Prevalência dos indicadores de saúde pré-concepcional das mulheres brasileiras em idade reprodutiva / Prevalence of preconception health indicators among Brazilian women of reproductive age

Resumo O objetivo deste artigo é avaliar o desempenho de indicadores de saúde pré-concepcional das mulheres brasileiras em idade reprodutiva segundo as características sociodemográficas. Estudo epidemiológico e descritivo com dados de 21.645 e 25.228 mulheres que responderam à Pesquisa Nacional de Saúde de 2013 e 2019 e provenientes do DATASUS de 2010 a 2020. Estimou-se a prevalência de indicadores, segundo características sociodemográficas, e as diferenças estatísticas por meio do teste qui-quadrado de Pearson. Calculou-se a taxa de incidência dos indicadores de sífilis e HIV. Houve aumento da prevalência de indicadores que se referem ao acesso aos serviços de saúde (consultas médica, odontológica e realização de Papanicolau recente). Contudo, houve aumento da hipertensão, do consumo de álcool e da obesidade. Observou-se manutenção da prevalência do uso de contraceptivo e tratamento de fertilidade. Além disso, a taxa de incidência da sífilis aumentou sete vezes entre 2010-2020. Os resultados foram ainda piores entre mulheres de baixa escolaridade, pretas/pardas, com maior paridade e do Norte/Nordeste. Apesar do aumento no acesso aos serviços de saúde, houve piora do desempenho de indicadores de saúde pré-concepcional, e manutenção das iniquidades em saúde.

Abstract This article aims to evaluate the performance of preconception health indicators according to sociodemographic characteristics among Brazilian women of reproductive age. We conducted a descriptive epidemiological study using data from 21,645 and 25,228 women, respectively, who responded the 2013 and 2019 national health surveys, and data for the period 2010 to 2020 derived from the national health system's Department of Informatics (DATASUS). We calculated the prevalence of indicators according to sociodemographic characteristics and statistical significance of differences was measured using Pearson's chi-squared test. Syphilis and HIV incidence rates were also calculated. There was an increase in the prevalence of access to health service indicators (medical and dental consultations and recent Pap smear). However, there was an increase in the prevalence of hypertension, alcohol use, and obesity. The prevalence of use of contraceptive methods and fertility treatment remained stable. Syphilis incidence increased sevenfold between 2010 and 2020. Black/brown women with a low level of education, higher parity, and living in the North or Northeast performed worse for preconception health indicators. Despite the increase in access to health services, performance on preconception health indicators declined and health inequities continued.

Preconception Care to Improve Pregnancy Outcomes: The Science

INTRODUCTION: In the last decades, improvements in the care of pregnancy and child development have been observed worldwide. However, pregnancy problems remain high in most countries. There was a concentration of care in the prenatal period as the primary approach for improving pregnancy results. Currently, attention to the care of pregnant women, women who have recently given birth, and newborns are focused on the care of preconception to improve the results of pregnancy and improve the outcomes of child growth and developmentOBJECTIVE: Describe the evidence for preconception care (PCC) and information to the health care provider, as well as describe instruments to present health care providers with PCC, its definition, its components, recommended interventions, and the scientific basis for recommendationsMETHODS: There was a search for published and unpublished literature related to scientific evidence for the effectiveness of PCC in improving pregnancy results. The search was carried out based on Pubmed and using data scraping techniques, in the material available on the internet and disseminated by international organizations, such as the World Health Organization and reports by government agenciesRESULTS: It is reported that the literature on the scientific basis for PCC is fragmented, and most publications discuss evidence of one or a few interventions, with the majority of reports considering PCC for specific populations, such as women with chronic health problems and couples with infertility. However, these publications do not offer a realistic view of the proposed PCC interventions, with the scientific evidence that supports them. The general aspects of the existing literature and the recommended preconceived care interventions are described, together with the quality of the scientific evidence and the strength of the recommendations behind each of these interventionsCONCLUSION: Many clinical interventions have been identified that could be offered to women before conception to help avoid adverse outcomes. Most of these interventions have scientific evidence to support their role in improving pregnancy outcomes. Therefore, it is recommended that clinical care providers incorporate evidence-based prejudice services in their daily care of women of reproductive age, in an effort to improve women's health before and during pregnancy, as well as improve pregnancy outcomes for women and their children

INTRODUÇÃO: As Nas últimas décadas, foram observadas melhorias no cuidado à gravidez e no desenvolvimento infantil em todo o mundo. No entanto, os problemas de gravidez continuam altos na maioria dos países. Houve uma concentração de cuidados no período pré-natal como a principal abordagem para melhorar os resultados da gravidez. Atualmente, a atenção aos cuidados de mulheres grávidas, mulheres que deram à luz recentemente e recém-nascidos está focada no cuidado de preconcepção para melhorar os resultados da gravidez e os resultados do crescimento e desenvolvimento infantilOBJETIVO: Descrever as evidências para os cuidado preconcepção (PCC) e informações para o profissional da saúde, bem como descrever instrumentos para apresentar aos profissionais de saúde o PCC, sua definição, seus componentes, intervenções recomendadas e a base científica para recomendaçõesMÉTODO: Houve uma pesquisa de literatura publicada relacionada a evidências científicas para a eficácia do PCC na melhoria dos resultados da gravidez. A pesquisa foi realizada com base no Pubmed e utilizando técnicas de raspagem de dados, no material disponível na internet e divulgado por organizações internacionais, como a Organização Mundial da Saúde e relatórios de órgãos governamentaisRESULTADOS: Relata-se que a literatura sobre a base científica do PCC é fragmentada e a maioria das publicações discute evidências de uma ou poucas intervenções, com a maioria dos relatórios considerando o PCC para populações específicas, como mulheres com problemas crônicos de saúde e casais com infertilidade. No entanto, essas publicações não oferecem uma visão realista das intervenções propostas do PCC, com as evidências científicas que as apoiam. Os aspectos gerais da literatura existente e as intervenções preconcebidas recomendadas são descritas, juntamente com a qualidade das evidências científicas e a força das recomendações por trás de cada uma dessas intervençõesCONCLUSÃO: Muitas intervenções clínicas foram identificadas que poderiam ser oferecidas às mulheres antes da concepção para ajudar a evitar resultados adversos. A maioria dessas intervenções possui evidências científicas para apoiar seu papel na melhoria dos resultados da gravidez. Portanto, recomenda-se que os prestadores de cuidados clínicos incorporem serviços de preconcepção baseados em evidências em seus cuidados diários a mulheres em idade reprodutiva, em um esforço para melhorar a saúde das mulheres antes e depois da gravidez. durante a gravidez, bem como melhorar os resultados da gravidez para mulheres e filhos

Preconception care: developing and implementing regional and national programs

INTRODUCTION: During the past few decades, health workers have come to agree that there is a very important place for preconception care (PCC) in improving maternal and infant pregnancy outcomes. The United States Centers for Disease Control and Prevention (CDC) and the World Health Organization issued recommendations encouraging countries to develop and implement preconception care programs. The reports include an in-depth discussion of the rationale and scientific evidence behind PCC as well as definitions, goals, components and recommended interventions to be included in PCC. These reports also offer very broad guidelines but do not offer details on how to develop and implement preconception care programsOBJECTIVE: The CDC and WHO reports identify the need for multi-sectoral engagement in developing and implementing preconception care programs and propose some activities and strategies to be considered in developing PCC programs. However, the recommendations fall short of specifying real steps that countries and regions should take in implementing PCC programs. In this publication we propose action steps for developing and implementing regional or national preconception care programsMETHODS: We reviewed the published and unpublished literature (using PubMed and the Internet) to identify reports that describe processes for developing and implementing PCC programs. We used information from the literature along with experiences we gained through our work and interaction with States and developing countries to prepare a detailed description of the steps involved in developing and implementing a PCC programRESULTS: We found very little in terms of "tools" for program managers and providers to use when developing and implementing PCC programs. We prepared a guide, including a summary of steps and a proposed timeline, for program directors to use for developing and implementing PCC programsCONCLUSION: Developing and implementing a sustainable PCC program should address issues related to educating the public, providers and policy makers about the benefits of PCC. It also includes establishing an infrastructure within the departments of health and ensuring resources to build, guide, monitor and evaluate the PCC program. Finally, implementation of a successful program depends heavily on the proper training of public health and clinical care providers in the delivery of the services included in the program

INTRODUÇÃO: Nas últimas décadas, os profissionais de saúde chegaram a um acordo sobre a importância dos cuidados preconcepção na melhoria dos resultados da gravidez materna e infantil. Os Centros dos Estados Unidos para Controle e Prevenção de Doenças (CDC) e a Organização Mundial da Saúde emitiram recomendações incentivando os países a desenvolver e implementar programas de assistência preconcepção. Os relatórios incluem uma discussão aprofundada da lógica e das evidências científicas por trás do PCC, bem como definições, objetivos, componentes e intervenções recomendadas a serem incluídas no PCC. Esses relatórios também oferecem diretrizes muito amplas, mas não oferecem detalhes sobre como desenvolver e implementar programas de assistência preconcepçãoOBJETIVO: Os relatórios do CDC e da OMS identificam a necessidade de envolvimento multissetorial no desenvolvimento e implementação de programas de assistência pré-conceitual e propõem algumas atividades e estratégias a serem consideradas no desenvolvimento de programas do PCC. No entanto, as recomendações não especificam as medidas reais que os países e regiões devem adotar na implementação de programas de assistência preconcepção. Neste artigo, propomos etapas de ação para o desenvolvimento e implementação de programas regionais ou nacionais de assistência pré-conceitualMÉTODO: Foi revisada a literatura publicada usando o PubMed para identificar relatórios que descrevem processos para o desenvolvimento e implementação de programas de assistência preconcepção. As informações da literatura foram utilizadas, juntamente com as experiências adquiridas por meio de nosso trabalho e interação com os Estados e os países em desenvolvimento, para preparar uma descrição detalhada das etapas envolvidas no desenvolvimento e na implementação de um programa de assistência preconcepçãoRESULTADOS: Pouco foi encontrado em termos de "ferramentas" para os gerentes e provedores de programas usarem ao desenvolver e implementar programas de assistência preconcepção. Este artigo foi preparado como um guia, incluindo um resumo das etapas e um cronograma proposto, para os diretores de programas usarem no desenvolvimento e na implementação de programas de assistência preconcepçãoCONCLUSÃO: O desenvolvimento e implementação de um programa sustentável do PCC deve abordar questões relacionadas à educação do público, fornecedores e formuladores de políticas sobre os benefícios do PCC. Também inclui o estabelecimento de uma infraestrutura nos departamentos de saúde e a garantia de recursos para construir, orientar, monitorar e avaliar o programa PCC. Finalmente, a implementação de um programa bem-sucedido depende muito do treinamento adequado dos prestadores de serviços de saúde pública e atendimento clínico na prestação dos serviços incluídos no programa

Preconception care to improve pregnancy outcomes: clinical practice guidelines

INTRODUCTION: There is scientific evidence that the health of women before pregnancy contributes to the maternal and infant outcomes of pregnancy. There is also scientific evidence that the health of women of reproductive age may be improved through the provision of Preconception Care (PCC). Preconception care includes interventions to assess, identify, address, and modify a woman's health conditions and risks to ensure that these health conditions and risks do not negatively affect the outcome of her pregnancy. Many of the medical conditions, environmental exposures, personal behaviors, and psychosocial risks associated with negative pregnancy outcomes have been identified and there are recommendations for including these conditions in PCC servicesOBJECTIVE: Our purpose is to present a tool for clinical care providers involved in delivering PCC services. We try to answer the following questions: what do providers actually do when a woman of reproductive age arrives at their offices? What questions to ask? What examinations to conduct? What laboratory tests to perform? And, what education and counselling to offer?METHODS: We reviewed published and un-published literature related to the scientific evidence for the effectiveness of PCC in improving pregnancy outcomes. We searched PubMed for published articles, and we searched the internet for unpublished reports prepared by international organizations such as the World Health Organization and reports from governmental agencies. We summarized the information and presented a comprehensive overview of actions that providers should take to address various risk behaviors, exposures and health conditionsRESULTS: Several scientists, countries, and international organizations have proposed answers to the above questions. However, there has been no consistency and there is not a single publication that includes a comprehensive compilation of the proposed actions. We summarized the recommended actions that clinical care providers should take in addressing various health conditions, risk behaviors, and exposuresCONCLUSION: It is recommended that all providers screen all women for their intentions to become pregnant and to provide them with appropriate services. Women should be referred to specialized care when risk behaviors and medical conditions that go beyond the skills and abilities of the primary care provider are identified

INTRODUÇÃO: Existem evidências científicas de que a saúde das mulheres antes da gravidez contribui para os resultados maternos e infantis da gravidez. Há também evidências científicas de que a saúde das mulheres em idade reprodutiva pode ser melhorada através da prestação de cuidados preconcepção. Os cuidados preconcepção incluem intervenções para avaliar, identificar, abordar e modificar as condições e riscos de saúde de uma mulher para garantir que essas condições e riscos não afetem negativamente o resultado de sua gravidez. Muitas condições médicas, exposições ambientais, comportamentos pessoais e riscos psicossociais associados a resultados negativos da gravidez foram identificados e existem recomendações para a inclusão dessas condições nos serviços de assistência preconcepçãoOBJETIVO: O objetivo deste estudo é servir como uma ferramenta para os prestadores de cuidados clínicos envolvidos na prestação de serviços de cuidados preconcepção. Tentamos responder às seguintes perguntas: o que os profissionais realmente fazem quando uma mulher em idade reprodutiva chega a seus escritórios? Que perguntas fazer? Quais exames realizar? Quais exames laboratoriais devem ser realizados? E que educação e aconselhamento oferecer?MÉTODO: Revisamos a literatura publicada e não publicada relacionada à evidência científica para a eficácia dos cuidados preconcepção na melhoria dos resultados da gravidez. Pesquisamos no PubMed por artigos publicados e pesquisamos na Internet relatórios não publicados preparados por organizações internacionais como a Organização Mundial da Saúde e relatórios de agências governamentais. Resumimos as informações e apresentamos uma visão abrangente das ações que os fornecedores devem adotar para abordar vários comportamentos de risco, exposições e condições de saúdeRESULTADOS: Vários cientistas, países e organizações internacionais propuseram respostas para as perguntas acima. No entanto, não houve consistência e não há uma única publicação que inclua uma compilação abrangente das ações propostas. Resumimos as ações recomendadas que os prestadores de cuidados clínicos devem adotar para lidar com várias condições de saúde, comportamentos de risco e exposiçõesCONCLUSÃO: Recomenda-se que todos os profissionais examinem todas as mulheres quanto à sua intenção de engravidar e forneçam-lhes os serviços adequados. As mulheres devem ser encaminhadas para atendimento especializado quando forem identificados comportamentos de risco e condições médicas que vão além das habilidades do prestador de cuidados primários

Identifying challenges to quality in preconception health care among women of reproductive age in Lipa City, Batangas

Background@#Preconception care is a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management. These interventions emphasize factors that must be addressed before conception or early in pregnancy in order to have maximal impact. Preconception health care is a key intervention in improving maternal and neonatal health care. Identification of specific needs of population-at-risk remains crucial in developing quality preconception health care programs in the Philippines. @*Objectives@#This paper: 1) described the preconception health status of women of reproductive age in selected communities in Lipa City Batangas; 2) identified the perceived preconception needs of women of reproductive age in selected communities; 3) determined the significant challenges to the provision of appropriate preconception health care; and 4) provided recommendations to address the gaps and challenges. @*Methods@#A total of 4,357 women of reproductive age were interviewed using a preconception checklist tool previously developed by researchers from Peking University (China), American University of Beirut (Lebanon), and University of the Philippines Manila (Philippines). Eleven Focus Group Discussions (FGDs) on various aspects of preconception health care were conducted among women of reproductive age from communities and workplaces (industries/factories, government offices, schools, entertainment centers, health centers). Thematic analyses of the data from the FGDs were performed. Recommendations for overcoming identified challenges to quality services were presented. @*Results@#There are salient gaps in preconception health care, particularly in micronutrient intake, immunization status, family planning and infectious diseases screening in both urban and rural communities. The study also showed major gaps in medical and educational services, particularly for adolescents. @*Conclusion@#Health and social challenges in the preconception health care delivery system for women of reproductive age in Lipa City Batangas were identified, including the prioritization of at-risk groups and development of strategies to address preconception health care gaps in both urban and rural settings. The alarming increasing rate of teenage pregnancy must be given highest priority with integration of safe and healthy pregnancy in the curriculum. The development of programs for men and women recognizes that parenthood is a partnership. To guarantee a successful program on preconception health care services, government must utilize an inter-sectoral and interdisciplinary approach with the participation of various stakeholders and sectors, both government and private. The engagement of women of reproductive age in planning provides a dynamic feedback for the relevance of the planned programs.

Gender-based Comparison of Knowledge on Preconception Care

BACKGROUND: There have been many voices highlighting the necessity of preconception care as a preventive approach to achieve better pregnancy outcomes for health promotion of mothers and babies. It is important to get preconception care for both men and women, as they play equally important roles for healthy pregnancy. Also, awareness and knowledge of men and women about their health are important factors for behavioral changes for preconception care. PURPOSE: The purpose of this study is to analyze the level of awareness about men and women's preconception care and knowledge of the determinants of healthy pregnancy by gender. Our second goal was to compare men and women's level of awareness and knowledge on it. METHODS: The participants were 500 males and females (aged over 19 years and under 49 years old) either living or working in Seoul city. The data collection period of the study was from July to December, 2017. An online survey was conducted using a panel of online vendors. Then the collected data were analyzed using SPSS 24.0. RESULTS: Awareness about both men and women's preconception care was significantly higher in women than in men (p=0.004, p=0.002). Furthermore, there was a significant difference between men and women (p=0.00) in the total score of knowledge on the determinants of preconception care, including smoking, alcohol drinking, age, folic acid intake, and check-up for infectious disease (p=0.00; means women 8.20±1.95 and men 7.27±2.38). Significant gender differences were also found on some items, such as men's alcohol drinking, men's age, men's check-up for infectious disease, women's intake of folic acid, women's check-up for infectious disease. The level of knowledge on men's folic acid intake was the lowest in both men and women. CONCLUSION: Based on the results on the analysis of gender differences in the awareness and knowledge about preconception care, it is necessary to develop and implement preconception care programs based on the gender perspective approach to make women and men equally share responsibility of the birth result.

The concepts and necessity of preconception care for men

Several international initiatives have taken place with themes such as "Men as Partners in reproductive health". Furthermore, many articles have recently been published concerning men's preconception care before pregnancy. However, little attention has been paid to this field in Korea. The concept of preconception health and health care for men is very important for pregnancy outcomes, and furthermore, for the health of their future families. Men's contribution to the pregnancy is clear for planned pregnancy and also offers an opportunity for disease prevention and health promotion in men themselves. This paper reviews the important concept of men's health for preparing for pregnancy, and summarizes key component of a comprehensive approach to optimizing the preconception health status of men as expecting fathers. In fact, many clinicians including most obstetricians-gynecologists in Korea are not trained to provide preconception health and care for men. In addition, no consensus has been developed on basic guidelines for preconception care including the pregnancy planning for men and women, laboratory tests before pregnancy, vaccination programs, and much more information on preparing for a successful pregnancy. To improve preconception care for men in Korea, many barriers must be overcome, such as lack of national services, financing, organization, and men's and women's understanding of the importance of preconception health for their pregnancy. Therefore, much more research is needed on men's preconception care in Korea.