'Parents to be' .The effectiveness of systematic population-based preconception advice and counselling initiated by GPs
09 / 1999 - 12 / 2003
What is the effect of GP-initiated preconception advice and counselling offered to fertile women by their own general practitioner on couples' knowledge, attitudes and decisions on further (genetic) diagnosis and (the moment of) adjustments of lifestyle in order to avoid an adverse pregnancy outcome. At least 20% of the pregnancies in the Netherlands have an adverse outcome (abortion, preterm birth, low birth weight, mortality, congenital disorders). Timely information on risk factors together with preventive measures has the potential to reduce adverse pregnancy outcomes. In the Netherlands 90% of the pregnancies are planned and every person in the Netherlands is registered with a GP. This creates the opportunity to inform couples of preventive measures on (personal) risk factors before pregnancy. As no other GP-initiated PAC has taken place in the Netherlands or in any other country, we had to develop a method to enable GPs to deliver PAC (stage 1). To evaluate the effects of GP-initiated PAC in a methodologically correct manner it is necessary to offer PAC in a larger number of general practices. 1) What is the effect of the GP's actively delivering PAC on couples' knowledge, attitudes and decisions, on further (genetic) diagnosis and (the moment of) adjustments of lifestyle in order to avoid an adverse pregnancy outcome? 2) Does the increased knowledge affect women's pregnancy perception and increase or diminish the fear for an adverse pregnancy outcome? 3) How many risk factors are found in this healthy population and in which cases is extra counselling or referral to a specialist needed? 4) Are couples satisfied with the advice and counselling they have received? To anticipate on future implementation in general practice, GPs and their assistants will be interviewed to determine their opinion on PAC in terms of: - Satisfaction with PAC (the method and the background information) - Time investment of the GP and the GP's assistant - Feasibility of PAC and the necessary preconditions (e.g. financial reimbursement) to enable GPs to continue offering PAC in the future without backup from the project-team.