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The Health Council of the Netherlands, a scientific advisory body, has recommended that the Dutch government introduce an integrated programme of preconception care, to reduce perinatal mortality, miscarriage, premature birth, and congenital abnormalities.
The Dutch government commissioned the council to draw up its advice because the Netherlands has lost its pre-eminent position on perinatal mortality compared with other European Union countries, partly because of a higher proportion of older mothers and mothers belonging to ethnic minorities (Ned Tijdschr Geneeskr 2004;148:1855-60).
The council's key message is that current antenatal care, which starts after the eighth week of pregnancy, can miss chances to improve the health of the mother and child. Information on health interventions should be brought forward until at least a month before any planned conception to allow the health benefits a chance to have effect, it says.
The proposal also advocates an “integrated, multidisciplinary approach,” in which all existing individual strands of care would be brought together with the same staff. These strands would include advice on diet, alcohol, and tobacco; genetic factors; chronic health conditions; current medication; and occupational health.
The measures recommended range from abstaining from tobacco, alcohol, and other recreational drugs to ensuring adequate intake of folic acid and vitamin D. Health professionals will also check for rubella antibodies; ensure diabetic women's blood sugar is under control; recommend that women with epilepsy adjust or phase out drugs completely; and treat any sexually transmitted infection.
Veronique Ruiz van Haperen, secretary to the council's committee which drew up the advice, said that the content may not be new but the timing was. “By not providing this knowledge to prospective parents before conception we miss out on the chance of having healthier mothers and babies.”
Some measures, such as campaigns for the use of folic acid, would target all women of child bearing age; others would target individual prospective parents by inviting them for preconception consultations with their GP or a midwife. They could then be referred to a gynaecologist or clinical geneticist if, for example, the parents wished to consider carrier screening for conditions such as cystic fibrosis and sickle cell anaemia.
Successful pilot studies of preconception care have already been done by the Dutch Organisation of Midwives and the Erasmus University Medical Centre, in Rotterdam. The Dutch Society of GPs, which sets professional standards, is meanwhile drawing up guidelines for regional cooperation between GPs, midwives, and gynaecologists.
The council's advice highlights international examples of preconception care, including programmes in Hungary, in the United States, and at the Queen Mother's Hospital in Glasgow. Dr Ruiz van Haperen does not think, however, that any of them are as “broad and integrated as we propose.”
The government will respond to the recommendations within three months.
Preconception Care: a Good Beginning is available at www.gr.nl.