Preconception care pertains to the delivery of biomedical, behavioral, and social health interventions to women and couples before conception. It aims to improve their health status, reduce the risks of poor maternal and child health outcomes, and, ultimately, improve short- and long-term maternal and child health through addressing health problems, unhealthy behaviors, and individual and environmental risk factors that may all contribute to maternal and child morbidity and mortality.
The prenatal period is a time of great fetal vulnerability due to in-utero conditions of the undeveloped fetus, namely (a) inability to filter chemical toxicants, (b) inability to efficiently detoxify contaminants, (c) high unbound fractions of bioactive toxicants, (d) recycling of excreted urinary pollutants, (e) increased permeability of blood-brain barrier to chemical agents, and (f) higher toxicant concentrations by weight. The combination of these conditions with other prenatal factors such as nutrient deficiencies and toxicant exposures may result in obstetrical complications, pediatric chronic diseases, or even genetic mutations.
An adequate amount of essential nutrients is necessary for proper fetal tissue formation, differentiation, and development. Nutritional deficiencies during pregnancy increase the likelihood of child morbidity. Examples of common nutrient deficiencies and their possible health effects are as follows:
- Folate deficiency contributes to greater risks of open neural tube defects, miscarriage, and Down’s syndrome.
- Gestational iron deficiency may be related to cognitive and immune impairments.
- Iodine deficiency can result in pediatric hypothyroidism and intellectual disabilities.
- Biotin deficiency may be associated with the development of a cleft palate.
- Vitamin B12 deficiency increases the risk of neural tube defects.
Additionally, gestational exposure to various toxicants also serves as determinants of chronic adverse sequelae. To begin with, chemical exposure from air, water, soil, and foodstuffs may prepollute infants and cause health problems such as autism, mental illness, and cancer. Household and vehicle exposure to toxicants like furniture flame retardant chemicals, personal care product chemicals, or shower chloroform may also be associated with unfavorable outcomes including pediatric allergy, respiratory illness, and congenital birth defects. Similarly, maternal occupational exposure to chemicals such as solvents, paints, or petroleum products during pregnancy may be associated with childhood leukemia, cardiac and neurological abnormalities, or lower functioning. Aside from these, other forms of exposure also exist including insecticide and herbicide exposures, prenatal supplement contamination, electrical exposures, paternal exposures, nanoparticles, and genetically modified foods.
Considering that the majority of women only receive prenatal care towards the latter part of their first trimester, by which time the beginnings of major organs have already formed, preconception care is pertinent to offering an earlier and wider scope of prevention that covers the entirety of fetal development, including the earlier stages of the first trimester. Additionally, it would be a challenge to only begin health interventions and lifestyle changes during pregnancy, as some women feel fatigued or suboptimal during the first trimester. Some interventions may also be inadvisable during pregnancy, such as certain immunizations or detoxification, while interventions given before conception optimize birth outcomes. Finally, certain medical conditions and pharmaceutical use are best dealt with prior to conception and may require a specific amount of time to be effectively addressed.
With high rates of unplanned pregnancies, such as 3 out of 10 pregnancies in the Philippines for 2020, it is possible for essential health interventions given once pregnancy has been recognized to be too late. Hence, preconception care is essential not only to couples who plan to have children but to all individuals of reproductive age. Regardless of whether conception occurs, preconception care offers health benefits to all individuals who utilize it, as part of it involves interventions and lifestyle changes toward health maintenance and promotion.
References
Genuis, S. J., & Genuis, R. A. (2016). Preconception care: A new standard of care within maternal health services. BioMed Research International, 2016, 1-30. https://doi.org/10.1155/2016/6150976
Johnson, H., Simonette, V., & Drury, F. (2020, December 23). Covid-19: The Philippines and its lockdown baby boom. BBC News. https://www.bbc.com/news/world-asia-55299912
Mason, E., Chandra-Mouli, V., Baltag, V., Christiansen, C., Lassi, Z. S., Bhutta, Z. A. (2014). Preconception care: Advancing from ‘important to do and can be done’ to ‘is being done and is making a difference’. Reproductive Health, 11(3), 1-9. https://doi.org/10.1186/1742-4755-11-S3-S8