title: Preconception health care and congenital disorders: mathematical modelling of the impact of a preconception care programme on congenital disorders.
abstract: OBJECTIVE
  This study aims to model the impact of preconception care on births with congenital disorders at a national level.
  
  
  METHODS
  Mathematical cross-sectional model based on life-table methodology.
  
  
  METHODS
  Research conducted in Cambridge, United Kingdom.
  
  
  METHODS
  Women aged 15-45 years in England, 2001.
  
  
  METHODS
  A mathematical model was constructed based on cross-sectional data from women aged 15-45 years in England undertaking one of three interventions, so as to reflect different strategies of preconception care: folic acid supplementation and fortification (representing national, universal interventions); alcohol intervention (reflecting primary care strategies); and diabetes management (targeting a population of high-risk women with a known chronic disease).
  
  
  METHODS
  Reduction in the prevalence of congenital disorders at birth.
  
  
  RESULTS
  Between 585 (lower estimate) and 1085 (upper estimate) congenital disorders could be prevented with a national preconception programme, based on a single-year national cohort in England. This represents an 8-15% reduction in annual notifications of congenital disorders in live births annually. According to modelled estimates, folic acid fortification or supplementation, alcohol intervention, and diabetic management may result in a 46, 32-62, 53, and 54% reduction in the live birth prevalence of specific congenital disorders, respectively. In an ideal scenario, the application of this model decreases the total annual number of congenital disorder notifications by approximately one-sixth.
  
  
  CONCLUSIONS
  A preconception care programme comprising three different strategies potentially can reduce the number of infants born with congenital disorders at a national level. This model provides strong support for preconception care to become a healthcare priority, and has major implications for healthcare planning.
authors: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK. geord_1@hotmail.com
authors: G D
authors: GD
authors: Shannon
authors: C
authors: C
authors: Alberg
authors: L
authors: L
authors: Nacul
authors: N
authors: N
authors: Pashayan
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects*; D000013:Congenital Abnormalities / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D009313:National Health Programs; D016742:Preconception Care / Q000379:methods*; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D006113:United Kingdom; D055815:Young Adult
chemical_list: D005492:Folic Acid