Preconception care (PC) can reduce risks of stillbirth (SB)

Preconception care (PC) can reduce risks of stillbirth (SB)

James A. McGregor (1,2), Janice I. French (2), Marti Perhach (1)

(1) Group B Strep International; (2) LA Best Babies Network

Preventive strategies for SB and other adverse pregnancy adverse outcomes (AOs) are underappreciated. Our goals are to a) utilize a Logic Model analysis to identify and prioritize life course, lifestyles, and medical strategies to reduce risks of SB and b) discuss Group B strep recommendations including testing and vaccine updates.

We employed electronic databases (PubMed, Medline, Google) to search information using “preconception care” and “stillbirth” or “fetal death” as search terms (1990-2018).

A. Recommendations are authoritatively available (CDC-P, ACOG, AAFP, WHO, Cochrane and Gates/Aga Khan).

B. The most applicable strategies for individual and family were suggested as:
a) Age; >17 years
b) Interpregnancy interval >1½ year< 3 years
c) Avoidance of toxic substances/pollution
d) Maintenance of recommended BMI

C. The most effective medical strategies were judged to be:
a))Pregnancy planning/spacing services
b) Nutritional and BMI counseling
c) Folate and omega-3 supplementation started preconception
d) Provision of genetic and vaccination services
e) Provision of evidence-based SB prevention services

D. Women and families require life course, lifestyle, and fertility knowledge and services including recommended nutrition, STI prevention, family planning and means to avoid toxicants and environmental hazards, as well as screening for ACEs and violence or abuse.

4) Conclusion
A. Recommendations for PC services are available and can reduce risks of SB
B. Because of generalized applicability, life course, lifestyles and evidence-based modeled strategies will likely be most effective for reducing SB in differing populations
C. Public health approaches can be effective in both rich and poor country settings, family planning, violence, nutrition, and general medical services are deemed most likely to reduce risks of SB
D. Specialized PC services should be implemented and measured for efficacy

Ethics statement:
No patients were involved. No institutional consent required/obtained.

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