Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Room Sp-4469, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
Department of Health Care Studies, Rotterdam University of Applied Sciences, Postbus, 25035 3001, HA, Rotterdam, the Netherlands.
BMC Pregnancy Childbirth. 2022 Mar 23;22(1):238. doi: 10.1186/s12884-022-04560-y.
Preconception care (PCC) is care prior to conception to optimize parental health, and health of the future child, through biomedical and behavioral changes. Providing PCC to all women with a wish to conceive will improve perinatal health. PCC is especially important for women with a chronic disease, such as inflammatory bowel disease (IBD) and rheumatic diseases (RD). At present PCC is not part of routine care for these women. The aim of this study is to identify facilitators and barriers on a patient and professional level regarding the provision of PCC in women with IBD and RD.
An explorative survey study among women with IBD and RD, their treating physicians and obstetric professionals was performed. Patients with a wish to conceive, pregnant women or those with a recent pregnancy (< 1 year ago) visiting the outpatient clinic of a secondary and tertiary hospital and involved physicians and obstetric professionals were eligible.
A total of 71% of the IBD patients (n = 22/31) and 35% of the RD patients (n = 20/58) received a PCC consultation. PCC consultation was considered easy to enter, short in time and patients felt comfortable. Patients (71% IBD; 62% RD) preferred a personal PCC consultation with their disease specific specialist together with an obstetrician. Patients specifically wanted to receive information about the safety of medication use and disease activity following delivery. Of the included healthcare professionals 67% (n = 31) agreed PCC was applicable to their patients. Main barrier to providing PCC was lack of time and unavailability of professionals. In total 41% (n = 16) of obstetric professionals felt they had the knowledge and skills to provide PCC compared to 33% (n = 1) and 75% (n = 3) of gastroenterologists and rheumatologists, respectively.
Lack of awareness and urgency for the effectuation can be seen as important barriers for implementation of PCC. Due to the explorative nature generalisation of the results is not allowed. In the future, adaptation of the curricula of healthcare professionals by implementing interventions for pregnancy planning and preparation will generate awareness. Modelling of the impact of PCC might prove useful in resolving the lack of urgency for PCC realization.
孕前保健（PCC）是指在受孕前通过生物医学和行为改变来优化父母双方的健康和未来孩子的健康。为所有有生育意愿的妇女提供 PCC 将改善围产期健康。PCC 对患有慢性疾病（如炎症性肠病[IBD]和风湿性疾病[RD]）的妇女尤为重要。目前，这些妇女的 PCC 并不属于常规护理。本研究的目的是确定患者和专业人员在为 IBD 和 RD 妇女提供 PCC 时在患者和专业人员层面上的促进因素和障碍。
对二级和三级医院的门诊就诊的 IBD 和 RD 妇女、她们的治疗医生和产科专业人员进行了一项探索性调查研究。有生育意愿、怀孕或最近怀孕（<1 年前）的患者以及参与的医生和产科专业人员符合条件。
31 名 IBD 患者中有 71%（n=22）和 58 名 RD 患者中有 35%（n=20）接受了 PCC 咨询。PCC 咨询被认为易于进入，耗时短，患者感到舒适。患者（71%的 IBD；62%的 RD）更喜欢与他们的疾病专科医生和产科医生一起进行个人 PCC 咨询。患者特别希望获得有关药物使用安全性和分娩后疾病活动的信息。在纳入的医疗保健专业人员中，67%（n=31）同意 PCC 适用于他们的患者。提供 PCC 的主要障碍是缺乏时间和专业人员的可用性。总共 41%（n=16）的产科专业人员认为他们有提供 PCC 的知识和技能，而相比之下，只有 33%（n=1）和 75%（n=3）的胃肠病学家和风湿病学家有这种感觉。
缺乏对实施效果的认识和紧迫性可被视为实施 PCC 的重要障碍。由于研究的探索性质，不允许对结果进行概括。未来，通过实施妊娠计划和准备干预措施来调整医疗保健专业人员的课程将提高认识。模型化 PCC 的影响可能有助于解决 PCC 实现缺乏紧迫性的问题。
