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Which health aspects require the most attention before getting pregnant?
A study conducted by researchers from USP and published in "The Lancet" proposes the creation of indicators to monitor preconception health
An international study published in the journal The Lancet proposes, for the first time, a set of indicators that can guide health monitoring for people who want to get pregnant. The research broke new ground by combining the views of healthcare professionals with the perspective of civil society in defining these indicators.
Based on scientific literature, but also on the viewpoint of people of reproductive age, the parameters proposed in the study relate to both individual and general health measures for those involved in the gestational process. Indicators describing individual health behaviors and conditions are the most commonly used or proposed for surveillance, given the ease of monitoring and guidance by a physician.
Mental health, for example, was considered the most important aspect of a hypothetical pregnancy among respondents, showing unanimity across the rankings, according to Ana Luiza Vilela Borges, professor at USP’s School of Nursing (EE) and a participant in the study.
The use of folic acid, advised for the prevention of congenital malformations and neural tube defects, is an example of an individual measure. Ana Luiza Vilela mentions that there are other more general measures that can be aimed at the population as a whole – such as encouraging physical activity and food labeling for excess sugar and fat – which also benefit those planning to get pregnant.
Some of these measures can be coordinated in a complementary way, as is the case in Brazil with the fortification of flour with iron and folic acid, which works to prevent both anemia and fetal malformations. Medical assistance, emotional and social support, and immunization against diseases are examples of important actions for both preconception health and the health of the general population.
In total, more than 5,000 people across 13 countries were consulted to identify which aspects are considered relevant to people’s health before they become pregnant. The research involved scientists from 13 other countries and was coordinated by Judith Stephenson, a professor at University College London.
Preconception health involves medical care and healthy habits adopted before pregnancy to ensure a safe gestation and a healthy baby. This care is aimed at everyone involved in the pregnancy and, ideally, should begin three months before conception, including medical consultations, routine exams, and the use of folic acid, among other measures. The lack of a consensus-based set of indicators to track preconception health makes it difficult to monitor pregnancy planning and to implement effective public health policies in the field.
Different indicators
To measure which indicators most influence preconception health, scientists conducted a survey across 11 countries, including Brazil. Analyzing the information qualitatively, respondents were asked to answer a hypothetical question: “Imagine you are thinking about getting pregnant; what would be the most important aspects to consider before pregnancy?” Next, they were asked to rank the aspects they believed to be most relevant in a potential pregnancy: Mental health, Physical health, Money, Living conditions, Relationships and family, Work/education, and Climate change.
A form was shared with people who have never had children, those considering it, and those who already have them, all between the ages of 18 and 49 and regardless of gender. “What really stands out, which I find quite interesting, is that across these 11 very different countries, the issue that came up most in first place was mental health”, the researcher points out.
For those interviewed, mental health plays a significant role both in being able to cope with the changes that pregnancy brings and for the well-being of the family, especially the woman. Ana Luiza also highlights that the rankings across countries are very similar, with mental health prevailing over physical health.
Furthermore, among the factors listed, climate change was not prioritized when considering a future pregnancy. “In Brazil, based on some reports, our hypothesis is that certain issues seem to be more under the individual’s control. Individually, I have more control over my mental and physical health, being able to go to therapy, see a doctor, or increase my leisure time and decrease my working hours”, the researcher notes. “It seems that this is more under individual control than climate change.”
People now understand that there are several other dimensions that should be considered important over purely physical health. They realize that mental issues can also influence their physical condition during pregnancy and even that of their children – Ana Luiza Vilela Borges
The International Alliance for Core Indicators for Preconception Health and Equity (iCIPHE), which includes the article’s authors, proposes a set of basic parameters to monitor preconception health across diverse regions of the globe. “There is still no consensus on a set of indicators to monitor preconception health, not just for women, but for all people who can become pregnant or have children”, explains Ana Luiza.
To this end, the proposed consensus list emerges as an alternative to facilitate the standardization of parameters, with the goal of improving the quality of public health services and general public knowledge.
For monitoring to be efficient, these indicators must be easily updated and comparable between countries, regardless of income level. The professor explains that some information systems already include the criteria indicated by the study. However, others are not as simple to collect and depend on national health surveys, which do not always occur with the necessary frequency.
In this sense, a consolidated information system could be an alternative to maintain the regularity of the collected information, uniting existing research in the country, such as the National Survey of Demography and Health of Children and Women (PNDS), a survey that has not been conducted in 20 years.
Considering indicator actions in the general population is extremely relevant, as it is not always possible to prepare and monitor the preconception health of couples. “We cannot forget that about half of pregnancies in Brazil are unintended—meaning they happened at an unwanted time or the people did not want to get pregnant at all”, says the researcher.
Ana Luiza points out that among the countries in the study, Brazil is in an intermediate position, as it has a lot of data available, though some of it is outdated or incipient. “I understand that Brazil, like many other countries, still does not prioritize pre-pregnancy care”, she emphasizes. “We have made significant progress in prenatal care—though still not enough—but the priority remains the woman who is already pregnant.”
The community’s understanding of the relevance of preconception health is one of the barriers scientists face, as this focus is often not included in professional training or health team routines. Assimilating the importance of the topic does not necessarily mean expecting everyone to plan their pregnancy in advance, but rather having the knowledge to seek out the health system in these situations and ensuring the health service itself can take a closer look at these cases.
Of course, the primary focus [of the indicators] is on women, but anyone involved in conception—whether men, transgender, or non-binary individuals—also needs to be in better health, as literature has already shown the impact of conception on obstetric and neonatal outcomes– Ana Luiza Vilela Borges
Now, in the next stage of the study, researchers from the Alliance are seeking a consensus among experts, public policy agents, and people of reproductive age in general. To this end, a questionnaire is being administered focusing on healthcare professionals and the community between 18 and 49 years old. The form can be accessed at this link.
The article Measuring progress in pregnancy planning and preconception health was published in The Lancet.
For more information: email alvilela@usp.br, with Ana Luiza Vilela Borges
*Intern under the supervision of Luiza Caires
**Intern under the supervision of Simone Gomes
English version: Translated and edited by Denis Pacheco
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A reprodução de matérias e fotografias é livre mediante a citação do Jornal da USP e do autor. No caso dos arquivos de áudio, deverão constar dos créditos a Rádio USP e, em sendo explicitados, os autores. Para uso de arquivos de vídeo, esses créditos deverão mencionar a TV USP e, caso estejam explicitados, os autores. Fotos devem ser creditadas como USP Imagens e o nome do fotógrafo.