Reproductive and Sexual Health Handbook

Optimising the health of patients prior to conception is critical for the health of parents, babies and future generations. General Practitioners (GPs), nurses and midwives play a central role in the delivery of optimal preconception care.

Good preconception care addresses lifestyle risk factors, nutritional status, pre-existing medical co-morbidities and risk factors, vaccination status, medication and any substance use, and an assessment for possible familial genetic issues of the prospective parents (see Table 9.1 Preconception care checklist). The preconception period is a unique opportunity for intervention to optimise pregnancy outcomes.^{(1, 2)}

Since a significant number of pregnancies are unplanned, it is important that clinicians opportunistically offer information on preconception care to all patients of reproductive age. The concept of “One Key Question” is a strategy developed by the Oregon Foundation for Health and endorsed by the American Public Health Association.^{(1, 3)} The approach encourages clinicians to routinely ask patients of reproductive age during consultations the screening question “Would you like to become pregnant in the next year” with the answer either triggering provision of opportunistic preconception care, or provision of adequate contraception. Effective contraception until the time of desired pregnancy is a key strategy in preconception planning. Clinicians can

Pregnant patients have access to several models of antenatal care in Australia, including tertiary public hospital multidisciplinary care, private obstetric care, GP Shared Care, and midwifery-led care.

Antenatal care should be patient-centred and delivered in a culturally sensitive manner. This is particularly important in providing care to Indigenous Australians, who experience increased adverse perinatal outcomes. This includes higher rates of maternal mortality, pre-term birth, low birth weight and perinatal deaths when compared to non-Indigenous Australians.⁽³²⁾

National evidence-based antenatal care guidelines for Australia were published in 2018, and are available here. Part A of antenatal care guidelines details strategies for optimising antenatal care for specific groups including Indigenous Australians, migrant and refugee women, women with serious mental health problems, adolescent women, and women in rural and remote settings.⁽³³⁾

The purpose of the postnatal visit is to ensure that the mother is coping well both physically and emotionally and identify early any perinatal mental health issues, assess any delays in recovery of the genital tract, assess breastfeeding, ensure that any medical issues are managed and that contraceptive needs are addressed.

Important issues in history taking

Delivery details, including gestation at delivery, mode of delivery and any complications; birth “debrief”- ensure the patient has opportunity for questions to be answered about their birth experience and any concerns addressed. General health since delivery. Do they have any concerns about their health, or that of the baby? Review any pregnancy complications such as gestational diabetes, hypertension, cholestasis or pre-eclampsia. Some pregnancy complications have implications for the future health of the mother.

Patients who have had pre-eclampsia have been shown to have a higher rate of coronary artery disease independent of other risk factors than patients who have not had pre-eclampsia, with the degree of future CVD risk comparable to traditional risk factors for coronary artery disease (see Table 9.6). Aggressive risk factor and lifestyle management is imperative for these patients to manage long term cardiovascular risk.⁽⁷⁹⁾

Table 9.6 Comparative risk ratios for the main causes of coronary

Family Planning NSW fact sheet:

Pre Pregnancy Planning

Mackenzie’s Mission

NSW Health Centre for Genetics Education – resources and fact sheets

Dorney E, Black K. Preconception Care. Australian Journal of General Practice. 2018;47(7). Stephenson J, Heslehurst N, Hall J, Schoenaker DA, Hutchinson J, Cade JE, et al. Preconception health 1: Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet. 2018;391:1830-41. Bateson D, Black K. Preconception Care: An important yet underutilised preventative care strategy. MJA. 2018;209(9). Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice. 9th ed. East Melbourne, Victoria: RACGP; 2018. Barker M, Dombrowski SU, Colbourn T, Fall CH, Kriznik NM, Lawrence WT, et al. Intervention strategies to improve nutrition and health behaviours before conception Lancet. 2018;391(1853-64). The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement C-Obs 3(a): Pre-Pregnancy Counselling. [Internet]. RANZCOG; 1992 [updated 2017 July]. Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Pre-pregnancy-Counselling-(C-Obs-3a)-review-July-2017_1.pdf?ext=.pdf. Schummers L, Hutcheon JA, Bodnar LM, Lieberman E, Himes KP. Risk of adverse pregnancy outcomes by pre-pregnancy body mass index: A population‑based study to inform pre-pregnancy weight loss counselling. Obstet Gynecol Clin North Am. 2015;125(1):133-43. Kim S, Nisenblat B. Male fertility. Improving sperm health and chance of pregnancy. Medicine Today. 2019;20(1):55-7. South Australia Maternal & Neonatal Clinical Network. South Australian Perinatal