Family Practice Vol. 21, No. 3, 307-309
Family Practice Vol. 21, No. 3 © Oxford University Press 2004, all rights reserved.
Current practice and future interest of GPs and prospective parents in pre-conception care in The Netherlands
Department of Clinical Genetics and Human Genetics, VU University Medical Center, Amsterdam, The Netherlands.
Correspondence to Leo ten Kate, MD, PhD, Department of Clinical Genetics and Human Genetics, VU University Medical Center, De Boelelaan 1117, PO Box 7057, NL-1007 MB, Amsterdam, The Netherlands; E-mail: lp.tenkate{at}vumc.nl
Received 19 May 2003; Revised 4 August 2003; Accepted 7 January 2004.
Poppelaars FAM, Cornel MC and ten Kate LP. Current practice and future interest of GPs and prospective parents in pre-conception care in The Netherlands. Family Practice 2004; 21: 307–309.
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Abstract |
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Background. Evidence for the effectiveness of pre-conception care is growing. GPs are among the possible providers of pre-conception care.
Objectives. Our first aim was to investigate current pre-conception care activities of GPs and to determine whether prospective parents would visit the GP in the existing health care system. A further aim was to determine the interest of GPs and prospective parents in the introduction of pre-conception care clinics.
Methods. A survey was conducted among 200 GPs and 303 recently married couples (606 individuals).
Results. Of the eligible GPs, 52% (n = 102) participated, as did 70% (n = 381) of the eligible individuals who are planning a pregnancy. In the current situation, only a few individuals visit their GP pre-conceptionally, and many GPs do not discuss family history or consanguinity with prospective parents. In general, the GPs and prospective parents had a positive attitude towards the introduction of pre-conception care clinics.
Conclusion. Since most GPs and prospective parents favoured the introduction of pre-conception care, future research should focus on the most appropriate way of implementation.
Keywords. GP, pre-conception care, prospective parents.
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Introduction |
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Evidence for the effectiveness of pre-conception care is growing. Pre-conception care results in improved folate status, a reduction in smoking and alcohol consumption, a decrease in the prevalence of birth defects, and higher birth weight.1–3 In The Netherlands, 85% of pregnancies are planned, which implies the option of preparation.4 In order to achieve optimal prevention, pre-conception care should be included as a routine component of care for all couples planning a pregnancy. GPs are often mentioned as the most appropriate care providers in this respect, because they can provide pre-conception care as part of ongoing primary care.
The aim of this study was to investigate the current pre-conception care activities of GPs and to determine whether prospective parents would visit their GP pre-conceptionally in the existing health care system. Furthermore, the interest of GPs and prospective parents in the introduction of pre-conception care clinics was determined.
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Methods |
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A questionnaire survey was carried out among GPs and recently married couples. The GPs (n = 200) were randomly selected by the Netherlands Institute of Primary Care Research (NIVEL). Six municipalities were asked to select the addresses of 50 recently married couples, in which the woman was under 36 years of age. One municipality selected 53 couples, resulting in a total of 303 couples. Both partners (n = 606) received a questionnaire. Couples who were not planning a pregnancy were excluded. Follow-up included a reminder after 1 week and 1 month, and a phone call reminder after 2 months. The survey was approved by the Medical Ethics Committee of the VU University Medical Center.
The survey included questions about socio-demographic data, what topics GPs discuss with prospective parents (yes/no questions), whether couples would visit their GP pre-conceptionally in the existing health care system (5-point Likert scale), and the interest of GPs and prospective parents in the introduction of pre-conception care clinics (5-point Likert scale).
To determine which socio-demographic variables were associated with a positive attitude towards the introduction of pre-conception care clinics and a positive intention to visit the GP pre-conceptionally, chi-square analyses were performed for age, gender, religion, level of education, existing children and the presence of hereditary/congenital anomalies in the family. To determine which socio-demographic variables were associated with GPs discussing many versus few topics pre-conceptionally, chi-square analyses were performed for age, gender and religion. Therefore, each of the topics was given a score of 0 if it was not discussed, and a score of 1 if it was discussed. These scores were totalled to form one score, which was then dichotomized by the median. A P-value <0.05 was considered to be statistically significant.
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Results |
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Response
The response rate of the eligible GPs and individuals planning a pregnancy was 52% (102/197) and 70% (381/544), respectively.
The current situation
With regard to the statement: "I will visit my GP before I am pregnant to get information about risk factors and test possibilities before and during pregnancy", 22% of the individuals planning a pregnancy answered that they (fully) agreed, 60% (fully) disagreed and 18% were unsure. No differences in socio-demographic variables were found between individuals with a positive intention and individuals with a negative/neutral intention to visit the GP.
The GPs were asked which topics they usually discussed with patients planning a pregnancy (Table 1). There were no differences in gender, age and religion between GPs discussing many and GPs discussing few topics. Of the GPs discussing many topics, 78% were in favour of the introduction of pre-conception care clinics, compared with 51% of the GPs discussing few topics (P = 0.008).
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Future interest
If a pre-conception care clinic did exist, 60% of the individuals planning a pregnancy stated that they would visit such a clinic, 12% would not and 28% were unsure. Of the individuals with a positive intention to visit future pre-conception care clinics, 34% stated that they would also visit their GP pre-conceptionally in the existing health care system, compared with 4% of the individuals with a negative intention (P = 0.000).
Of the GPs, 63% were in favour of the introduction of pre-conception care clinics, 18% were against and 19% remained neutral. Of the GPs in favour, 52% felt that the pre-conception consultation should be provided by the GP. No differences were found for gender, age or religion between respondents with a positive and respondents with a negative/neutral attitude towards pre-conception care clinics.
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Discussion |
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The majority of respondents favoured the introduction of pre-conception care clinics, while most prospective parents did not intend to visit their GP in the current health care system.
Limitations of this study are the modest response rate of the GPs and the difference between the studied population (recently married prospective parents) and the target population for pre-conception care (all couples planning a pregnancy). Furthermore, in other countries, the proportion of planned pregnancies is lower.
The interest of the target population in pre-conception care was also found to be high (70%) in another Dutch survey,5 but low (10–40%) in a UK survey and in a Hungarian centre where pre-conception care was actually offered.1,6 Caution must be exercised in equating positive intention to actual participation.
Before implementation, it will be necessary to determine who should provide the pre-conception care. In this study, only half of the GPs who favoured the introduction of pre-conception care were convinced that GPs should provide this care, unlike an earlier survey in The Netherlands, in which 93% of the GPs considered pre-conception care part of their job.7 It also seems feasible to train practice nurses to provide pre-conception counselling.6 Other possible providers of pre-conception care are midwives and gynaecologists. Furthermore, promotion of pre-conception health could be managed by school education programmes, mass media campaigns and information websites. Finally, for countries with a high percentage of unplanned pregnancies, pre-conception care could be offered opportunistically to people of reproductive age by physicians in obstetrics and gynaecology, internal medicine and family medicine, for example during annual visits, family planning visits or infertility visits.8
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References |
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1 Czeizel AE. Ten years of experience in periconceptional care. Eur J Obstet Gynecol Reprod Biol 1999; 84: 43–49.[Medline]
2 De Weerd S, Thomas CMG, Cikot RJLM, Steegers-Theunissen RPM, De Boo TM, Steegers EAP. Preconception counseling improves folate status of women planning pregnancy. Obstet Gynecol 2002; 99: 45–50.
3 De Weerd S, Thomas CMG, Cikot RJLM, Steegers EAP. Maternal smoking cessation intervention: targeting women and their partners before pregnancy. Am J Public Health 2001; 91: 1733–1734.
4 De Walle HE, De Jong-Van den Berg LT, Cornel MC. Periconceptional folic acid intake in the northern Netherlands. Lancet 1999; 353: 1187.[Medline]
5 De Jong-Potjer LC, De Bock GH, Zaadstra BM, De Jong ORW, Verloove-Vanhorick SP, Springer MP. Women's interest in GP-initiated pre-conception counselling in The Netherlands. Fam Pract 2003; 20: 142–146.
6 Wallace M, Hurwitz B. Preconception care: who needs it, who wants it, and how should it be provided? Br J Gen Pract 1998; 48: 963–966.[Medline]
7 Cikot RJLM, Gaytant MA, Steegers EAP. Dutch GPs acknowledge the need for preconceptual health care. Br J Gen Pract 1999; 49: 314.[Medline]
8 Freda MC, Chazotte C, Bernstein P, Harrison E, March of Dimes preconception working group. Interdisciplinary development of a preconception health curriculum for four medical specialties. Obstet Gynecol 2002; 99: 301–306.
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