1. Pre- and periconception care Exploration of the relevance of EFPC involvement in the disclosure and exchange of expertise regarding pre- and preconception care in respect of the implementation and delivery of this care in primary care settings in European countries Denhard de Smit, PhD, Health Care researcher/Epidemiologist Managing director Research and Projects, MediClara Projects BV, Abcoude NL

2. Today’s programme Starting up a.Who is who? b.Expertise and vision of participants Pre- and periconception care: an overview a.The health issues of interest b.Involvement of PC, PH and specialist care c.Policy development: examples and events

3. I- Starting up

4. a. Who is who? As a person As a professional Main reason to attend this workshop? Starting up

5. b. Expertise and vision from you and your country General status of policy making Political and societal focus points Scope of implementation Awareness and feelings of urgency Starting up

6. II- Pre- and periconception care: an overview

7. The health issues of interest “Preconception care is defined in this advisory report as the entire raft of measures to promote the health of the mother-to-be and her child. If they are to be effective, these measures should preferably be undertaken prior to conception. Preconception care is therefore multidisciplinary, encompassing lifestyle (including food, drink, tobacco and other recreational drugs), working conditions, illness, medication and genetic factors.” Health Council of the Netherlands. Preconception care: a good beginning. The Hague: Health Council of the Netherlands, 2007; publication no. 2007/19. An overwiew

8. The health issues … (2) From the Dutch health council report Food, drink, tobacco and other recreational drugs Folic Acid prevention (general population 0,4 mg; increased risk 4,0 mg) Vitamin D suppletion (if needed) Vitamin A (prevent too high intake) Alcohol (fertility, FAS) Tobacco (fertility, birth weight) Working conditions Chemical agents (pesticides, solvents, …) Stress An overwiew

9. The health issues … (3) Illness and medication Infectious diseases (Vaccination, treatment and prevention) Chronic diseases ilke diabetes, epilepsy (optimization of medication) Teratogenic drugs (pregnancy prevention) Obesity, anorexia and maternal/paternal age Genetic factors Extend range of options in the case of unfavourable genetic background –Known increased risks (genetic diagnosis/counselling done previously) –Indications from family history –Carrier screening (cystic fibrosis, hemoglobinopathies) An overwiew

10. The health issues … (4) Additional issues that can/should be dealt with in the preconception period Personal preparation for pregnancy? Prenatal screening options (triple test, 20-wk ultrasound) Medical preparation for pregnancy Obstetric history Increased risks from pre-existing disease Timely uptake of prenatal care An overwiew

11. The involvement of primary care, public health and specialist care “ Preconception care has various, complementary forms. Some are aimed at individual parents-to-be, while others may, for example, collectively target all women of child- bearing age”. and “ … the various components of the programme … should not be provided as separate elements but as an integrated healthcare concept.” An overwiew

12. The involvement of … (2) Care sectors Folic acid  ph Genetic risk assessment  pc, sc “Lifestyle”  ph, pc, sc Preconception consultation  pc, sc Promotion of preconception consultation  ph, pc An overwiew

13. The involvement of … (3) Primary care workers GP’s: (promotion of) preconception consutlation and follow-up as appropriate Midwives, nurses: preconception consultation and follow-up as appropriate Pharmacists: FA-education, medication surveillance, promotion of preconception consultation An overwiew

14. Policy development: examples and events Existing implementation in Hungary Programme development 1984-1994 Current implementation by specialized nurses Policy development in The Netherlands Ministry of Health reply to Health Council report Coordination of resources for public information (RIVM) Preconception consultation fee in basic insurance? Major role for midwives in preconception consultation? Very pro-active involvement of patient organisations (VSOP, Erfocentrum) Policy development in Walloon provinces in Belgium Coordinated by Office de la Naissance et de l’Enfance (ONE) Current status? An overwiew

15. Policy development: … (2) Recent events First CEE Summit on Preconception Health and Prevention of Birth defects (Budapest, August 2008) National conference on preconception care (Utrecht, September 2009) Extended neonatal screening in NL since 1-1-2007  Preconception care? EU policy Rare diseases COM (2008) 679 …?? An overwiew

16. The End Thank you for your participation! djedesmit@mediclara.nl www.mediclara.nl Recommendations and closing