The impact of pre-conception health on maternal and child health outcomes is increasingly recognised. The challenge is therefore to address modifiable medical, psychosocial and environmental risks before conception.
Pre-existing medical conditions
Despite potential additional risks, women with long-term health conditions are no more likely to plan the timing of their pregnancy. However, contact with healthcare workers and therefore opportunities for counselling are increased.
For the woman with pre-existing medical conditions additional factors need to be addressed including:
- Optimisation of pre-existing health condition
- Potential impact of pregnancy on health conditions
- Potential impact of health conditions on pregnancy
- Potential impact of pregnancy on current medication
- Potential impact of medication on pregnancy
- Review of medication +- revision before conception
- Risk reduction of pregnancy complications including e.g. Aspirin and thromboprophylaxis
- Monitoring plans
Who should offer pre-conception advice?
For women with conditions that carry low inherent risks pre-conception, advice may be delivered in the community by pharmacists, practice nurses, ACPs and GPs.
For more complex and higher risk conditions this discussion should be supplemented by review in secondary or tertiary care.
Pre-conception care should be personalised. For some women this is best offered through a multidisciplinary approach, e.g. joint diabetologist/cardiologist/nephrologist/haematologist, and/or obstetric physician and obstetric appointment. Some of these more specialist appointments may only be available in tertiary centres.
Who should be referred?
National guidance as to which conditions should trigger referral to secondary care is currently limited; but it is reasonable to expect women who are under hospital follow-up for their long-term condition to also be seen by secondary care teams for pre-pregnancy counselling. This is already routinely included in many specialist clinic consultations.
- Women with mental health, obstetric, or fetal concerns should be referred as per local guidance. This lies outside the remit of the Maternal Medicine Network.
- For women with diabetes the national guidance is supported by local referral pathways
- Woman with low risk conditions should continue to be seen in the community by practitioners with appropriate experience and expertise
- More complex women and those with higher risk conditions should be referred to secondary or tertiary care. This includes as a minimum all women with conditions that fall into risk categories B or C
How can women be referred
for pre-conception care?
- Please use existing local pathways for diabetes and haematology referrals
- Joint cardiology – obstetric clinics are available in Leicester, Nottingham, Derby, Lincoln and Northampton
- Joint renal – obstetric clinics are available in Leicester, Nottingham and Derby
- If the referrer is not aware of appropriate local pre-conception pathways, the Network is happy to facilitate these referrals
