Preconception counselling initiated by general practitioners in the Netherlands: reaching couples contemplating pregnancy [ISRCTN53942912]

BACKGROUND To maximise the potential for reducing the risk of adverse pregnancy outcomes, preconception counselling (PCC) is used to inform couples contemplating pregnancy about general and personal risk factors. Many initiatives have been developed to provide PCC, but none offers it routinely in a presumed low-risk population. The objective of the study was to investigate the extent to which women contemplating pregnancy can be reached when a PCC programme is routinely offered by general practitioners (GPs). METHODS 30 GPs actively offered PCC to all women aged 18 to 40 over a three-year period. GPs reviewed lists of these women and excluded women with adverse social circumstances. The remaining women received an invitation for PCC. They were requested to indicate whether they were interested in PCC, and if so, when they were contemplating pregnancy. Those both interested and contemplating pregnancy within one year were invited for PCC. All pregnancies occurring within one year of an invitation were monitored. Response rates and percentages of pregnancies preceded by an invitation or actual attendance to PCC were calculated. RESULTS Overall, 72-75% of the interested responders, who returned the risk-assessment questionnaire (80%), actually attended PCC. However, the GPs excluded a large number of women. In 2002 27% of all pregnancies occurred in the group of women who had been interested and had indicated that they hoped to get pregnant within one year. Another 33% of the pregnancies occurred in the group of women who had been excluded, 13% in the group who had not responded, and 14% in the group who had not been interested. CONCLUSION A quarter of the women who became pregnant in the year after the invitation were reached in time. In order to increase this number, methods should be developed to decrease the exclusion of women by the GPs and to increase women's response.