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      Women participating in a web-based preconception study have a high prevalence of risk factors for adverse pregnancy outcomes

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          Abstract

          Background

          Adverse pregnancy outcomes (APOs) can be increased by preconception risk factors and lifestyles.

          We measured the prevalence of preconception risk factors for APOs in a population of Italian women of childbearing age enrolled in a web-based study.

          Methods

          Participants were enrolled through a web platform ( http://www.mammainforma.it). After enrollment, participants filled in a questionnaire regarding socio-demographic characteristics, clinical data and preconception risk factors for adverse pregnancy outcomes. Through logistic regression, we explored how the prevalence of risk factors was affected by age, education level, employment, parity, physician’s recommendation and knowledge of the specific risk factor.

          Results

          We enrolled a total of 728 women. Sixty-two percent had a University degree, 84% were employed and 77% were planning their first pregnancy.

          Nearly 70% drank alcohol in any quantity; 16% were smokers; 6% was underweight; 21.4% was overweight; 51.6% did not assume folic acid; 22% was susceptible to rubella, 44.5% to hepatitis b and 13.2% to varicella.

          According to the multivariate analysis, compared to women who already had at least one pregnancy, nulliparous women had a higher BMI [OR 1.60 (CI 1.02;2.48)] and were less likely to be susceptible to rubella [OR 0.33 (CI 0.20;0.58)] and to be consuming alcohol [OR 0.47 (CI 0.31;0.70)] or cigarettes [OR 0.48 (CI 0.26;0.90)].

          Appropriate knowledge was associated with a correct behavior regarding smoking, drinking alcohol and folic acid supplementation.

          Conclusions

          This study shows that the prevalence of risk factors for APOs in our population is high.

          Interventions aimed at reducing risk factors for APOs are needed and, to this purpose, a web intervention may represent a feasible tool to integrate tailored information and to inform preconception counseling targeting a specific group of women planning a pregnancy who are engaged on the web.

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          Most cited references13

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          Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis

          Objective To summarise the benefits and harms of treatments for women with gestational diabetes mellitus. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Embase, Medline, AMED, BIOSIS, CCMed, CDMS, CDSR, CENTRAL, CINAHL, DARE, HTA, NHS EED, Heclinet, SciSearch, several publishers’ databases, and reference lists of relevant secondary literature up to October 2009. Review methods Included studies were randomised controlled trials of specific treatment for gestational diabetes compared with usual care or “intensified” compared with “less intensified” specific treatment. Results Five randomised controlled trials matched the inclusion criteria for specific versus usual treatment. All studies used a two step approach with a 50 g glucose challenge test or screening for risk factors, or both, and a subsequent 75 g or 100 g oral glucose tolerance test. Meta-analyses did not show significant differences for most single end points judged to be of direct clinical importance. In women specifically treated for gestational diabetes, shoulder dystocia was significantly less common (odds ratio 0.40, 95% confidence interval 0.21 to 0.75), and one randomised controlled trial reported a significant reduction of pre-eclampsia (2.5 v 5.5%, P=0.02). For the surrogate end point of large for gestational age infants, the odds ratio was 0.48 (0.38 to 0.62). In the 13 randomised controlled trials of different intensities of specific treatments, meta-analysis showed a significant reduction of shoulder dystocia in women with more intensive treatment (0.31, 0.14 to 0.70). Conclusions Treatment for gestational diabetes, consisting of treatment to lower blood glucose concentration alone or with special obstetric care, seems to lower the risk for some perinatal complications. Decisions regarding treatment should take into account that the evidence of benefit is derived from trials for which women were selected with a two step strategy (glucose challenge test/screening for risk factors and oral glucose tolerance test).
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            Associations between preconception counseling and maternal behaviors before and during pregnancy.

            Preconception counseling (PCC) is a vital component of preconception care. Through counseling, providers educate and recommend strategies to improve health and birth outcomes for women of reproductive age. The objective of our analysis was to assess the associations between receipt of PCC and positive maternal behaviors before and during pregnancy. We analyzed 2004-2008 Pregnancy Risk Assessment Monitoring System data from Maine, New Jersey, Utah, and Vermont. Multivariable logistic regression was used to investigate the associations between receipt of PCC and prepregnancy daily multivitamin consumption, first-trimester entry into prenatal care, and cessation of smoking and drinking before pregnancy among women who smoked/drank in the 2 years preceding the survey, adjusting for a wide range of maternal characteristics. Overall, 32% of women reported receipt of PCC, with particularly low rates reported among women with an unintended pregnancy (14%) and no health insurance prior to pregnancy (14%). Receipt of PCC was associated with daily prepregnancy multivitamin consumption (adjusted odds ratio [AOR] = 4.4; 95% confidence interval [CI] = 4.0, 4.7), first-trimester entry into prenatal care for women with an intended pregnancy (AOR = 2.1; 95% CI = 1.8, 2.4), and drinking cessation before pregnancy among women who drank in the 2 years preceding the survey (AOR = 1.3; 95% CI = 1.2, 1.5). PCC was associated with positive maternal behaviors that increase the likelihood of a healthy woman, pregnancy, and infant. Unfortunately, less than one-third of women with a recent live birth reported receiving PCC. These data provide population-based evidence suggesting the value of PCC in the promotion of healthy maternal behaviors for women with intended or unintended pregnancies.
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              ACOG Committee Opinion number 313, September 2005. The importance of preconception care in the continuum of women's health care.

              (2005)
              The goal of preconception care is to reduce the risk of adverse health effects for the woman, fetus, or neonate by optimizing the woman's health and knowledge before planning and conceiving a pregnancy. Because reproductive capacity spans almost four decades for most women, optimizing women's health before and between pregnancies is an ongoing process that requires access to and the full participation of all segments of the health care system.
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                Author and article information

                Contributors
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central
                1471-2393
                2014
                17 May 2014
                : 14
                : 169
                Affiliations
                [1 ]Bambino Gesù Children’s Hospital IRCCS, Epidemiology Unit, Piazza S. Onofrio 4, 00165 Rome, Italy
                [2 ]Departement of Onco-Ematology and Transplantation Medicine, Bambino Gesù Children’s Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
                [3 ]Alessandra Lisi International Centre on Birth Defects and Prematurity, Via Carlo Mirabello 14, 00192 Rome, Italy
                Article
                1471-2393-14-169
                10.1186/1471-2393-14-169
                4038071
                f3ed084d-fe5c-4fd4-ab76-9dd34bc0fea6
                Copyright © 2014 Pandolfi et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 December 2013
                : 28 April 2014
                Categories
                Research Article

                Obstetrics & Gynecology
                adverse pregnancy outcomes,prevalence,preconception care,maternal-child health services

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