Jenny Stern

Introducing reproductive life plan-based information in contraceptive counselling: an RCT.

STUDY QUESTION Can reproductive life plan (RLP)-based information in contraceptive counselling before pregnancy increase womens knowledge of reproduction, and of the importance of folic acid intake in particular? SUMMARY ANSWER The RLP-based information increased womens knowledge of reproduction including knowledge of folic acid intake. WHAT IS KNOWN ALREADY Many women have insufficient knowledge of reproduction, including a health-promoting lifestyle prior to conception, and highly educated women in particular postpone childbearing until an age when their fertile capacity has started to decrease. STUDY DESIGN, SIZE, DURATION The study was an randomized controlled trial with one intervention group (IG) and two control groups (CG1, CG2). A sample size calculation indicated that 82 women per group would be adequate. Recruitment took place during 3 months in 2012 and 299 women were included. The women were randomized in blocks of three. All groups received standard care (contraceptive counselling, Chlamydia testing, cervical screening). In addition, women in the IG were given oral and written RLP-based information about reproduction. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 299 out of 338 (88%) Swedish-speaking women visiting a Student Health Centre were included (mean age 23 years); response rate was 88%. Before the counselling, women in the IG and the CG1 completed a baseline questionnaire, including questions about lifestyle changes in connection to pregnancy planning, family planning intentions and knowledge of reproduction (e.g. the fecundity of an ovum). At follow-up 2 months after inclusion, a structured telephone interview was performed in all groups (n = 262, 88% participation rate). MAIN RESULTS AND THE ROLE OF CHANCE There was no difference between the groups regarding the mean knowledge score at baseline. The IG scored higher at follow-up than at baseline (P < 0.001); the mean increased from 6.4 to 9.0 out of a maximum 20 points. The women in the CG1 scored no differently at follow-up than at baseline. The difference in the knowledge score between the IG and the two CGs was significant (P < 0.001), whereas no difference was shown between the two CGs. There was no difference between the groups at baseline regarding how many women could mention folic acid intake among the things to do when planning to get pregnant. At follow-up, 22% in the IG, 3% in CG1 and 1% in CG2 mentioned folic acid intake (P < 0.001). At follow-up, more women in the IG also wished to have their last child earlier in life (P < 0.001) than at baseline, while there was no difference in the CG1. LIMITATIONS, REASONS FOR CAUTION As the study sample consisted of university students, it is possible that the effect of the intervention was connected to a high level of education and conclusions for all women of reproductive age should be drawn with caution. WIDER IMPLICATIONS OF THE FINDINGS The provision of RLP-based information seems to be a feasible tool for promoting reproductive health. STUDY FUNDING/COMPETING INTEREST(S) Study funding was received from the Faculty of Medicine, Uppsala University, Sweden. There are no conflicts of interest. TRIAL REGISTRATION NUMBER ClinicalTrial.gov Identifier NCT01739101.

Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom

Abstract Objectives Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries. Methods In 2013, an electronic search and investigation was undertaken of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. Findings were compared within five categories: Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites. Results All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations for healthy women and men were fragmented and inconsistent. Preconception guidance was often included in antenatal and pregnancy guidelines. Differences between countries were seen with regard to nutritional and lifestyle advice particularly in relation to fish, caffeine and alcohol consumption, and vitamin supplementation. Conclusions Current guidelines are heterogeneous. Collaborative research across Europe is required in order to develop evidence-based guidelines for preconception health and care. There is a need to establish a clear strategy for promoting advice and guidance within the European childbearing population. Chinese Abstract 摘要 目的 孕前保健对于那些影响妊娠结局的风险因素的筛查、预防和管理是非常重要的。我们旨在调查六个欧洲国家的孕前保健政策、指南、推荐规范和服务项目 方法 2013年，一项服务于医疗专家和公众的电子搜索和调查项目在六个欧洲国家：比利时（弗兰德斯）、丹麦、意大利、荷兰、瑞典和英国展开。其结果从以下五个方面进行比较：政府政策和立法；专业团队和机构；医务人员；慈善组织；基于网络的公共信息和互联网站。 结果 所有国家对于患有慢性病的女性（如糖尿病和癫痫）均有相应的孕前推荐规范。而对于健康男女的推荐规范则比较分散且不一致。孕前指南常包括在产前和妊娠指南中。各个国家关于营养和生活方式的建议，尤其涉及鱼类、咖啡因、饮酒和维生素补充方面是不同的。 结论 现行的指南多种多样，需要整个欧洲进行合作研究，从而为孕前卫生保健制定循证指南。因此有必要为促进建议和指南在欧洲生育年龄人群中的实施建立清晰的方法。

Pregnancy planning and lifestyle prior to conception and during early pregnancy among Danish women

Abstract Objective To investigate the extent to which Danish women attending antenatal care plan their pregnancies and to determine the association between pregnancy planning and the intake of folic acid, alcohol consumption and smoking habits prior to conception and before the 16th week of gestation. Methods A cross-sectional survey of 258 women. Main outcome measures: intake of folic acid, alcohol consumption and smoking. Pregnancy planning was assessed by the London Measure of Unplanned Pregnancy (LMUP) and the five graded Swedish Pregnancy Planning Scale. Results Most (77%) of the participants reported that their pregnancies were very or fairly well planned. Higher median LMUP scores were observed in women taking folic acid (p < 0.001), in those consuming less alcohol, and in women who stopped smoking prior to pregnancy (p = 0.043). However, 43% of the respondents with a high degree of pregnancy planning and 98% of those with a low degree of planning had not taken folic acid prior to pregnancy. Binge drinking during early pregnancy was reported by 20% of women with a high degree of planned pregnancy and 31% of those with a low degree (p = 0.1). Conclusion Pregnancy planning was associated with a healthier lifestyle but still many women could improve their lifestyle in connection to pregnancy. Their level of alcohol consumption is higher than that recommended for best pregnancy outcome. Chinese abstract 目的。探讨在何种程度上参加产前保健计划的丹麦妇女怀孕，并确定妊娠规划和叶酸的摄入量，饮酒和吸烟习惯受孕前和怀孕第16周前之间的关联。 方法。采用横断面调查的258名妇女。主要观察指标：摄取叶酸，饮酒和吸烟。怀孕计划是由伦敦的的意外怀孕（ LMUP ）和五个梯度瑞典妊娠规划规模测量评估。 的结果。大多数（77％ ）的参与者报道，怀孕非常或相当精心策划。较高的平均LMUP分数，观察妇女服用叶酸（ P < 0.001 ） ，在那些消耗少饮酒，在妇女怀孕前戒烟（ P = 0.043） 。然而，具有高度的怀孕计划， 98％的那些低度的规划有43％的受访者并没有采取叶酸，怀孕前。具有高度的计划怀孕的程度低（ P = 0.1 ）和31％ ， 20％的女性在怀孕早期报道暴饮。 结论。健康的生活方式是与怀孕计划，但仍有许多连接到怀孕妇女可以改善他们的生活方式。他们的酒精消费水平高于建议最佳妊娠结局。.

Pregnancy planning in Sweden : a pilot study among 270 women attending antenatal clinics

Objective. Health status and lifestyle before and at the time of conception could affect the health of both mother and child, but there is a lack of knowledge about the degree to which pregnancies are planned. The aim of this pilot study was to investigate whether and how women plan their pregnancies. Material and methods. The main outcome measures were use of timetables, ovulation tests and lifestyle changes. Women (n= 322) visiting four antenatal clinics were asked to fill out a questionnaire (participation rate = 83.9%, n= 270). Results. Three of four pregnancies (n= 202) were very or rather well planned, whereas 4.4% (n= 12) were totally unplanned. During the planning period, 37.1% (n= 100) made up a timetable for getting pregnant, 23% (n= 62) used ovulation tests, 20.7% (n= 56) took folic acid and 10.4% (n= 28) changed alcohol consumption. Conclusion. Although a majority of these women had planned pregnancies, only one in five had taken folic acid during the planning period.

Is pregnancy planning associated with background characteristics and pregnancy‐planning behavior?

Prevalence of planned pregnancies varies between countries but is often measured in a dichotomous manner. The aim of this study was to investigate to what level pregnant women had planned their pregnancies and whether pregnancy planning was associated with background characteristics and pregnancy‐planning behavior.

Midwives' adoption of the reproductive life plan in contraceptive counselling: a mixed methods study

STUDY QUESTION How is the reproductive life plan (RLP) adopted in midwifery contraceptive counselling? SUMMARY ANSWER A majority of midwives adopted the RLP in their counselling, had predominantly positive experiences and considered it a feasible tool for promoting reproductive health. WHAT IS KNOWN ALREADY The RLP is a health-promoting tool recommended by the Centers for Disease Control and Prevention in the USA for improving preconception health. It was recently used in a clinical setting in Sweden and was found to increase womens knowledge about fertility and to influence womens wishes to have their last child earlier in life. STUDY DESIGN, SIZE, DURATION An exploratory mixed methods study among 68 midwives who provided contraceptive counselling in primary health care to at least 20 women each during the study period. Midwives received an introduction and materials for using the RLP in contraceptive counselling. Three months later, in the spring of 2014, they were invited to complete a questionnaire and participate in a focus group interview about their adoption of the RLP. PARTICIPANTS/MATERIALS, SETTING, METHODS Data collection was through a questionnaire (n = 53 out of 68; participation rate 78%) and five focus group interviews (n = 22). Participants included both younger and older midwives with longer and shorter experiences of contraceptive counselling in public and private health care in one Swedish county. Quantitative data were analysed for differences between users and non-users, and qualitative data were analysed by qualitative content analysis to explore the midwives experiences and opinions of using the RLP. MAIN RESULTS AND THE ROLE OF CHANCE Sixty-eight per cent of midwives had used the RLP in their contraceptive counselling. Four categories emerged through the focus group interviews: (i) A predominantly positive experience; (ii) The RLP—a health-promoting tool; (iii) individual and societal factors influence the RLP counselling; and (4) long-term implementation comprises opportunities, risks and needs. The most common reason for not using the RLP was lack of information. LIMITATIONS, REASONS FOR CAUTION There was general lack of experience of using the RLP with women from different cultural backgrounds, with non-Swedish speaking women and, when a partner was present. Due to the non-random sample, the limited knowledge about non-responders and a short follow-up period, results apply to short-term implementations and might not fully apply to long-term implementation. WIDER IMPLICATIONS OF THE FINDINGS The use of RLP in contraceptive counselling appears a feasible way of promoting reproductive health. Results from the USA and Sweden indicate it is a promising tool for midwives and other health professionals involved in reproductive counselling, which deserves to be explored in other nations. STUDY FUNDING/COMPETING INTEREST(S) Grants were received from the Medical Faculty at Uppsala University and the European Society of Contraception and Reproductive Health. There are no competing interests. TRIAL REGISTRATION NUMBER N/A.

Ukrainian medical students’ attitudes to parenthood and knowledge of fertility

ABSTRACT Objectives: The aim of our study was to investigate Ukrainian medical students’ intentions and attitudes in relation to future parenthood, and their knowledge about fertility. Methods: A classroom survey was carried out of randomly selected groups among 3568 Russian-speaking medical students. The response rate was 88.8%; 858 were female and 407 were male; the mean age was 20.6 (standard deviation [SD] 2.4) years. Results: One in four male and 16% of female respondents did not want to have children, 3.3% had children and 17% wanted one child only. Female respondents wished to have their first child when they were 24.4 (SD 2.4) years of age, and male respondents when they were 26.8 (SD 3.4) years of age. Around 60% of respondents reported there was a pronounced decline in female fertility after the age of 45 years. Conclusions: The desire to have children in the future is not apparent among medical students, especially not among men. Gaps in students’ knowledge about fertility need to be addressed by sexual and reproductive education.

Coherence of pregnancy planning within couples expecting a child

BACKGROUND joint planning and decision-making within couples have evident effects on the well-being of the family. The purpose of this study was to investigate the level of pregnancy planning among pregnant women and their partners and to compare the coherence of pregnancy planning within the couples. METHODS pregnant women and their partners were recruited from 18 antenatal clinics in seven Swedish counties between October 2011 and April 2012. Participants, 232 pregnant women and 144 partners, filled out a questionnaire with questions about pregnancy planning, lifestyle and relationship satisfaction. 136 couples were identified and the women׳s and partners׳ answers were compared. RESULTS more than 75% of the pregnancies were very or rather planned and almost all participants had agreed with their partner to become pregnant. There was no significant difference in level of pregnancy planning between women and partners, and coherence within couples was strong. Level of planning was not affected by individual socio-demographic variables. Furthermore, 98 % of women and 94 % of partners had non-distressed relationships. CONCLUSION one of the most interesting results was the strong coherence between partners concerning their pregnancy and relationship. Approaching these results from a social constructivist perspective brings to light an importance of togetherness and how a sense and impression of unity within a couple might be constructed in different ways. As implications for practice, midwives and other professionals counselling persons in fertile age should enquire about and emphasise the benefits of equality and mutual pregnancy planning for both women and men.

Adverse childhood experiences influence development of pain during pregnancy

To investigate the association between adverse childhood experiences (ACE) and pain with onset during pregnancy.

Exploring men's pregnancy-planning behaviour and fertility knowledge : a survey among fathers in Sweden

Abstract Introduction: Research about pregnancy-planning behaviour mostly focuses on women, even though pregnancy planning usually also concerns men. The purpose of this study was to investigate how men plan for family, and to measure their fertility knowledge after having become fathers. Material and methods: Data were collected in 2014 as part of a Swedish longitudinal pregnancy-planning study. Men were recruited through their female partner one year after childbirth. Participants were asked to fill out a questionnaire about pregnancy planning, lifestyles, and fertility. Results: Of the 796 participants, 646 (81%) stated that the pregnancy had been very or fairly planned, and 17% (n = 128) had made a lifestyle adjustment before pregnancy to improve health and fertility. The most common adjustments were to reduce/quit the consumption of alcohol, cigarettes, or snuff, and to exercise more. First-time fathers and those who had used assisted reproductive technology to become pregnant were more likely to have made an adjustment. Fertility knowledge varied greatly. Men with university education had better fertility knowledge than men without university education. Conclusion: Our findings indicate that there is variation in how men plan and prepare for pregnancy. Most men did not adjust their lifestyle to improve health and fertility, while some made several changes. Both pregnancy-planning behaviour and fertility knowledge seem to be related to level of education and mode of conception. To gain deeper understanding of behaviour and underlying factors, more research is needed.