New Guidance for Preconception Care Research and Policy Development
The term ‘preconception care’ typically attracts the attention of women and couples hoping to start a family. Since the majority of pregnancies are unplanned, today’s blog applies to anyone involved in improving maternal, newborn and child health.
Dean and colleagues propose a framework to prioritize objectives and guide research policy to have the greatest impact on the health of women and couples of reproductive age (and their children). They identify 3 highest scoring research questions within each of 6 priority-setting criteria: 1) Answerability, 2) Effectiveness, 3) Deliverability, 4), Impact on reduction of maternal and newborn mortality and severe morbidity, 5) Impact on long-term outcomes for women and children, and 6) equity.
In an accompanying article, Young and colleagues endorse the Age-Specific Maternal Mortality Rate (ASMM Rate) using five-year age groups to more accurately compare countries. An advantage of the ASMM Rate is its accounting for lives saved through the postponement or foregoing of pregnancy.
Omega-3 fatty acid supplementation during pregnancy (last half) increases birth weight and days of gestation, potentially reducing the risk of preterm birth and low-birth weight infants. Carlsen and colleagues report an inverse association between maternal omega-3 status at gestational week 24 and length of the femur, but not with fetal weight. The study may be confounded because mothers having higher omega-3 status also lived healthier lifestyles and had a higher socioeconomic status.
Understanding nutrient-health outcome relationships is complicated. Many factors – physical activity, socioeconomic status, access to health care, etc – are integrally connected with nutrition and health outcomes. It is valuable to have non-government organizations, such as the Bill & Melinda Gates Foundation, helping establish frameworks to guide nutrition policy research and development.
Dean S, Rudan I, Althabe F, Webb GA, Howson C, Langer A, Lawn J, Reeve M-E, Teela KC, Toledano M, Venkatraman C-M, Belizan JM, Car J, Chan KY, Chatterjee S, Chitekwa S, Doherty T, Donnay F, Exxati M, Humayun K, Jack B, Lassi ZS, Martorell R, Poortman Y, Bhutta ZA. Setting research priorities for preconception care in low- and middle-income countries: Aiming to reduce maternal and child mortality and morbidity. 2013 PLoS doi:1371/journal.pmed.1001508
Young CT, Urquia ML, Ray JG. Preconception care in low- and middle-income countries: New opportunities and a new metric. 2013 PLoS doi:10.1371/journal.pmed.1001507
Carlsen K, Pedersen L, Bonnelykke K, Stark KD, Lauritzen L, Bisgaard H. Association between whole-blood polyunsaturated fatty acids in pregnant women and early fetal weight. 2013 Eur J Clin Nutr doi:10.1038/ejcn.2013.108