Delvoye Pierre, Guillaume Caty, Collard Sarah, Nardella Tonia, Hannecart Valérie, Mauroy Marie-Christine
Office de la Naissance et de l'Enfance (ONE), Brussels, Belgium.
Eur J Contracept Reprod Health Care. 2009 Aug;14(4):307-16. doi: 10.1080/13625180903056123.
To assess means and constraints of preconception care implementation.
Three strategies were applied to promote preconception health: organisation of a campaign, production of guidelines, and implementation of a preconception pilot clinic. Three surveys investigated the knowledge and practices of women before and after the campaign, and one survey assessed the attitudes of gynaecologists.
Posters and leaflets are more efficient than TV spots; implementation of a pilot clinic enhances all activities in the field of preconception health. With regard to constraints, we observed that (i) preconception care could not be provided when pregnancy was unplanned; (ii) the necessity of postponing pregnancy interfered with vaccinations; (iii) the compliance of women with regard to the prolonged intake of folates is poor; (iv) the application of guidelines by providers is inconsistent; (v) providers lack training regarding genetic ethical stakes; and (vi) practitioners find it difficult to integrate the concept of private eugenics and to envision the probabilistic character of the clinical manifestations of inherited diseases.
We propose (i) flour fortification with folic acid; (ii) timely immunisation by preventive medicine at school, and (iii) continuous training of health care providers in the provision of preconception care.
评估孕前保健实施的方法和制约因素。
采用三种策略促进孕前健康：组织一场运动、编制指南以及开设一家孕前试点诊所。三项调查研究了运动前后女性的知识和做法，一项调查评估了妇科医生的态度。
海报和传单比电视广告更有效；开设试点诊所促进了孕前健康领域的所有活动。关于制约因素，我们观察到：（i）意外怀孕时无法提供孕前保健；（ii）推迟怀孕的必要性干扰了疫苗接种；（iii）女性对长期服用叶酸的依从性较差；（iv）提供者对指南的应用不一致；（v）提供者缺乏关于遗传伦理问题的培训；（vi）从业者发现难以整合私人优生学的概念并设想遗传病临床表现的概率特征。
我们建议：（i）用叶酸强化面粉；（ii）由学校预防医学进行及时免疫接种；（iii）对医疗保健提供者进行持续培训以提供孕前保健。
