Journal of Womens Health, Issues and Care ISSN: 2325-9795

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Research Article, J Womens Health Issues Care Vol: 3 Issue: 1

Preconception Care: Prevalence of Chronic Disease

Min-Young Lee1, Hyun-Mee Ryu1, Moon-Young Kim1, Hyun-Kyeong Ahn1,2, June-Seek Choi1,2, Min-Hyoung Kim1, Jin-Hoon Chung1, Si-Won Lee1, You-Jung Han1, Dong-Wook Kwak1 and Jung-Yeol Han1,2*
1Korean Motherisk Program, Cheil Hospital and Women’s Health-care Center, Kwandong University College of Medicine, Seoul, Korea
2Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cheil General Hospital & Women’s Healthcare Center, College of Medicine, Kwandong University, Seoul, Korea
Corresponding author : Jung Yeol Han
The Korean Motherisk Program, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cheil General Hospital & Women’s Healthcare Center, 1-19 Mookjung-dong, Jung-gu, Seoul 100-380, Republic of Korea
E-mail: [email protected]
Received: September 30, 2013 Accepted: January 10, 2013 Published: January 14, 2014
Citation: Lee MY, Ryu HM, Kim MY, Ahn HK (2014) Preconception Care: Prevalence of Chronic Disease. J Womens Health, Issues Care 3:1. doi:10.4172/2325-9795.1000135

Abstract

Preconception Care: Prevalence of Chronic Disease

All women of childbearing age hope that their children will be born healthy when they become pregnant. To have a healthy baby and be a healthy mother are universally valued goals. If women want to give birth to a healthy baby, the health of the mother should be the initial priority; this idea forms the basis of preconception care.

Keywords: Preconception; Chronic; Women; Pregnancy

Keywords

Preconception; Chronic; Women; Pregnancy

Introduction

All women of childbearing age hope that their children will be born healthy when they become pregnant. To have a healthy baby and be a healthy mother are universally valued goals. If women want to give birth to a healthy baby, the health of the mother should be the initial priority; this idea forms the basis of preconception care.
Preconception care is aimed at identifying and modifying biomedical, behavioral, and social risks through preventive management and interventions [1]. In addition, preconception care includes the detection and optimal control of specific medical conditions to improve pregnancy-related outcomes for the woman and her offspring [2].
It has been reported that during the past 30 years, there has been an increasing trend among women in the industrialized world to delay childbearing [3]. At the same time, the proportion of women delivering infants at the age of 35 years of older has also increased [4]. The reasons motherhood is postponed are manifold and complex. Common reasons include: the availability of safe, effective contraception; to pursue further education; to build a career, to achieve financial independence, and to be in a stable relationship with a supportive partner [5].
With the rapid progression of economic development, the average level of education of women has become similar to that of men. The number of women in social life has also increased. As a result, the age of women at the time of their first marriage and first pregnancy has increased. The increased rate of pregnancy in women over 35 years old has led to an increase in the proportion of women with chronic diseases upon conception [6].
Women with chronic diseases often lack accurate knowledge about their own disease. Little is known about whether women with chronic disease understand their pregnancy-related risks, how there conditions influence intent for pregnancy, and how chronic diseases influence pregnancy avoidance and/or pregnancy planning behaviors [7].
They may not have received proper counseling by medical providers. Therefore, these women often delay or avoid pregnancy because of their disease, which may result in adverse effects to the baby when they become pregnant.
In order to help women to decide whether to get pregnant or not, medical providers should provide these women with more information about the risk of pregnancy complications, maternal morbidity, maternal mortality, disease prognosis during pregnancy, conflicts between maternal and fetal well-being, the extent of fetal risk due to their conditions or medications used to treat the conditions, optimal timing of pregnancy, and the woman’s ability to conceive at present and in the future [2].
It is certainly true that women with chronic medical conditions have a higher risk of pregnancy-related complications. Therefore, they need to maintain strict control of their own disease before pregnancy as well as preconception care.
There are several medical conditions for which there is a link to adverse pregnancy outcomes and evidence that preconception care can affect the condition [2]. However, there is not yet accurate data on how preconception care affects chronic diseases in women. The purpose of our study was to evaluate the prevalence of chronic disease in women receiving preconception care at our center. Our healthcare setting for preconception care is based on Korean Mother Risk Program, a teratology information service, at a representative OB & Gyn hospital that has approximately 7,000 baby births, 1.5% of total Korean baby births, a year in Seoul, Korea.

Materials and Methods

This retrospective study included a cohort of 914 women who visited the Cheil Hospital & Women’s Health Care Center to receive preconception care a self-referral. We excluded 24 women who did not complete the questionnaire properly.
The questionnaires were completed by the study participants. Questionnaire items included demographic characteristics, obstetrical history, medical history, lifestyle, and reasons for seeking out preconception care.
We defined chronic disease as a condition that persists for a long time, has generally slow progression, and cannot be prevented by vaccines or cured by medication according to CDC guidelines [8].
The list of chronic disease includes long-term “life-threatening” conditions such as cancer and diabetes, “chronic manageable” conditions such as asthma or arthritis, and mental health conditions such as mood disorders [8]. It was messured from medical exam and self-report form that was provided from our preconception care center.
We assessed the prevalence of chronic disease, the type of chronic disease, and medication use for chronic disease in women receiving preconception care.

Results

The study subjects consisted of 890 women aged 19-45. Table 1 describes the characteristics of the subjects. The proportion of advanced aged women (≥ 35) was lower than that of younger women (<35). With regard to obstetric history, 45.3% were nulligravida and 81.7% were nulliparous. The prevalence of drinking and smoking was 58.3% and 4.8%, respectively. The majority of women had jobs (67.1%). Table 2 displays the reasons for visits to our preconception care clinic. The most common reason was desire to have a healthy baby (n=338, 37.9%), followed by care for medical problems including medication and acute or chronic disease (22.5%, n=200). The third most common reason was previous missed abortion history (16.6%, n=148).
Table 1: The demographic characteristics of study subjects (n=890).
Table 2: Reasons for preconception clinic visit (n=890).
Among women who visited our preconception care clinic, 133 women had chronic diseases (14.9%). It was compared by age category (≥ 35 or not), the prevalence of chronic disease in advanced maternal age group is 20.7% (42 cases of total 203 cases) and the other group is 13.2% (91 cases of total 687 cases). The most common chronic disease was thyroid disease (n=52, 39.1%), followed by hypertension (n=16, 15.8%), kidney disease such as chronic pyelonephritis, chronic glomerulonephritis, nephritic syndrome (n=15, 11.3%) and asthma (n=14, 10.5%). Women with cancer, such as thyroid and breast cancer were noted. All women with cancer had undergone surgery. There were cases of rare disease such as systemic lupus erythematosis (SLE, n=2, 1.5%) and Behcet’s disease (n=1, 0.75%) (Table 3).
Table 3: Chronic diseases in study subjects (n=133).
Among those with chronic disease, 62 women (46.6%) had received medication for their disease. Table 4 presents the rate of medication use by type of chronic disease. The most common type of chronic medication was for thyroid disease (n=30). The rate of medication usage in women with thyroid disease was only 57.7%. However, rate of medication use was 100% in women with mood disorders, rheumatoid arthritis, Bechet’s disease, SLE, epilepsy and cancer.
Table 4: The percent of medication use by chronic disease (n=62).

Discussion

As South Korean society is quickly transforming into an aging society, the low birth rate has emerged as a major social issue. In the same vein, the average age of mothers at first birth has been rapidly increasing as well. According to the Korean Statistical Information Service, the average age of women at first pregnancy was 34.4 years in 2011, which is about 7 years older than in 1993 (27.5 years) [9]. In addition, the birth rate among women of advanced age is also currently increasing in relation to the birth rate among all women [10]. This phenomenon is inevitable as result of the increase in women’s higher education and social engagement.
Advanced age at pregnancy has a negative effect on the outcome of pregnancy itself, including prenatal complications and neonatal complications such as preterm birth, low birth weight and perinatal mortality [11,12]. Moreover, women of advanced age women who are preparing for a pregnancy are more likely to have chronic illness than younger expectant mothers. Chronic illness leads to further deterioration of pregnancy outcomes and resultant avoidance or delay of pregnancy which, in turn, further increases the falling birth rate. Thus, the vicious cycle is self-perpetuating. To address this problem, it is very important to appropriately manage child-bearing women with chronic disease.
To improve pregnancy outcomes, prenatal care has been emphasized. Prenatal care that begins in the first trimester is associated with positive outcomes [13], whereas prenatal care when pregnancy is confirmed is often too late to prevent several complications. Accordingly, the importance of preconception care has recently been emphasized. Preconception care is important in the detection and control of medical conditions before conception, rather than during the prenatal period, in order to improve pregnancyrelated prognoses.
The findings of our study shows that 14.9% (n=133) of the women who visited our preconception care clinic had chronic disease, 46.6% of whom were taking medications for their chronic disease. This means that more than one in ten mothers have a chronic disease and that roughly half among of the women taking medications are likely to have an adverse fetal outcome. In other words, this is a very serious potential problem for individuals and for public health. The need for preconception care to control and manage women with chronic illness is evident.
In our study, chronic diseases included asthma, hypertension, mood disorders and autoimmune diseases. Some medications used to treat these conditions have potential adverse effects on the fetus. Preconception care is an opportunity for women with chronic disease to avoid delaying pregnancy, address fears and anxiety about how their disease will affect their baby, and facilitate the best outcomes for mothers and infants.
There are several limitations to our study. First, we may not have identified all chronic disease in our study because the diagnosis of chronic disease was based on the subjects’ medical history and limited laboratory tests conducted in prenatal care. Therefore, it is possible that the prevalence of women with chronic disease was underestimated. Second, in this study we did not investigate the pregnancy outcomes of women receiving preconception care. Therefore, the study was unable to compare pregnancy outcomes between those receiving and not receiving preconception care. If this analysis were done, it would elucidate the importance of perception care in high-risk women. Further studies are needed to examine the association between preconception care and pregnancy outcomes in women with chronic disease. Third, we did not survey the socioeconomic status and education status of the women, so we did not investigate several factors associated with preconception care.
Despite these limitations, our findings on the importance of preconception care for women with chronic disease should be very useful to medical providers. Medical providers should be aware that chronic disease is not taboo in pregnancy and that proper control of chronic disease can lead to good pregnancy outcomes.
The use of preconception care is becoming more common, and has been shown to be beneficial to high-risk women with chronic disease through counseling women, minimizing risk factors, and facilitating the early detection and treatment of diagnosed disease.
In the past, many studies have emphasized the importance of women’s health before childbearing, including the persistent intergenerational effect of low birth weight, lending greater importance to a life-course model of health for women versus a narrow focus on prenatal health [14-16].
Despite the growing prevalence of advanced maternal age and the concurrent increase in women with chronic disease, prevention opportunities exist to improve women’s health and the health of future generations. An important preventive measure is preconception care. Focusing on the health of women with chronic disease throughout their lives and not only during pregnancy allows us to achieve the goals of maternal and baby health. Ultimately, it will improve the overall well-being of the woman, her family, and public health outcomes.

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