|Title:||Preconception Care - Issues Paper|
|Authors:||Lum, Margaret N.|
Todd, Angela L.
modifiable risk factors
|Abstract:||The evidence for the link between maternal risk factors (including smoking, obesity, alcohol use and maternal mental health) and perinatal morbidity and mortality rates among Australian women is clear. There is also a growing body of evidence that Indigenous women are significantly more likely than their non-Indigenous counterparts to be impacted by these risk factors. Risk factors originate from genetic, environmental and behavioural factors. In alignment with the Health and Social Policy Branch’s Strategic Plan, Healthy, Safe and Well, the purpose of this paper is to focus on those risk factors that have a behavioural element and can, therefore, be modified, or impacted by strategies to minimise associated harms. Smoking in pregnancy has been highlighted as the most significant preventable cause of morbidity and death among women and infants. The risk of smoking increases among Indigenous and other disadvantaged women. A combination of policy and social marketing interventions involving comprehensive bans on advertising and sponsorship, tobacco price increases, bans on smoking in work and public places, health warnings on packs, mass media, QUIT telephone coaching and monitoring by a physician have been found to be most effective. Trends in nutrition, physical activity and obesity suggest a need for greater awareness and education of women in their reproductive years, prior to conception. Given women who are overweight or obese at conception are at increased risk of excessive gestational weight gain, parenting education and the setting of weight management goals have had some traction in antenatal care, however, the success of such programs relies on regular attendance and health practitioner skill. Although targeted health promotion interventions have increased acceptance of the importance of a healthy diet and exercise, many health practitioners lack skills to manage the problem, and evidence of the efficacy of such interventions in achieving reductions in obesity at the population level is lacking. Aboriginal women are at increased risk of obesity and government support for culturally appropriate programs targeting lifestyle behaviours and supporting health eating and physical activity in local communities have the potential to impact positively. Alcohol consumption among young women and pregnant women in NSW represents a significant risk factor potentially impacting the unborn fetus. Whilst the proportion of women engaged in heavy drinking in pregnancy is low, the adverse outcomes (including FASD) of heavy gestational alcohol consumption and the lack of evidence around safe levels of consumption highlight the issue as a high public health priority. Mandatory labelling of alcohol products and training of health professionals have been proposed as best practice interventions, in combination with addressing issues of pricing and taxation and advocating abstinence from drinking during pregnancy. The estimated prevalence of harmful drinking in Indigenous populations is twice that of non-Indigenous populations and the normalisation of harmful consumption highlights the need to target Indigenous populations, Aboriginal Medical Services (AMS) and Aboriginal clinicians to give health practitioners the skills and resources needed to advocate for reduced alcohol consumption in pre-pregnancy. Key components of effective interventions targeting Aboriginal women and health practitioners in contact with women in preconception and pregnancy are interactive community-based education, culturally appropriate printed resources and ongoing community engagement. Maternal mental health issues are estimated to affect 10-15% of women in high income countries during the perinatal period. Policy frameworks in NSW reflect recognition of the need for greater awareness of maternal mental health and the requirement to integrate programs that provide support for women’s well-being in the antenatal and postnatal phase into policy, planning and delivery of health services. An evidence-based health home visiting program called Sustaining NSW Families, developed for the identification and treatment of women at risk of antenatal and postnatal depression, has been found to be effective as an early intervention tool. Factors impacting the health and well-being of Aboriginal people include spirituality, the relationship with family, land and culture and these factors are all intertwined. Programs targeting these women need to be culturally appropriate, driven by the community and run by a workforce who understands the psycho-social risks resulting from intergenerational trauma.|
|Type of Work:||Article|
|Type of Publication:||Pre-print|
|Appears in Collections:||Healthy Start to Life|
|Lum_MN_2017_PreconceptionIssues_Unpublished.pdf||811.11 kB||Adobe PDF|
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