How GPs can play a vital role in improving preconception care
Withanage
It’s really important to be as healthy as possible before getting pregnant to improve the health of both the mother and the baby.
Unfortunately, many people don’t realise the significance of taking care of their health before pregnancy, and by the time they start thinking about it, they’re already pregnant.
Certain factors, such as smoking, drinking too much alcohol, and being overweight or obese, can be addressed before pregnancy.
Doing so can reduce the chances of having complications during pregnancy, such as stillbirth, low birth weight, and preterm delivery. This helps make sure both the mother and the baby stay healthy.
Preconception care (PCC) involves educating people about these risk factors, and what they can do before getting pregnant to reduce these risk factors.
This includes advising them to take folate before trying to conceive, making sure any medications they take are safe for pregnancy, and addressing issues such as smoking, alcohol consumption, and weight.
GPs are well-positioned to help
Approximately 85% of the people in Australia visit their general practitioner each year; hence, GPs are in a great position to provide preconception care.
Electronic medical records (EMRs) in general practices are like a detailed file of a person’s health history, including factors such as past illnesses, vaccinations, prescriptions, and lifestyle habits such as smoking and drinking.
There’s evidence that general practice holds the most complete resource of patient information for the Australian population. This information can potentially assist GPs in identifying patients who may be at risk of adverse pregnancy outcomes based on their risk factors.
Read more: Family planning: The importance of preconception health
Our recent SPHERE research (co-authored by Professor Danielle Mazza and Dr Jessica Botfield from Monash University, and Professor Kirsten Black from the University of Sydney) shows that many reproductive-aged women (18 to 44) visiting general practice have a significant burden of risk factors based on their electronic medical records.
Consistent with the prevalence of medical and lifestyle risk factors recorded in national datasets, our study reveals that “among the women audited, 14% were smokers, 24% were obese, 7% had high blood pressure, 5% had diabetes, 28% had a mental health condition, 13% had asthma, 6% had thyroid disease, and 17% had been prescribed and could be using a potentially teratogenic medication”.
This shows there’s a great opportunity to use the information in these records to initiate preconception care.
Some preconception risk factors not well-documented
The study also showed that GPs commonly record information about risk factors in patients’ records, such as smoking (79%), blood pressure (74%), alcohol consumption (63%), and body mass index (57%). However, other important factors such as blood glucose levels, and obstetric and family history were not documented as often.
Improving the recording of all these factors in the electronic medical records can help GPs identify and provide preconception care to women who may most benefit from it.
It’s important to work on making these records more accurate and complete so everyone can get the best care possible.
This article was co-authored with Professor Kirsten Black, from the University of Sydney.
About the Authors
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Nishadi withanage
PhD Candidate, SPHERE; Department of General Practice, Faculty of Medicine, Nursing and Health Sciences
Nishadi joined SPHERE as a PhD student. She completed her undergraduate studies and honours in biomedical science at Monash in 2019. As a summer scholar, she assisted with a project involving medical termination of pregnancy in culturally and linguistically diverse populations. Within SPHERE, she’ll will be working on a research project with a focus on primary care-based preconception interventions that reduce the risk of adverse pregnancy outcomes.
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Jessica botfield
Research Fellow, SPHERE; Department of General Practice, Faculty of Medicine, Nursing and Health Sciences
Jessica is a clinician-researcher with research and clinical expertise in sexual and reproductive health. She’s a research fellow with the SPHERE NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care at Monash University, and a senior research officer at Family Planning NSW. She’s a qualitative and mixed method researcher, and has experience working in academic, non-government and clinical settings. Her research interests focus on promoting equitable access to contraception, pregnancy options and abortion care; task-sharing, and nurse and midwifery-led models of care; and health services research and evaluation.
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Danielle mazza
Professor, General Practice, Monash University
Danielle major interest is in translational research, with particular focus on closing evidence practice gaps in women's sexual and reproductive health, preventive care, and primary care aspects of cancer. Her methodological expertise lies in primary care research, the development and trial of complex interventions in the general practice setting, using routinely collected primary care data to inform policy and practice and in guideline development and implementation. She is particularly committed to improving the quality of sexual and reproductive health care for women in general practice.
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