PEARLS No. 231, February 2010, written by Brian R McAvoy

Clinical question

How effective is routine pre-pregnancy health promotion for improving pregnancy outcomes for mothers and babies?

Bottom line

There was some evidence that compared with no pregnancy care or usual care, health promotion interventions (encompassing education, advice and general health assessment) encouraged women to have more healthy lifestyles, such as lower rates of binge drinking. Overall, there was little evidence from one trial on the effects of pre-pregnancy health promotion on the health of mothers and babies (preterm birth, congenital anomalies or weight for gestational age). The babies of women who had received the health promotion intervention had slightly lower birthweights. This finding needs to be interpreted with caution, as pregnancy outcome data were available for only half of the women randomised. More evidence is needed before widespread implementation of pre-pregnancy health promotion can be recommended.  

Caveat

For most outcomes, data were only available from individual studies. In only one study were women followed up through pregnancy. This review included only trials aimed at the general population of women of childbearing age, in developed countries, and excluded trials targeting specific high-risk women.

Context

Smoking, drinking excess alcohol, poor nutrition and other lifestyle factors can lead to poor outcomes for mothers and babies. The provision of routine health promotion (including advice and education and sometimes screening tests) before conception may encourage changes to improve health, and may be an opportunity to identify risk factors, such as infection that can be treated before pregnancy begins.

Cochrane Systematic Review

Whitworth M and Dowswell T. Routine pre-pregnancy health promotion for improving pregnancy outcomes. Cochrane Reviews 2009, Issue 4. Article No. CD007536. DOI: 10.1002/14651858. CD007536.pub2. This review contains 4 studies involving 2300 participants.