Gebelik öncesi (prekonsepsiyonel) bakım: Halk sağlığı perspektifi

Gebelik öncesi (prekonsepsiyonel) bakım anne ve fetus için risk oluşturan fiziksel, tıbbi ve psikososyal durumları gebelikten önce saptayarak uygun şekilde çözmek veya yönlendirmek esasına dayanan bir koruyucu hizmettir. Gebelik öncesi bakım terimi, tarama ve tedavinin yanı sıra danışmanlık kavramını da içermekte ve özünde, eşlerin sağlığını ve dolayısıyla çocuk sağlığı düzeyini geliştirmeyi hedeflemektedir. Gebelik öncesi bakım tüm dünyada, sağlık personelinin tümünün görevi kabul edilmektedir. Türkiyede doğum öncesi (prenatal/antenatal) bakım alanında önemli gelişmeler olmuştur ancak, standart bir gebelik öncesi bakım kılavuzu henüz uygulamaya konulmamıştır. Bu yazının amacı, gebelik öncesi bakım kavramını açıklamak ve önemini dile getirmek; tüm sağlık çalışanlarının gözden kaçırmaması gereken, kanıta dayalı bicimde saptanmış evrensel gebelik öncesi bakım önerilerini özetlemek ve ülkemizde pratik uygulamalarda kullanılabilecek bir risk belirleme listesi sunmaktır. Bu yazıda dünyada gebelik öncesi bakım deneyimlerinden yola çıkarak, ulusal veriler ışığında Türkiye için gebelik öncesi tarama/destek/tedavi kapsamında nelerin onceliklenmesi gerektiği tartışılmıştır. Ayrıca, gebelik öncesi bakım kapsamında yapılması gereken muayeneler ile testler konusunda önermede bulunulmuştur. Yazının sonunda sunulan kontrol listesi (Gebelik öncesi Bakım Öykü/Fizik Muayene/Tetkik Formu) sağlık çalışanları için riskleri belirleyici ve gebelik öncesi danışmanlıkta yönlendirici pratik bir araçtır. Bu nedenle, bu derleme kapsamında oluşturulan Gebelik öncesi Bakım Öykü/ Fizik Muayene/ Tetkik Formu ulusal gebelik öncesi bakım programımızda kullanılabilir. (Gazi Med J 2012; 23: 77-90)

Preconception care: A public health perspective

Preconception care is a preventive attempt to detect, solve or consult the risky physical, medical and psychosocial conditions that threaten maternal and fetal health in an appropriate way before pregnancy. The term preconception care covers screening, and therapy as well as counseling concepts and fundamentally intend to improve the couple s health and consequently to improve child health status. Preconception care is accepted as a duty of the whole medical staff. In Turkey, there is considerable progress in the field of prenatal/antenatal care, but no preconception care guidelines are put into practice at present. The aim of this review is to define the preconception care, to clarify the importance of the subject, to summarize the evidence-based universal preconception care applications that no health care worker should overlook, and to prepare a practical preconception risk assessment check-list that can be used in our country. In this review, preconception screening/supplementation/treatment priorities for Turkey were discussed in the context of the preconception care experiences of the world and in the light of national data. Also, some physical examinations/ laboratory tests for preconception care were proposed. The check-list (Preconception Care History/ Physical Examination/ Laboratory Test Form) presented at the end of this review is a practical tool for health care workers to define risks and to guide preconception counseling. Thus, the Preconception Care History/ Physical Examination/ Laboratory Test Form constituted in this review can be integrated into Turkey s national preconception care program. (Gazi Med J 2012; 23: 77-90)

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1. Centers for Disease Control and Prevention Health Resources and Services Administration. Maternal, Infant and Child Health. In: U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, 2000.p.3-56.
2. T.C. Sağlık Bakanlığı Ana Çocuk Sağlığı ve Aile Planlaması Genel Müdürlüğü. [Safe Motherhood Participant Book]. Sexual Health reproductive Health Yayın No: 2B. Ankara, 2005. [Prenatal Care and Preconceptional Care]. p.17-22.
3. Kirkham C, Harris S, Grzybowski S. Evidence-based prenatal care: Part I. General prenatal care and counseling issues. Am Fam Physician 2005; 71: 1307-16.
4. Moos MK, Dunlop AL, Jack BW, Nelson L, Coonrod DV, Long R, et al. Healthier women, healthier reproductive outcomes: recommendations for the routine care of all women of reproductive age. Am J Obstet Gynecol 2008; 199: 280-9.
5. Atrash H, Jack BW, Johnson K, Coonrod DV, Moos MK, Stubblefield PG, et al. Where is the Woman in MCH? Am J Obstet Gynecol 2008; 199: 259-65.
6. Jack BW, Atrash H, Coonrod DV, Moos MK, ODonnell J, Johnson K. The clinical content of preconception care: an overview and preparation of this supplement. Am J Obstet Gynecol 2008; 199: 266-79.
7. Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS, et al. Recommendations to improve preconception health and health care-- United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR 2006; 55: 1-23.
8. Health Council of the Netherlands. Preconception care: a good beginning. The Hague: Health Council of the Netherlands, 2007; publication no. 2007/19E.
9. Shores S, Bailey T. Recommendations for Women of Reproductive Age. NC Med J 2009; 70: 432-8.
10. Allaire AD, Cefalo RC. Preconceptional health care model. Eur J Obstet Gynecol Reprod Biol 1998; 78: 163-8.
11. Gottessman MM. Preconception education: Caring for future. J Pediatr Health Care 2004; 18: 40-4.
12. Dunlop AL, Jack B, Frey K. National recommendations for preconception care: the essential role of the family physician J Am Board Fam Med 2007; 20: 81-4.
13. Frayne D, Hudspeth R, Beste J. The unique role of family physicians in caring for women across the reproductive age span. N C Med J 2009; 70: 439-44.
14. Frey KA. Preconception care by the nonobstetrical provider. Mayo Clin Proc 2002; 77: 469-73.
15. Files JA, David PS, Frey KA. The patient-centered medical home and preconception care: an opportunity for internists. J Gen Intern Med 2008; 23: 1518-20.
16. Menard MK, Goodnight WH. The role of specialists in providing preconception health care and guidance to women with chronic medical conditions. N C Med J 2009; 70: 445-8.
17. Holland WW, Stewart S, Masseria C. Screening in Europe a policy summary. In: World Health Organization on behalf of the European Observatory on Health Systems and Policies,eds. Policy Brief: Screening in Europe. Brussels: WHO Regional Office for Europe; 2006. p.1-10.
18. Ergocmen BA, Tezcan S, Cağatay P. [Reproductive Health]. Hacettepe Universitesi Nufus Etudleri Enstitusu, Sağlık Bakanlığı Ana Cocuk Sağlığı ve Aile Planlaması Genel Mudurluğu, Başbakanlık Devlet Planlama Teşkilatı Musteşarlığı, TUBİTAK. [Turkish Population and Health Survey (TNSA)-2008]. 1. Baskı. Ankara: Hacettepe Universitesi Hastaneleri Basımevi; 2009.p. 143-58.
19. Anderson JE, Ebrahim S, Floyd L, Atrash H. Prevalence of risk factors for adverse pregnancy outcomes during pregnancy and the preconception period--United States, 2002-2004. Matern Child Health J 2006; 10: 101-6 .
20. Moos MK. Preconception health: where from here? Womens Health Issues 2006; 16: 156-8.
21. de Weerd S, van der Bij AK, Cikot RJ, Braspenning JC, Braat DD, Steegers EA. Preconception care: a screening tool for health assessment and risk detection. Prev Med 2002; 34: 505-11.
22. Chamberlain G. The prepregnancy clinic. Br Med J 1980; 281: 29-30.
23. Ebrahim SH, Lo SS, Zhuo J, Han JY, Delvoye P, Zhu L. Models of preconception care implementation in selected countries. Matern Child Health J 2006; 10: 37-42.
24. Boulet SL, Parker C, Atrash H. Preconception care in international settings. Matern Child Health J 2006; 10: 29-35.
25. Czeizel AE. Ten years of experience in periconceptional care. Eur J Obstet Gynecol Reprod Biol 1999; 84: 43-9.
26. Mennuti MT. Genetic screening in reproductive health care. Clin Obstet Gynecol 2008; 51: 3-23.
27. Solomon BD, Jack BW, Feero WG. The clinical content of preconception care: genetics and genomics. Am J Obstet Gynecol 2008; 199: 340-4.
28. T.C. Sağlık Bakanlığı Ana Cocuk Sağlığı ve Aile Planlaması Genel Mudurluğu. [Prenatal Care Management Guidelines]. Genelge 2008/13. Protokol 02-V1.
29. T.C. Sağlık Bakanlığı Ana Cocuk Sağlığı ve Aile Planlaması Genel Mudurluğu. [Prenatal Care Risk Assessment Form]. Genelge 2008/13. Protokol 01-V1.
30. İstanbul Tabip Odası Pratisyen Hekim Komisyonu. [Marital Reports]. STED 2002; 11: 212-4.
31. Gardiner PM, Nelson L, Shellhaas CS, Dunlop AL, Long R, Andrist S, et al. The clinical content of preconception care: nutrition and dietary supplements. Am J Obstet Gynecol 2008; 199: 345-56.
32. Floyd RL, Jack BW, Cefalo R, Atrash H, Mahoney J, Herron A, et al. The clinical content of preconception care: alcohol, tobacco, and illicit drug exposures. Am J Obstet Gynecol 2008; 199: 333-9.
33. Stubblefield PG, Coonrod DV, Reddy UM, Sayegh R, Nicholson W, Rychlik DF, et al. The clinical content of preconception care: reproductive history. Am J Obstet Gynecol 2008; 199: 373-83.
34. Coonrod DV, Jack BW, Stubblefield PG, Hollier LM, Boggess KA, Cefalo R, et al. The clinical content of preconception care: infectious diseases in preconception care. Am J Obstet Gynecol 2008; 199: 296-309.
35. Coonrod DV, Jack BW, Boggess KA, Long R, Conry JA, Cox SN, et al. The clinical content of preconception care: immunizations as part of preconception care. Am J Obstet Gynecol 2008; 199: 290-5.
36. Dunlop AL, Jack BW, Bottalico JN, Lu MC, James A, Shellhaas CS, et al. The clinical content of preconception care: women with chronic medical conditions. Am J Obstet Gynecol 2008; 199: 310-27.
37. McDiarmid MA, Gardiner PM, Jack BW. The clinical content of preconception care: environmental exposures. Am J Obstet Gynecol 2008; 199: 357-61.
38. Dunlop AL, Gardiner PM, Shellhaas CS, Menard MK, McDiarmid MA. The clinical content of preconception care: the use of medications and supplements among women of reproductive age. Am J Obstet Gynecol 2008; 199: 367-72.
39. Klerman LV, Jack BW, Coonrod DV, Lu MC, Fry-Johnson YW, Johnson K. The clinical content of preconception care: care of psychosocial stressors. Am J Obstet Gynecol 2008; 199: 362-6.
40. Frieder A, Dunlop AL, Culpepper L, Bernstein PS. The clinical content of preconception care: women with psychiatric conditions. Am J Obstet Gynecol 2008; 199: 328-32.
41. Ruhl C, Moran B. The clinical content of preconception care: preconception care for special populations. Am J Obstet Gynecol 2008; 199: 384-8.
42. Frey KA, Navarro SM, Kotelchuck M, Lu MC. The clinical content of preconception care: preconception care for men. Am J Obstet Gynecol 2008; 199: 389-95.
43. Saracoglu A, Ergun B. Composition of some herbal slimming tea preperations marketed in Turkey and their possible adverse effects. Turkiye Klinikleri J Med Sci 2006, 26: 355-63.
44. Gencoglu N, Pekiner FN, Gumru B, Helvacioglu D. Periapical status and quality of root fillings and coronal restorations in an adult Turkish subpopulation. Eur J Dent 2010; 4: 17-22.
45. Ereş G, Saribay A, Akkaya M. Periodontal treatment needs and prevalence of localized aggressive periodontitis in a young Turkish population. J Periodontol 2009; 80: 940-4.
46. Toygar HU, Seydaoglu G, Kurklu S, Guzeldemir E, Arpak N. Periodontal health and adverse pregnancy outcome in 3,576 Turkish women. J Periodontol 2007; 78: 2081-94.
47. Yuksel İ, Akadlı Ergocmen B, Cağatay P. [Status of Women]. Hacettepe Universitesi Nufus Etudleri Enstitusu, Sağlık Bakanlığı Ana Cocuk Sağlığı ve Aile Planlaması Genel Mudurluğu, Başbakanlık Devlet Planlama Teşkilatı Musteşarlığı, TUBİTAK. [Turkish Population and Health Survey (TNSA)-2008]. 1. Baskı. Ankara: Hacettepe Universitesi Hastaneleri Basımevi; 2009.p. 189-203.
48. Ertug S, Okyay P, Turkmen M, Yuksel H. Seroprevalence and risk factors for toxoplasma infection among pregnant women in Aydin province, Turkey. BMC Public Health 2005; 5: 66.
49. Incı M, Yağmur G, Aksebzecı T, Kaya E, Yazar S. [The Investigation of Toxoplasma gondii Seropositivity in Women in the Kayseri Province.] Turkiye Parazitol Derg 2009; 33: 191-4.
50. Kurtuluş Yiğit E, Tezcan S, Tunckanat H. [Nutrition Status of Children and Mothers]. Hacettepe Universitesi Nufus Etudleri Enstitusu, Sağlık Bakanlığı Ana Cocuk Sağlığı ve Aile Planlaması Genel Mudurluğu, Başbakanlık Devlet Planlama Teşkilatı Musteşarlığı, TUBİTAK. [Turkish Population and Health Survey (TNSA)-2008]. 1. Baskı. Ankara: Hacettepe Universitesi Hastaneleri Basımevi; 2009.p. 171-87.
51. Aydin C, Baloglu A, Yavuzcan A, Inci A. The effect of body mass index value during labor on pregnancy outcomes in Turkish population (obesity and pregnancy outcomes). Arch Gynecol Obstet 2010; 281: 49-54.
52. Siega-Riz AM, Giannini C. Promoting healthy weight in women: what the physician can do to help. N C Med J 2009; 70: 449-53.
53. Galtier F, Raingeard I, Renard E, Boulot P, Bringer J. Optimizing the outcome of pregnancy in obese women: from pregestational to long-term management. Diabetes Metab 2008; 34: 19-25.
54. Satpathy HK, Fleming A, Frey D, Barsoom M, Satpathy C, Khandalavala J. Maternal obesity and pregnancy. Postgrad Med 2008; 120: 1-9.
55. Yiğit E, Yuksel İ, Turkyılmaz AS. [Basic Characteristics of Women]. Hacettepe Universitesi Nufus Etudleri Enstitusu, Sağlık Bakanlığı Ana Cocuk Sağlığı ve Aile Planlaması Genel Mudurluğu, Başbakanlık Devlet Planlama Teşkilatı Musteşarlığı, TUBİTAK. [Turkish Population and Health Survey (TNSA)-2008]. 1. Baskı. Ankara: Hacettepe Universitesi Hastaneleri Basımevi; 2009.p.57-8.
56. Botto LD, Lisi A, Robert-Gnansia E, Erickson JD, Vollset SE, Mastroiacovo P, et al. International retrospective cohort study of neural tube defects in relation to folic acid recommendations: are the recommendations working? BMJ 2005; 330: 571.
57. Kondo A, Kamihira O, Ozawa H. Neural tube defects: prevalence, etiology and prevention. Int J Urol 2009; 16: 49-57.
58. Wilson RD, Johnson JA, Wyatt P, Allen V, Gagnon A, Langlois S, et al. Genetics Committee of the Society of Obstetricians and Gynaecologists of Canada and The Motherrisk Program. Pre-conceptional vitamin/folic acid supplementation 2007: the use of folic acid in combination with a multivitamin supplement for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can 2007; 29: 1003-26.
59. Erdogan MF, Erdogan G. [Endemic goiter and iodine deficiency disorders in the world and Turkey.] T Klin J Med Sci 1999; 19: 106-13.
60. Sağlam H, Buyukuysal L, Koksal N, Ercan I, Tarim O. Increased incidence of congenital hypothyroidism due to iodine deficiency. Pediatr Int 2007; 49: 76-9.
61. Rashid M, Rashid MH. Obstetric management of thyroid disease. Obstet Gynecol Surv 2007; 62: 680-8.
62. Kapoor N, Sankaran S, Hyer S, Shehata H. Diabetes in pregnancy: a review of current evidence. Curr Opin Obstet Gynecol 2007; 19: 586-90.
63. Kuru U, Turan O, Kuru N, Saglam Z, Ceylan Y, Nurluoglu M, et al. Prevalance of hepatitis B virus infection in pregnant Turkish women and their families. Eur J Clin Microbiol Infect Dis 1996; 15: 248-51.
64. Atilgan R, Kavak SB, Celik A. [The ratio of hepatitis B and hepatitis C seropositivity in pregnants]. Turkiye Klinikleri J Gynecol Obst 2009; 19: 34-7.
65. T.C. Sağlık Bakanlığı Ana Cocuk Sağlığı ve Aile Planlaması Genel Mudurluğu. [Sexually Transmitted Infections]. [National Reproductive Health Care Guidelines] Cilt 1: Aile Planlaması ve Ureme Sağlığı, 4. Baskı. Ankara: Damla Matbaacılık; 2005.p.239-307.
66. Jonas MM. Hepatitis B and pregnancy: an underestimated issue. Liver Int 2009; 29: 133-9.
67. Libbus MK, Phillips LM. Public health management of perinatal hepatitis B virus. Public Health Nurs 2009; 26: 353-61.
68. Robinson JL, Lee BE, Preiksaitis JK, Plitt S, Tipples GA. Prevention of congenital rubella syndrome--what makes sense in 2006? Epidemiol Rev 2006; 28: 81-7.
69. Aytac N, Yapıcıoğlu AB, Cetinalp S, Kibar F, Karaomerlioğlu O. [Rubella seroprevalence of unvaccinated child-bearing age married women]. TSK Koruyucu Hekimlik Bulteni 2007; 6: 9-16.
70. Şener K, Kılıc A, Guney C, Acıkel CH, Gul HC, Başustaoğlu AC. [Rubella seroprevalence before expanded vaccination program]. TSK Koruyucu Hekimlik Bulteni 2007; 6: 371-4.
71. Oner S, Bugdayci R, Kurt AO, Ozturk C, Sasmaz T. [Tetanus seroprevalance among women 15-49 years old, in Mersin, Turkey.] Turkiye Klinikleri J Med Sci 2008; 28: 839-46.
72. Akın L. [Epidemiology of sexually transmitted infection: review.] Turkiye Klinikleri J Med Sci 2006; 26: 655-65.
73. Riskin-Mashiah S, Auslander R. Preconception care--when and what: the attitude of Israeli gynaecologists to preconception counseling. Arch Gynecol Obstet 2007; 275: 367-71.
74. Heyes T, Long S, Mathers N. Preconception care: practice and beliefs of primary care workers. Fam Pract 2004; 21: 22-7.
75. Wallace M, Hurwitz B. Preconception care: who needs it, who wants it, and how should it be provided? Br J Gen Pract 1998; 48: 963-6.
76. Frey KA, Files JA. Preconception healthcare: what women know and believe. Matern Child Health J 2006; 10: 73-7.
77. Hillemeier MM, Weisman CS, Chase GA, Dyer AM, Shaffer ML. Womens preconceptional health and use of health services: implications for preconception care. Health Serv Res 2008; 43: 54-75.