarkers brain-derived neurotrophic factor, reelin and 5-bromo-2′-deoxiuridine. Finally, the global DNA methylation of paternal sperm was not significantly changed by physical exercise. These results suggest a link between paternal preconception physical activity and cognitive benefit, which may be associated with hippocampal epigenetic programming in male offspring. However, the biological mechanisms of this modulation remain unclear.

Maternal pre-conception serum homocysteine instead of folate concentration predict offspring congenital heart diseases:evidence from the real world patient data

Objective This study aimed to investigate predictability of preconception maternal circulating folate and homocysteine concentrations,glycemic and lipid profiles to the risk of congenital heart disease(CHD)in offspring.Methods A cohort of pregnancies was derived from a single hospital where pre-and post-conceptional serum folate,homocysteine,lipids,glycemic profiling and neonatal CHD screening program were facilitated.

Preconception Care Health Education for Female Workers of Reproductive Age in Japan Evaluation up to 6 Months after the Program

Objectives: The aim of this study was to implement a health education program for education of preconception care (PCC) for female workers of reproductive age through a seminar and to evaluate the program based on PCC knowledge and awareness and behaviors before the seminar and at 3 and 6 months after the seminar. Methods: A small group health education seminar was implemented using leaflets for 84 female workers of reproductive age, age 20 to 35 years old, and an intervention by group discussion and feedback was provided. Of these participants, 60 (71%) who provided valid survey responses were included in the analysis. The primary outcome indicators were PCC knowledge, PCC awareness and behaviors, and a food frequency questionnaire, and the secondary outcome indicators were self-efficacy and the health awareness and stress management subscales of the Health-Promotion Lifestyle Profile scale. The survey was conducted three times, before the seminar and at 3 and 6 months after the seminar, and the results were compared. Results: The percentage of individuals with PCC knowledge was significantly increased at 3 months after the seminar as compared with before the seminar, and it remained at this level even at 6 months after the seminar. The percentage of individuals with PCC awareness and behaviors was significantly increased for the items actively eat foods containing folic acid, prevent sexually transmitted diseases, and conduct self-examinations for breast cancer at 3 months after the seminar and for the items eat well-balanced meals, make the mind active, prevent sexually transmitted diseases, and conduct self-examinations for breast cancer at 6 months after the seminar. Furthermore, the score for the health awareness subscale of the Health-Promotion Lifestyle Profile scale was significantly increased at 6 months after the seminar. Conclusion: The health education program established PCC knowledge at 6 months after the seminar and improved some PCC awareness and behaviors. Therefore, it was suggested that the program would be effective for education of PCC for female workers of reproductive age.

An Expanded Carrier Screening Tool Enhances Preconception Cystic Fibrosis Screening in Infertile Couples

The American College of Obstetricians and Gynecologists recommends offering preconception and prenatal screening for cystic fibrosis (CF) while the American College of Medical Genetics also recommends screening for spinal muscular atrophy (SMA) to all couples. Both groups suggest specific screening if there is a family or personal history of a genetic disease or if the individual is from a high risk ethnic group. The purpose of this study was to determine whether availability of a more comprehensive, affordable genetic screening tool increased the number of infertility patients choosing to be screened for CF and other genetic diseases. This was a retrospective chart review of new infertility patients evaluated between May 2010 and May 2013. Sixteen hundred seventy-five new infertility couples were offered CounsylTM expanded carrier screening. The carrier frequency for CF was 6.8% with 0% of the couples concordant heterozygotes. The carrier frequency for SMA was 2.51% with 0% of the couples concordant heterozygotes. With availability of the CounsylTM screening test, the percentage of new infertility patients choosing to have preconception genetic screening increased from 2% to 8% in this population. The largest increase (17.5% of new patients) in screening followed the reduction in out-of-pocket expense in May 2013. Infertility patients are in a unique position to investigate their family history, discuss appropriate preconception genetic screening, and, if discovered to be at high risk of a genetic illness, to review their reproductive options.

Seroepidemiology of Syphilis Infection among 2 Million Reproductive-age Women in Rural China：A Population-based, Cross-sectional Study

Background：Quantifying syphilis prevalence is important for planning interventions and advocating for resources on syphilis.However,data on large sample studies regarding the prevalence of syphilis among reproductive-age women in rural China were not available for analysis.The aim of the study was to determine the prevalence,epidemiological characteristics,and related factors of syphilis infection among reproductive-age women in rural China.Methods：Data were obtained from a nationwide,population-based,cross-sectional study under the National Free Preconception Health Examination Project which covered all the 31 provinces in China's Mainland.Women intending to get pregnant within the next 6 months were enrolled between January 1,2010,and December 31,2012.Sociodemographic,gynecological and obstetric characteristics,and other relevant information were obtained through face-to-face interviews.Treponema pallidum particle agglutination assay test was used to detect positive samples of syphilis.Univariate and multivariate logistic regressions were performed to assess the associations between syphilis seropositivity and related factors.Results：The overall seroprevalence of syphilis （SPS） among the 2,044,126 women who received syphilis screening test during 2010-2012 was 0.37% （95% confidence interval [CI]：0.36-0.37%）.The SPS appeared 0.24% （95% CI：0.23-0.26%） and 0.66% （95% CI：0.59-0.72%） in women at 21-24 and 40-44 years of age,respectively,showing an increase of SPS,parallel with age,and the difference was significant.SPS was significantly higher in ethnic minorities than that in Han nationality （0.58% vs.0.35%,respectively,odds ratio [OR] =1.41,95% CI：1.30-1.53） and higher in workers than that in farmers （0.45% vs.0.36%,respectively,OR =1.27,95% CI：1.14-1.41）.Women with primary school or below level had a higher SPS as compared to those with college or above educational level （0.61% vs.0.32%,respectively,OR =2.49,95% CI：2.14-2.89）,and the increase reversely correlated with the levels of education.Women whose spouses were syphilis seropositive had significant greater risk （OR =48.26,95% CI：44.38-52.48） as compared those whose spouses were seronegative.Women who reported having had a history of sexually transmitted infections were more likely to be tested positive for serological syphilis （OR =27.17,95% CI：20.44-36.11） as compared to those without.Conclusions：High SPS is seen among reproductive-age women in rural China that calls for targeted interventions on syphilis prevention and control in this target population,with emphasis on those who are 35 years of age and above,less educated,being minor ethnicity,workers,and living in the western regions of China.

Women’s preconception health patterns in traditional Chinese medicine as a predictor of fertility outcomes

Objective: To examine the association between traditional Chinese medicine(TCM), preconception health patterns and fertility outcomes.Methods: A community-based prospective cohort study was conducted in China. A total of 3012 newly married women who were willing to conceive within 2 years were enrolled in the study and took National Free Prepregnancy Checkups(NFPC). A reliably structured self-rating scale was used to measure the TCM preconception health patterns of the enrolled women. A 3-year follow-up was conducted to obtain the fertility outcomes, including pregnancy rate, time to pregnancy, spontaneous miscarriage and newborn status. Statistical analyses were conducted using Chi-square or Fisher’s exact tests, logistic regression models, general linear models and the Cox proportional hazard model.Results: The fertility outcomes showed no statistic correlations to the terms of NFPC in this population.Approximately a half of the women(46.66%) had unhealthy patterns. Women with qi & blood-deficiency(odds ratio [OR] = 35.19, 95% confidence interval [CI] = 1.55–801.15) or qi-stagnation(OR = 4.55, 95% CI =0.90–23.06) pattern took a longer time to get pregnant, and those with qi-stagnation(OR = 2.05, 95% CI =1.1–3.82) or yang-deficiency(OR = 1.91, 95% CI = 1.12–3.25) pattern had a higher risk of spontaneous miscarriage.Conclusion: Three unhealthy TCM patterns during the preconception period might be risk factors for low fecundity or poor pregnancy outcomes. The TCM preconception pattern identification may provide a convenient and effective way to screen for potential pregnancy risks beyond the NFPC. Further, appropriate interventions based on the TCM preconception health patterns are needed to improve quality in women’s fecundability and birth outcomes.

Menstrual cycle characteristics as an indicator of fertility outcomes:evidence from prospective birth cohort study in China

OBJECTIVE:To evidently assess the applicability of regulate menstrual cycle(MC)characteristics in Traditional Chinese Medicine(TCM)as an indicator for fertility.METHODS:A community-based prospective cohort study was conducted in China.Between January 2010 and December 2012,women who were willing to conceive within 2 years were enrolled in the study.Other than the MC length pattern,a well-adopted MC characteristic,menstrual blood color and clots were specifically concerned for women enrolled.All participants were followed up in 2 years by trained nurses.Pregnancy rate,fecundability odds ratio(FOR)and risk of miscarriage were assessed as fertility outcomes.RESULTS:A total of 2109 women were effectively included in this cohort for analysis.Results show that women with irregular MC length were less likely to achieve conception(FOR_(irregular)=0.59;95%CI=0.45-0.77,P<0.001).Menstrual blood in bright red color was also associated with decline in likelihood of conception(FOR=0.79;95%CI=0.63-0.98,P=0.04).Women with menstrual blood in light red were at higher risk of miscarriage(OR=2.39;95%CI=0.91-6.28,P=0.08).No significant impact was found between menstrual blood clots and fertility outcomes(FOR=1.02,95%CI=0.83-1.25,P=0.88;OR=1.2695%CI=0.77-2.07,P=0.35).CONCLUSIONS:MC characteristics can be an effective and simple indicator for women’s fertility.Increasing the knowledge of MC characteristics for women in reproductive ages would bring great benefits to their preconception health conditions.

A review of guidelines,recommendations,and framework of men’s preconception care

The focus of men’s health is within the context of preconception health and primary care,which involves a new method of engaging men’s attention to their preconception and general health.The aim of this review research is to offer health care practitioners a complete framework for men’s preconception care.From 2000 to October 2021,researchers examined electronic databases such as Web of Science,PubMed,Scopus,ScienceDirect,ProQuest,Cochrane,SAGE,Springer,UpToDate,and Google Scholar for published papers on men’s preconception care.Two independent authors assessed the quality of the included studies using techniques suitable for this type of investigation.Only 14 of the 835 studies that were found in the original search matched the inclusion criteria.Individual responsibility across the life span(evaluation of reproductive life plan,acquiring information about contraception)and risk assessment(age,medical and surgical history,medications,family history and genetic risks,social history,sexual health assessment,physical examination,laboratory testing,mental health,and intimate partner violence)are the two main topics of preconception care in men according to a review of studies.Our findings clearly demonstrated the critical components of a comprehensive preconception care approach for men.Therefore,preconception care for men remains a developing concept.Further research is required to develop standards for evaluating males during the preconception period.