Engaging women in improving their health, prior to becoming pregnant, has been found to be associated with improved maternal and infant outcomes (WHO, Citation2013). However, approximately 40% of pregnancies worldwide are not planned (Singh, Sedgh, & Hussain, Citation2010) and therefore, preconception care cannot solely target those planning to conceive. Consequently, there are many questions about the best time to delivery preconception care and who to deliver it to.
Research suggests there is a clear need to support women with mental health problems as early as possible to optimise their mental health and that of their baby in the perinatal period. For example, Witt, Wisk, Cheng, Hampton, and Hagen (Citation2012) found that women who self-reported ‘fair’ or ‘poor’ when asked: ‘In general, would you say that your mental health is excellent, very good, good, fair, or poor?’ were more likely to have pregnancy complications and a low birth weight baby. Preconception care provides an important opportunity to support women and to reduce these pregnancy complications and adverse birth outcomes.
As 40% pregnancies are not planned and the prevalence of mental health problems is higher for women in their reproductive years, there is a debate over whether preconception mental health care should be targeted or universal. Universal approaches have the benefit of ensuring all women and their partners are aware of their mental health and have the opportunity to optimise their well-being. In addition, the preconception period provides a unique opportunity to tackle health inequalities associated with mental health; early universal intervention can help ensure that more infants have the best start in life regardless of socio-economic background.
On the other hand, targeted interventions for women with mental illness who are considering pregnancy and who may have to manage major decisions around medication use and lifestyle changes have obvious benefits. Women with pre-existing mental illness are likely to relapse if they discontinue using medication when they find out they are pregnant and preconception discussion with their health provider is key. Women with mental health problems are also more likely to have higher drug, smoking and alcohol use and they need support in managing behaviour change so the potential benefits of targeted preconception care are numerous.
Preconception care includes a range of interventions aimed at identifying and modifying medical, behavioural and social risks to women’s health and well-being during their reproductive years (WHO, Citation2013). A scoping review of general pre-conceptual care interventions found that the majority of interventions included assessment or screening for health risks followed by brief intervention or counselling and the majority of interventions reveal improvements in at least one of the health outcomes measured (Hemsing, Greaves, & Poole, Citation2017). While these findings are encouraging, there are challenges moving forward as there is little research into the preconception needs of women with mental illness to inform the development of preconception interventions. We also need to consider whether a universal approach to improving pre-conceptual mental health would offer greater benefits at the population level, or if targeted interventions for those with pre-existing conditions would have greater impact and be a more effective use of resources. There is also a recognition that we should look beyond women’s perinatal health and well-being to include men and reproductive health more generally.
Interest in preconception care is growing in many countries as they seek to improve maternal, child and family health, reduce inequalities, and reduce health care costs and demands on services. However, the limited research on the preconception mental health needs of men and women (Nguyen, Brothoks, Frayne, Watt, & Fisher, Citation2015) and the current lack of effective care suggests that we are missing a big opportunity to make a real difference to the mental health of women, their partners, family and society.
Disclosure statement
No potential conflict of interest was reported by the author.
References
- Hemsing, N., Greaves, L., & Poole, N. (2017). Pre-conception health care interventions: A scoping review. Sexual and Reproductive Healthcare 14 24–32.
- Nguyen, T., Brothoks, J., Frayne, J., Watt, F., & Fisher, J. (2015) The pre-conception needs of women with severe mental illness: A consecutive clinical case series. Journal of Psychosomatic Obstetrics & Gynecology, 36:3, 87–93.
- Singh, S., Sedgh, G., & Hussain, R. (2010) Unintended pregnancy: Worldwide levels, trends, and outcomes. Studies in Family Planning, 41(4): 241–250.
- WHO (2013). Meeting to develop a global consensus on pre-conception care to reduce maternal and childhood mortality and morbidity. Geneva: Author.
- Witt, W. P., Wisk, L. G., Cheng, E. R., Hampton, J. M., & Hagen, E. W. (2012) Pre-conception mental health predicts pregnancy complications and adverse birth outcomes: A national population based study. Maternal and Child Health Journal 16 (7) 1525–1541.