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Semin Reprod Med 2022; 40(03/04): 205-213
DOI: 10.1055/s-0042-1749684
Review Article

Health Economics and Equity in Preconception Health Care: A Systematic Review

Alayna Carrandi
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
,
Claudia Bull
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
,
Emily Callander
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
› Author Affiliations Funding No specific funding was received for this study. EC receives salary support from an NHMRC Fellowship.
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Abstract

Poor pregnancy outcomes affect a child's lifelong health and disadvantaged populations are at higher risk of poor pregnancy outcomes. Preconception care aims to improve pregnancy outcomes by managing conditions and risks prior to conception. Given known inequities in pregnancy outcomes, the adoption of preconception care may benefit disadvantaged populations. Health economics plays an important role in the implementation of interventions, as economic evaluations seek to identify the most efficient and equitable care options. This review aimed to identify the cost-effectiveness of preconception care and how equity has been considered in these evaluations. A systematic review of literature published between 2012–2022 was undertaken to identify studies that evaluate the economic outcomes of preconception care. Studies that met the inclusion criteria were manually searched for consideration of equity in the economic evaluation analysis. Costs were presented and a narrative synthesis of studies reporting on outcomes of equity was conducted. Eight studies met the inclusion criteria, and only two reported on aspects of equity, specifically ethnicity. Considering the significant disparities in pregnancy outcomes among disadvantaged populations, aspects of equity are important to consider when implementing and evaluating preconception interventions. Therefore, it is recommended that future research focuses on the cost-effectiveness of preconception care and that these evaluations incorporate aspects of equity.

Keywords

preconception - health equity - health economics - cost-effectiveness

Supplementary Material



Publication History

Article published online:
01 July 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Sullivan MC, Msall ME, Miller RJ. 17-year outcome of preterm infants with diverse neonatal morbidities: Part 1–Impact on physical, neurological, and psychological health status. J Spec Pediatr Nurs 2012; 17 (03) 226-241
    CrossrefPubMedGoogle Scholar
  • 2 Bentley JP, Roberts CL, Bowen JR, Martin AJ, Morris JM, Nassar N. Planned birth before 39 weeks and child development. Pediatrics 2016; 138 (06) e20162002
    CrossrefPubMedGoogle Scholar
  • 3 Johnson Sr RC, Schoeni RF. Early-life origins of adult disease: national longitudinal population-based study of the United States. Am J Public Health 2011; 101 (12) 2317-2324
    CrossrefPubMedGoogle Scholar
  • 4 Räikkönen K, Pesonen A-K, Roseboom TJ, Eriksson JG. Early determinants of mental health. Best Pract Res Clin Endocrinol Metab 2012; 26 (05) 599-611
    CrossrefPubMedGoogle Scholar
  • 5 Mameli C, Mazzantini S, Zuccotti GV. Nutrition in the first 1000 days: the origin of childhood obesity. Int J Environ Res Public Health 2016; 13 (09) E838
    CrossrefPubMedGoogle Scholar
  • 6 Pylypjuk C, Sellers E, Wicklow B. Perinatal Outcomes in a Longitudinal Birth Cohort of First Nations Mothers With Pregestational Type 2 Diabetes and Their Offspring: The Next Generation Study. Can J Diabetes 2021; 45 (01) 27-32 DOI: 10.1016/j.jcjd.2020.05.001.
    CrossrefPubMedGoogle Scholar
  • 7 Ng S-K, Cameron CM, Hills AP, McClure RJ, Scuffham PA. Socioeconomic disparities in prepregnancy BMI and impact on maternal and neonatal outcomes and postpartum weight retention: the EFHL longitudinal birth cohort study. BMC Pregnancy Childbirth 2014; 14 (01) 314
    CrossrefPubMedGoogle Scholar
  • 8 Australian Institute of Health and Welfare (AIHW), National Perinatal Statistics Unit. Australia's mothers and babies 2013. 2015 :106 p. 9781740248655 1321–8336. 2015. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129554140
    PubMedGoogle Scholar
  • 9 Sheppard AJ, Shapiro GD, Bushnik T. et al. Birth outcomes among First Nations, Inuit and Métis populations. Health Rep 2017; 28 (11) 11-16
    PubMedGoogle Scholar
  • 10 Katterl R. Socioeconomic status and accessibility to health care services in Australia. Primary Health Care Research & Information Service; 2011
    Google Scholar
  • 11 Garcia R, Ali N, Papadopoulos C, Randhawa G. Specific antenatal interventions for Black, Asian and Minority Ethnic (BAME) pregnant women at high risk of poor birth outcomes in the United Kingdom: a scoping review. BMC Pregnancy Childbirth 2015; 15: 226-226 DOI: 10.1186/s12884-015-0657-2.
    CrossrefPubMedGoogle Scholar
  • 12 Grobman WA, Parker CB, Willinger M. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) Network*. Racial Disparities in Adverse Pregnancy Outcomes and Psychosocial Stress. Obstet Gynecol 2018; 131 (02) 328-335 DOI: 10.1097/AOG.0000000000002441.
    CrossrefPubMedGoogle Scholar
  • 13 Jack BW, Bickmore T, Yinusa-Nyahkoon L. et al. Improving the health of young African American women in the preconception period using health information technology: a randomised controlled trial. Lancet Digit Health 2020; 2 (09) e475-e485 DOI: 10.1016/S2589-7500(20)30189-8.
    CrossrefPubMedGoogle Scholar
  • 14 Heslehurst N, Brown H, Pemu A, Coleman H, Rankin J. Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews. BMC Med 2018; 16 (01) 89-89 DOI: 10.1186/s12916-018-1064-0.
    CrossrefPubMedGoogle Scholar
  • 15 Yelland J, Sutherland G, Brown SJ. Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women. BMC Public Health 2010; 10 (771) 771
    CrossrefPubMedGoogle Scholar
  • 16 Lahti-Pulkkinen M, Bhattacharya S, Wild SH. , et al. Consequences of being overweight or obese during pregnancy on diabetes in 2019;62(8):1412–1419. DOI: 10.1007/s00125-019-4891-4
    CrossrefPubMed
  • 17 NSW Centre for Epidemiology and Evidence. NSW Perinatal Data Collection (SAPHaRI). Sydney: Centre for Epidemiology and Evidence, NSW Ministry of Health.; 2019
    Google Scholar
  • 18 Riaz M, Lewis S, Naughton F, Ussher M. Predictors of smoking cessation during pregnancy: a systematic review and meta-analysis. Addiction 2018; 113 (04) 610-622 DOI: 10.1111/add.14135.
    CrossrefPubMedGoogle Scholar
  • 19 Mason E, Chandra-Mouli V, Baltag V, Christiansen C, Lassi ZS, Bhutta ZA. Preconception care: advancing from 'important to do and can be done' to 'is being done and is making a difference'. Reprod Health 2014; 11 (03, Suppl 3): S8
    CrossrefPubMedGoogle Scholar
  • 20 Atrash H, Jack B. Preconception care to improve pregnancy outcomes: clinical practice guidelines. J Hum Growth Dev 2020; 30 (20) DOI: 10.7322/jhgd.v30.11075.
    CrossrefPubMedGoogle Scholar
  • 21 Inskip HM, Crozier SR, Godfrey KM, Borland SE, Cooper C, Robinson SM. Southampton Women's Survey Study Group. Women's compliance with nutrition and lifestyle recommendations before pregnancy: general population cohort study. BMJ 2009; 338: b481
    CrossrefPubMedGoogle Scholar
  • 22 Mazza D, Chapman A. Improving the uptake of preconception care and periconceptional folate supplementation: what do women think?. BMC Public Health 2010; 10 (01) 786
    CrossrefPubMedGoogle Scholar
  • 23 Fekene DB, Woldeyes BS, Erena MM, Demisse GA. Knowledge, uptake of preconception care and associated factors among reproductive age group women in West Shewa zone, Ethiopia, 2018. BMC Womens Health 2020; 20 (01) 30 DOI: 10.1186/s12905-020-00900-2.
    CrossrefPubMedGoogle Scholar
  • 24 O'Donnell JC, Pham SV, Pashos CL, Miller DW, Smith MD. Health technology assessment: lessons learned from around the world–an overview. Value Health 2009; 12 (Suppl. 02) S1-S5
    CrossrefPubMedGoogle Scholar
  • 25 Verguet S, Kim JJ, Jamison DT. Extended cost-effectiveness analysis for health policy assessment: a tutorial. PharmacoEconomics 2016; 34 (09) 913-923
    CrossrefPubMedGoogle Scholar
  • 26 Asaria M, Griffin S, Cookson R. Distributional cost-effectiveness analysis: a tutorial. Med Decis Making 2016; 36 (01) 8-19
    CrossrefPubMedGoogle Scholar
  • 27 University of York. Search strategies. Centre for Reviews and Dissemination. 25 January, 2022. Accessed 25 January, 2022. https://www.crd.york.ac.uk/crdweb/searchstrategies.asp#nhseedcinahl
    PubMedGoogle Scholar
  • 28 Clark JM, Sanders S, Carter M. et al. Improving the translation of search strategies using the Polyglot Search Translator: a randomized controlled trial. J Med Libr Assoc. 2020; 108 (02) 195-207 DOI: 10.5195/jmla.2020.834.
    CrossrefPubMedGoogle Scholar
  • 29 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) n71 DOI: 10.1136/bmj.n71.
    Google Scholar
  • 30 National Institutes of Health. Module 3: Identification and Retrieval of Published Health Economic Evaluation Studies. Health Economics Information Resources: A Self-Study Course. National Institutes of Health; 2016 https://www.nlm.nih.gov/nichsr/edu/healthecon/03_he_intro.html
    PubMedGoogle Scholar
  • 31 Covidence systematic review software. www.covidence.org
    PubMedGoogle Scholar
  • 32 OECD. Exchange rates. Accessed 10 March, 2022. https://data.oecd.org/conversion/exchange-rates.htm
    PubMedGoogle Scholar
  • 33 Jing W, Liu J, Wu Y, Ma Q, Liu M. Cost-effectiveness of couple-based immunization strategy to prevent mother-to-child transmission of hepatitis B virus in China: A decision-analytic Markov model. eClinicalMedicine. 2020;19 DOI: 10.1016/j.eclinm.2020.100264
    CrossrefPubMedGoogle Scholar
  • 34 Olmos P, Borzone G, Poblete A. 47-Fold rise of diabetes in childbearing age Chilean women: Markov model and cost-effectiveness of prevention of birth defects. J Obstet Gynaecol Res 2018; 44 (09) 1719-1730 DOI: 10.1111/jog.13712.
    CrossrefPubMedGoogle Scholar
  • 35 Hughes CS, Brown J, Murombedzi C. et al. Estimated costs for the delivery of safer conception strategies for HIV-discordant couples in Zimbabwe: a cost analysis. BMC Health Serv Res 2020; 20 (01) 940 DOI: 10.1186/s12913-020-05784-4.
    CrossrefPubMedGoogle Scholar
  • 36 Bartáková J, Potluková E, Rogalewicz V. et al. Screening for autoimmune thyroid disorders after spontaneous abortion is cost-saving and it improves the subsequent pregnancy rate. BMC Pregnancy Childbirth 2013; 13 (01) 217 DOI: 10.1186/1471-2393-13-217.
    CrossrefPubMedGoogle Scholar
  • 37 Egan AM, Danyliv A, Carmody L, Kirwan B, Dunne FP. A Prepregnancy Care Program for Women With Diabetes: Effective and Cost Saving. J Clin Endocrinol Metab 2016; 101 (04) 1807-1815 DOI: 10.1210/jc.2015-4046.
    CrossrefPubMedGoogle Scholar
  • 38 Gaskin J, Rennie C, Coyle D. Reducing Periconceptional Methylmercury Exposure: Cost-Utility Analysis for a Proposed Screening Program for Women Planning a Pregnancy in Ontario, Canada. Environ Health Perspect 2015; 123 (12) 1337-1344 DOI: 10.1289/ehp.1409034.
    CrossrefPubMedGoogle Scholar
  • 39 Wise LA, Rothman KJ, Mikkelsen EM. et al. Design and Conduct of an Internet-Based Preconception Cohort Study in North America: Pregnancy Study Online. Paediatr Perinat Epidemiol 2015; 29 (04) 360-371 DOI: 10.1111/ppe.12201.
    CrossrefPubMedGoogle Scholar
  • 40 Beauchamp KA, Johansen Taber KA, Muzzey D. Clinical impact and cost-effectiveness of a 176-condition expanded carrier screen. Genet Med 2019; 21 (09) 1948-1957 DOI: 10.1038/s41436-019-0455-8.
    CrossrefPubMedGoogle Scholar
  • 41 Dorney E, Black KI. Preconception care. Aust J Gen Pract 2018; 47 (07) 424-429
    CrossrefPubMedGoogle Scholar
  • 42 Tydén T. Why is preconception health and care important?. Ups J Med Sci 2016; 121 (04) 207-207 DOI: 10.1080/03009734.2016.1211776.
    CrossrefPubMedGoogle Scholar
  • 43 Montanaro C, Lacey L, Robson L, Estill A, Vukovic S. Preconception Care: A Technology-Based Model for Delivery in the Primary Care Setting Supported by Public Health. Matern Child Health J 2019; 23 (12) 1581-1586 DOI: 10.1007/s10995-019-02806-4.
    CrossrefPubMedGoogle Scholar