A Preconception Care Strategy

INTRODUCTION: Time to act
Eric A. P. Steegers, gynaecologist, professor and chair Obstetrics & Gynaecology, Erasmus MC, Rotterdam,The Netherlands Parental preconception health and the first 1,000 days of a child’s antenatal and postnatal life are main determinants of one’s later health, wellbeing and
social opportunities.

Fifteen years ago in the Dutch city of Rotterdam, poverty, deprivation and related toxic stress were identified, next to medical risks, as drivers of early life initiation of health inequities. Perinatal health heatmaps on a
neighbourhood level in Dutch cities were then shared with local counsellors and subsequent national ministers of Health. This created a sense of urgency and resulted in the taking up of responsibility by local and national
governments recognizing the public health importance of preconception and antenatal care and the opportunity to prevent further impact of the ‘poverty trap’ on future generations.
During the next twenty years local programs in Rotterdam such as ‘Ready for a baby’ and the ‘Healthy Pregnancy for All’ program in seventeen other cities were initiated. The shared ambition was to combine efforts from the medical
and social health domains. This was labelled as ‘social obstetrics’. Programs included pre- and interconception care and multidisciplinary risk assessment
at pregnancy booking not only focused on medical risks but also at those related to lifestyle and nutrition, mental health and the social environment.
Care pathways were developed tailored to the individual and neighbourhood. After the local counsellor of Rotterdam became national minister of Health in
2017, the Netherlands Ministry of Health, Welfare, and Sport launched a nationwide action program entitled ‘Solid Start’. Building on the principles and know-how acquired through the previously mentioned programs, ‘Solid Start’ currently supports 285 out of the 340 Dutch municipalities in addressing health inequities before, during, and after pregnancy.
Next to ‘social obstetrics’, preconception health is a key component of this Solid Start program. Small multi-agency conferences with professional organizations are being set up to tackle perceived barriers to implementing
preconception health and care. They all gave their dedicated support to a pledge of the Ministry of Health on the importance of preconception health entitled ‘little effort, great impact’. Key is the One Key Question® approach
(Stranger Hunter, 2017) at every available opportunity to improve both preconception care and contraceptive counselling by asking the question, ‘Do you plan to become pregnant in the next year?
Lessons learned during this period of transitions were, among others, the need; a. to create a sense of urgency to improve preconception health as prevailing antenatal care systems do not optimise early development, b. that universities take up their responsibility for the ‘societal valorization of new knowledge’ for the benefit of the welfare, health and opportunities of the general population, c. to acknowledge the massive existing evidence of associations between preconception risks and adverse pregnancy outcomes and the (cost-) effectiveness of many related interventions available, d. to also tackle preconception non-medical risks in a context based manner, often related to poverty and e. that, in order to do so, new local and national governmental public health policies must be developed.

Genuine partnership and communication are essential, both within and between countries. It is time to act.