A Systematic Review of Clinical Guidelines for Preconception Care

Edwina Dorney; Jacqueline A. Boyle; Ruth Walker; Karin Hammarberg; Loretta Musgrave; Danielle Schoenaker; Brian Jack; Kirsten I. Black

doi:10.1055/s-0042-1748190

Seminars in Reproductive Medicine, Table of Contents

Semin Reprod Med 2022; 40(03/04): 157-169
DOI: 10.1055/s-0042-1748190

Review Article

A Systematic Review of Clinical Guidelines for Preconception Care

Authors

Edwina Dorney

¹Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
Jacqueline A. Boyle

²Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
Ruth Walker

²Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
Karin Hammarberg

³Global and Women's Health, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia
Loretta Musgrave

⁴School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia
Danielle Schoenaker

⁵School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom

⁶NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Brian Jack

⁶NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Kirsten I. Black

¹Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia

Abstract

Preconception care (PCC) involves a wide-ranging set of interventions to optimize health prior to pregnancy. These interventions seek to enhance conception rates, pregnancy outcomes, childhood health, and the health of future generations. To assist health care providers to exercise high-quality clinical care in this domain, clinical practice guidelines from a range of settings have been published. This systematic review sought to identify existing freely accessible international guidelines, assess these in terms of their quality using the AGREE II tool, and assess the summary recommendations and the evidence level on which they are based. We identified 11 guidelines that focused on PCC. Ten of these were classified as moderate quality (scores ranging from 3.5 to 4.5 out of 7) and only one was classified as very high quality, scoring 6.5. The levels of evidence for recommendations ranged from the lowest possible level of evidence (III) to the highest (I-a): the highest quality evidence available is for folic acid supplementation to reduce risk of neural tube defects and the role of antiviral medication to prevent HIV transmission. This systematic review identified that high-quality guidelines on PCC are lacking and that few domains of PCC recommendations are supported by high-quality evidence.

Keywords

preconception - pre-pregnancy - clinical practice guideline - policy - systematic review

Full Text

References

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