title: The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review.
abstract: BACKGROUND
  Reproductive health and pregnancy outcomes may be improved if the reproductive risk assessment is moved from the antenatal to the preconception period. Primary care has been highlighted as an ideal setting to offer preconception assessment, yet the effectiveness in this setting is still unclear.
  
  
  OBJECTIVE
  To evaluate the effectiveness of preconception interventions on improving reproductive health and pregnancy outcomes in primary care.
  
  
  METHODS
  MEDLINE, CINAHL, EMBASE and PsycINFO databases were searched from July 1999 to the end of July 2015. Only interventional studies with a comparator were included, analysed and appraised systematically, taking into consideration the similarities and differences of the participants, the nature of interventions and settings.
  
  
  RESULTS
  Eight randomized controlled trials were eligible. Preconception interventions involved multifactorial or single reproductive health risk assessment, education and counselling and the intensity ranged from brief, involving a single session within a day to intensive, involving more than one session over several weeks. Five studies recruited women planning a pregnancy. Four studies involved multifactorial risks interventions; two were brief and the others were intensive. Four studies involved single risk intervention, addressing folate or alcohol. There was some evidence that both multifactorial and single risk interventions improved maternal knowledge; self-efficacy and health locus of control; and risk behaviour, irrespective of whether brief or intensive. There was no evidence to support reduced adverse pregnancy outcomes. One study reported no undue anxiety. The quality of the studies was moderate to poor.
  
  
  CONCLUSIONS
  The evidence from eligible studies is limited to inform future practice in primary care. Nevertheless, this review has highlighted that women who received preconception education and counselling were more likely to have improved knowledge, self-efficacy and health locus of control and risk behaviour. More studies are needed to evaluate the effects on adverse pregnancy outcomes.
authors.affiliation: a Department of Primary Care Medicine, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia ;
authors.forename: Norita
authors.initials: N
authors.lastname: Hussein
authors.affiliation: b Division of Primary Care, School of Medicine , University of Nottingham , Nottingham , UK.
authors.forename: Joe
authors.initials: J
authors.lastname: Kai
authors.affiliation: b Division of Primary Care, School of Medicine , University of Nottingham , Nottingham , UK.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Qureshi
mesh_terms: D005260:Female; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods; D016742:Preconception Care / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011320:Primary Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D060728:Reproductive Health; D018570:Risk Assessment / Q000379:methods; D020377:Self Efficacy
keywords: Preconception care; general practice; pregnancy outcomes; primary healthcare